Zytiga Not Working

[Newyork6264]

Looking for advice. I was diagnosed in December. PSA 250, With mets on bones and tumors on Lymph nodes. Was put on Lupron and Zytiga and saw PSA drop to 5 in May, rise to 7in early June. My blood test this week shows my PSA rising to 14 and Alk Phos up also. Oncologist has ordered CT and bone scans and says it’s time to look at other options. For those who have reached point where Zytiga is no longer helping what path did you follow?

[tango65]

When one of the new antiandrogens fails, the next treatment should be to continue with ADT and try chemotherapy (in your situation most probable docetaxel, other possibility cabazitaxel). This approach could be more effective than trying other new antiandrogen. Chemo could resensitize the cancer to the new anti androgens.

You could consider to apply to a clinical trial with modified niclosamide which seems to resensitize the cancer to abiraterone or enzalutamide.

clinicaltrials.gov/ct2/resu...

You could also consider getting treatment abroad with Lu 177 PSMA and /or Ac 225 if financially possible and if the cancer is PSMA positive (a Ga 68 PSMA or a DCFPyl PET/CT could determine if the cancer is PSMA positive).

You should discuss getting a direct biopsy if possible, or a liquid biopsy to study if the cancer has mutations making it susceptible to specific drugs, such as keytruda, olaparib, rucaparib etc.

[Hidden]

Chemo, quickly.

[Hidden in reply to Hidden]

I agree with you Fran. ✌️

[Haniff in reply to Hidden]

Yup 👍

[Fairwind]

NewYork, how old are you and what was your Gleason score ?

[Newyork6264 in reply to Fairwind]

63. Gleason 9.

[Hidden]

Hey Newyork6264 ! I’m no expert and I’m not a dr Either. You have an aggressive Pc. Whatever new path you take I wish you well. You just might have to throw the kitchen sink at this one. I had a t-4 super aggressive Pc initially myself . Double adt and imrt has keep mine down four years now. Live healthy but stomp your pc to the ground. Good luck .

[Newyork6264 in reply to Hidden]

Thanks Wimpy. I’m willing to do whatever it takes. Doc said chemo but also said a couple of trial at their school of a new treatments might be better. All depends on what scans say. Two weeks until that.

[Hidden in reply to Newyork6264]

THats the right attitude. Tell yourself that you will push the pc away . DO anything daily to not think abou c . It can be all consuming if you let it . It’s an uphill slog all of the way until you get to a better place. I think that you will improve . It is very good that you have options . Half of my battle is emotions and attitudes.. we’ve got to eek out some daily happiness in any form or what is the point? I’m pulling for you to get in top of this thing and back to some normalcy. We are altered . Be well Sir!

[Newyork6264 in reply to Hidden]

Thanks Whimpy. My place of peace is walking along a stream. Going to do a lot of that. Lol

[Hidden in reply to Newyork6264]

I am with you . Walking in nature is peace .You will find now that anytime away from treatments and doctors is a blessing. Do what you’ve got to do to save yourself. Today is important. You’re going to conquer yourself . ✌️🌵

[depotdoug in reply to Hidden]

You got that right Whimpy-p. Half or more of my battles are emotions and attitude.

[Hidden in reply to depotdoug]

Me too my friend.

[Tall_Allen]

Try substituting dexamethasone for prednisone - sometimes that helps Zytiga work longer. Docetaxel was be a good next treatment, perhaps with Provenge.

[mcp1941 in reply to Tall_Allen]

Zytiga is also starting to fail me. I see my MO in 3 weeks and I was going to suggest switching to Dexa. Is there any evidence that I can show him that it might work?

[Newyork6264 in reply to mcp1941]

If you google it you can find a couple of studies. I emailed my onc this morning asking why not switch. Once I get an answer I’ll let you know.

[Tall_Allen in reply to mcp1941]

Yes. Here it is. I suggest you email him the link before your meeting.

bjui-journals.onlinelibrary...

[Hidden in reply to Tall_Allen]

You give good answers .🤙🏽

[Newyork6264]

Thanks much.

[Pleroma]

Wouldn't he be a good candidate for BRCA-1/2 genome testing? Just to be sure...

[Newyork6264 in reply to Pleroma]

I am Brca 2. Just got that testing

[GoBucks in reply to Newyork6264]

Do a search for that or write a new post about brca2. You will get more responses.

[Pleroma in reply to Newyork6264]

Docetaxel looks like a good option about now. I am also BRCA-2 positive. Zytiga has failed for me very quickly (seems like a common testimony for those with BRCA-2). Olaparib is the new drug for us with BRCA-2 that seems to have some very good results. I hope to start on it next month. I would start sooner if insurance would allow. Talk with your doc about sequence: Olaparib before or after chemo.

More often than not, it is all about playing the right cards at the right time. Some of us have to follow along with what insurance is willing to pay (unless you are financially independent of insurance companies).

[Hidden in reply to Pleroma]

Got to know when to fold em!

[ellie2211 in reply to Newyork6264]

What kind of testing should you ask for?

[dougnola]

Hey Newyork, just FYI on me regarding chemo, I was psa 498 and Gleason 9 w bone mets all over the place. I agree with the chemo thoughts here. My doc did taxotere and carboplatin with me simultaneously with oral ADT followed by lupron and Zytiga once chemo was over. It was tough but really knocked the psa down. Hang tight. ✌️ Dougnola

[Hidden in reply to dougnola]

It worked well for you Doug. Right on!👏🏼

[Survivor1965]

I was in the same boat, Gleason 9 (4+5) and to quote Dr Kwon at Mayo- “we’re going to throw a nuclear bomb on a dandelion “.

Hit it hard!

[Goldberg]

I am Brca 2. Went thru zytega,Extandi, Did gene tests. PSA,pet doubling up to 70. Mets to bones and lymph nodes. PSA down to 12 over 8 months. Some shrinking of tumers~10-15%. Working for now don’t know how long it will work?. Taking Xcheva and lupron.

[HopingForTheBest1]

Also BRCA2+. Went on to Olaparib after 6 mos failed Zytiga. Amazing results as PSA undetectable for over a year. Studies show up to 80% effectiveness.

[Hidden in reply to HopingForTheBest1]

Good job 👍

[ellie2211 in reply to HopingForTheBest1]

What kind of testing should we ask for?

[HopingForTheBest1 in reply to ellie2211]

There are several types of genetic testing. I had 2. One from COLOR, which is a simple saliva test, and not very expensive. The other from Foundation Medicine that used a tissue sample from a recent biopsy, and is more comprehensive and costly. Both identified BRCA2+ mutation, and offer genetic counselors for you to talk with.

[MelaniePaul]

I am sorry it has stopped working. You only got a very short time out of it. In our case, the next step was chemotherapy because at the time when it had stopped working my husband had multiple metastasise on his liver. Please let us know how you get on.

[Newyork6264 in reply to MelaniePaul]

I’ll do that. If I go a different direction than chemo I’ll let you know what it is. Also I hope the best for the two of you.