Zoladex and Enzalutamide?

[Hillwalker87]

Good evening all! This is just a drop in post asking you folks a couple of questions off the back of my Fathers recent consultation with his oncologist; He was diagnosed in Feb with mets to lower spine and lower rib and has initially been placed on Zoladex. We took a long shot and asked if he could be placed on abiraterone along with this as the NHS are currently offering this in place of chemo but they refused but have offered him enzalutamide as an alternative. He also asked if he could be placed on zometa but she refused to put him on this. The question basically is is zoladex and enzalutamide usually a good combination statistically and do you think his oncologist is being unreasonable in refusing to put him on zometa? Thanks again in advance!

[LearnAll]

Clinical decisions about whether to use Abiraterone or Enzalutamide is made on a few factors. First one is his cardiac and blood sugar status..if he has high blood sugar, high blood pressure and/or Diabetes..it is prudent to avoid Abiraterone as this medication worsens diabetes and heart problems.

If he has h/o epilectic seizures or has had seizures in the past...it is prudent to avoid Enzalutamide as this medication can cause worsening of seizures.

So, Doctor has to take his individual situation into account when choosing a medication.

About Zometa (Zaledronic acid) It should not be started as long as his bone density and other data of risk of fractures is calculated by getting a DEXA bone density scan and putting all his data into fracture risk calculator..if his FRAX score is in green area, one should wait for this to reach into yellow or red zone and then start Zometa. Zometa itself has serious side effects and decision to start this should be done on scientific basis as explained above.

[Hillwalker87 in reply to LearnAll]

Some really interesting information, that's great, thank you very much!

[alangeorge in reply to LearnAll]

Zoladex 10.8 treats only the symptoms of prostate cancer but does not treat the cancer itself. Common side effects of Zoladex 10.8 include:

I was researching side effects and read this... true or not true??

[Tall_Allen]

Enzalutamide was recently FDA-approved for men with metastatic hormone sensitive PC (mHSPC).

prostatecancer.news/2019/05...

There are now 4 FDA-approved medicines for newly diagnosed metastatic men (abiraterone, enzalutamide, apalutamide, and docetaxel). They all seem to have approximately the same benefit when used as a first therapy with Zoladex:

prostatecancer.news/2017/06...

There is a benefit in sequencing abiraterone ->enzalutamide rather than the other way around because that sequence lasts longer. But by the time your father is resistant to enzalutamide, there will be other longer-lasting hormonal agents available.

She is right to withhold Zometa until he needs it. It can have some bad side effects that accumulate with longterm use. He can have an annual DEXA scan to show if his bone mineral density is too low. If it is, he can get it then. Meanwhile, resistance exercise can help maintain bone strength.

[Hillwalker87 in reply to Tall_Allen]

Really useful Allen, many thanks yet again!

[RyderLake2]

Hello,

I have been on Zoladex since June, 2013 and Xtandi (enzalutamide) since September 2017. They are, so far, working well together with few side effects. The ones I do get (i.e. body hair loss, lack of libido) are manageable. As for Zometa (zoledronic acid) if you are worried about bone strength or density, ask your oncologist about Prolia (denosumab). My oncologist feels it is a superior drug to Zometa and you don't have to check kidney function as often. I have been on a maintenance dose of Prolia (every six months) since 2013. Hope that helps.

[Hillwalker87 in reply to RyderLake2]

It does help a lot, thank you, very positive info!

[Metungboy]

The decisions about which is the best way to treat someone is quite complex. Sometimes although it decreases fracture risk somewhat has some potentially nasty side-effects. Similarly for denosumab with some patients having severe problems with low calcium requiring long hospital visits and multiple symptoms. If your bones are in reasonable nick and the treatment for the metastasis is working with either reduction in disease volume or at least holding the disease as it is then you can delay either of these medications. The decision to use abiraterone or enzalutatmide is entirely dependent on the persons characteristics and which side-effects will drive them the most crazy. I am currently on Abiraterone,low dose dexamethasone as well as Zoladex. I really dislike the side-effects of all of this with the inability to train and get much gain but this is the price for low testosterone. I would much rather have chemotherapy and get it over and done with then be on this stuff however it is working very well and lengthening my life. It is very unpleasant though. I think the idea that the oncologist “refuses” is probably not quite correct. She probably strongly recommends and is somewhat constrained by what is available by whatever regulatory process you are controlled by. When I started on Abiraterone part of the reason for this choice was it was the only agent that was funded under the health system where I live. I had to be castrate resistant to get it but fortunately my PSA went up from hardly anything to a little bit more which technically made me qualify although I am probably not castrate resistant. In summary these decisions are complex and I think the oncologist that you are seeing is trying to sort through a maze of complexity.

[LearnAll in reply to Metungboy]

Metungboy..Your post is well balanced and logical way of looking at various available treatments. Indeed..choosing treatments is a complex process as it requires a careful detailed analysis of a man's individual unique health status and other relevant factors. Shoving SOC to every throat is a primitive method promoted by profiteers. Every man deserves a unique, individualized treatment plan.

[TheBrain56]

Hi Hillwalker87, I'm on both Zoladex & Enzaludamide right now. It has reduced my PSA in the first 2 months from 6.30 down to 1.96. I'm due to have my regular "review" blood test this afternoon to see where the numbers are at before I see my Oncologist next Wednesday.

I was on Zoladex (stand alone) for about 8 months after chemo / Zoladex brought my PSA down from 85 to < 1. The PSA started to rise in early 2020 so my Oncologist put me on Enzalutamide in June.

The only downside I have endured so far is lethargy ..... always tired!! I struggle each day to do the most very basic things and then have to sit for a while (luckily I'm not working so I can rest at any time I choose).

BUT I'll take that if it gives me more time to somewhat enjoy life

[Hillwalker87 in reply to TheBrain56]

Thanks for sharing your experience with me, the best of luck to you!