Failed Docetaxel, then Xtandi, what next?

[Barbara345]

Hi, can anyone help? Hoping to hear from anyone with experience in next treatment/step after docetaxel failed and Xtandi failed? Or places for further consults? Dear husband Barry first failed docetaxel (5 treatments), and then Xtandi failed after 6 weeks, PSA rising. Still on Lupron, continuing Xtandi for now. Diagnosed last August with PC with extensive bone mets, PSA was 49. It initially went down, then went up after second chemo treatment (he had 5 treatments).

I admit this is scary -- I didn't think the cancer would become resistant this fast. He's still feeling okay, exercising. Scans are scheduled next week, I think biopsy and genetic testing will come. I feel I really need the group's collective experience. Not sure if MO will recommend carboxitaxel (Jetvana) or something else.

Other options, or trials? Any ideas for places for further consults? Telephone conference with MO scheduled next week after scans. Thanks all!!!!

[Hidden]

I thnk the biopsy is important to see what you are dealing with.

[Barbara345 in reply to Hidden]

Absolutely agreed. Discussed with MO.... Thanks.

[Hidden in reply to Barbara345]

My guess is they will recommend a chemo regimen based on what they see in the biopsy.

If there is NEPC, they will probably add a platinum-based chemo. There are different combinations depending on the IHC. There are also nueroendocrine blood markers that can be looked at: Chromogranin A, Synaptophysin, Neuron Specific Enolase and

CD56.

[Barbara345 in reply to Hidden]

Thanks. Are those blood markers automatically looked at in the Foundation One series, or do they need to be specifically requested?

[Hidden in reply to Barbara345]

As far as I know, they wouldn't be looked at by Foundation One.

The blood markers can support the diagnosis, but are not by themselves specific enough to be determinant.

They could also be used as "tumor markers" to help determine progression in the future since PSA is often not useful for this purpose in prostate cancers with significant neuroendocrine differentiation.

[Barbara345 in reply to Hidden]

Thanks. Three questions based on your reply (and thanks again!!!):

1.How would they find the blood markers, if not in the genetic test? Is there another way to ask for them?

2. Would the genetic test reveal the same mutations the blood markers would show?

3. In addition, would we need to request the IHC at time of biopsy (I assume that's immunohistochemistry, right?). Thanks.

[Hidden in reply to Barbara345]

The blood markers are found with a blood test, just like you would get for anything else in your blood. Those markers are separate from the mutations. I would talk to Foundation One about IHC. Another option for that is Guardant360.

[Magnus1964]

Abiraterone would be a good next step.

[Tall_Allen]

Xofigo (with Provenge, if he hasn't already had it) or Jevtana, based on this:

pcnrv.blogspot.com/2019/12/...

[Attitude67]

RP, then Radiation washout after a few years, then Lupron and .5mg of prednisone twice daily for more than ten years. Small doses of prednisone reduce tumor size and slow metastatic disease. I supplement with lots of mild botanicals.

Everyone’s biochemistry is different. If you aren’t getting enough assistance, explanation, and guidance from your Oncologist or Urologist, you need to move on and find another. Preferably one who has treated many cases of PCa and is young enough to be current.

The experimental therapy with the most potential for treatment with intent to cure is CART-T for Prostate Cancer. Check for Clinical Trials frequently. Many times advanced tests that are not funded by your health care insurer are funded as part of a clinic trial.