denied guardant360 testing, failed Xtandi. Help!

[ellie2211]

Hi, my dad was denied the guardant360 next gen sequencing (NGS)

His onc said his metastasis is limited to bone and that it is difficult to biopsy prostate cancer from the bone. So I'm thinking that's why he's asking for guardiant instead of foundation one.

Are there foundations that help people pay for this out of pocket? Or another way to go?. I feel helpless through the insurance (earlier this year he was notified he could no longer go to city of hope because they don't accept médicare advantage hmo anymore and we can't afford the supplemental insurance so that's up in the air too

He failed Xtandi and we are at a standstill for now

Would value your input.thank you!

[Hidden]

Did they say why they couldn't get a bone biopsy? I got one when I was diagnosed. I know it's not possible to do some mets in the spine, but there are usually other places. Doesn't sound right to me.

If his mets are limited to the bones, Xofigo is a treatment option for him. He can also go to second-line chemotherapy Cabazitaxel. LU-177 is an option outside the US, although he would have to travel and pay out-of-pocket. From what you said, it sounds like that might not be an option.

I wouldn't try another anti-androgen such as Zytiga since there is cross-resistance between Xtandi and Zytiga. Getting chemotherapy might help to resensitize him to Zytiga to try later on.

[ellie2211 in reply to Hidden]

Thanks Gregg,

His onc said it calcifies and is not very useful For the tests

[Tall_Allen]

Jevtana would be a good next step.

I'm sorry you didn't get insurance approval, but I'm not surprised - it's a very expensive test.

Most times such tests reveal nothing useful anyway. Germline (saliva or blood) tests are much cheaper - only $250 for the Color Genome Dx test:

prostatecancer.news/2018/02...

If he is BRCA+ on a germline test, he can get a PARP inhibitor.

[ellie2211 in reply to Tall_Allen]

Thank you I'll tell my dad to ask about the color genome test

[ellie2211 in reply to Tall_Allen]

Is Cabazitaxel and carboplatin a good idea in your opinion?

[Tall_Allen in reply to ellie2211]

Yes! I recent small trial showed it was superior to Jevtana alone:

pubmed.ncbi.nlm.nih.gov/315...

[tango65]

He could qualify for the modified niclosamide trials which could make the cancer sensitive to enzalutamide again:

clinicaltrials.gov/ct2/resu...

health.ucdavis.edu/synthesi...

if he does not want to have chemo, then he could try the Lu 177 PSMA trials and see if he qualifies:

clinicaltrials.gov/ct2/resu...

Chemo with docetaxel if he did not have chemo before or with jevtana if he did have chemo before could be also good choices.

He should discuss having provenge now and eventually Xofigo along with medicines to increase the strength of the bones such as zoledronic acid or denosumab.

Foundation one offers tests in liquid biopsies:

foundationmedicine.com/test....

Depending on the mutations found in the study of the cancer genome he could qualify for olaparib, rucaparib and/or keytruda.

[tango65]

His doctor according to his clinical condition will have to decide how to do Provenge and Jevtana. Doing provenge and chemo at the same time could be a possibility .

ncbi.nlm.nih.gov/pmc/articl...

[bluedmnd]

Guardant360 have financial assistance if you live in the US. Call them and they'll walk you through the form. I believe it's through a program called indigent. We did that.

[ellie2211 in reply to bluedmnd]

Thank you!