Treatment after chemo - PARP inhibitor or immunotherapy trial?

[WhiteStrat]

After completing 7 rounds of docetaxel, my PSA went from 32 to 8. Bone scan and CT show no disease progression but no significant decrease either. The majority of my mets are in bone with several suspicious lymph nodes.

Without going into great detail about my history, I was initially diagnosed in Jan., 2011 with a PSA of 18 and the cancer out of the prostate. RP, radiation; I have been on ADT since 2011. I've taken Xtandi and Abiraterone. I had Provenge in 2016.

I have discussed the next step with my MO at MD Anderson. One option is a PARP inhibitor. Caris genomic testing of my original tumor shows, in what I think is relevant, the following: 1)mutations in BRCA1, PTEN, EP300, and NTRK3; 2) Mismatch repair status = proficient; and 3) PD-L1 = negative.

Trying a PARP inhibitor seems like the next choice to me. But, there is an immunotherapy trial, nivolumab and ipilimumab, at MD Anderson that my MO suggests I try. She also indicated we might try the PARP inhibitor with the immunotherapy.

At some point, I assume I will try Lu-177 and Ac-225. I applied for this to Heidelberg last Fall and was told my PSMA expression was not high enough for them at that time.

Any advice would be, as usual, greatly appreciated.

[Tall_Allen]

I vote for the PARP inhibitor with the immunotherapy. Your BRCA1 qualifies you for the PARP inhibitor, and I expect it will last longer with the immunotherapy. If it works, maybe follow with Jevtana+Carboplatin. I know MDAnderson has a big trial of the reverse sequence, but I don't know of any reason that PARP first may be equally beneficial.

[WhiteStrat in reply to Tall_Allen]

Thank you for your prompt reply. I try to be realistic about this disease (and its progression) but I am cautiously optimistic I can knock it back a little bit with these treatments.

[scarlino]

I will be entering the trial at MD Anderson using Keytruda and the PARP inhibitor Oliparib. I will post when it starts for me, probably end of August.

[j-o-h-n in reply to scarlino]

Knock em dead............

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 07/23/2020 5:37 PM DST

[scarlino in reply to j-o-h-n]

Thanks! I hope it does something.