Zytiga with dexamethasone

[Cynthgob]

My husbands zytiga seems to be losing its efficacy. Has anyone had success in changing from prednisone to dexamethasone? And if so how much longer did you get to stay on the Zytiga? Just wondering as I have read about many men changing to dexamethasone but I haven’t read success stories. Thank you!

[ITCandy]

Didn’t do a thing for me.

[Cynthgob in reply to ITCandy]

How many weeks did you try it?

[ITCandy in reply to Cynthgob]

6 months. I’d still take dexamethasone over prednisone in a heartbeat.

[Cynthgob in reply to ITCandy]

My husband seems to have a lot more energy. What did you do after zytiga?

[ITCandy in reply to Cynthgob]

Long story but I was pissed that I couldn’t have Xtandi unless I did six rounds of chemo first and took the summer off while watching my psa climb by several thousand. I went to Germany for failed psma treatment, came back for spinal cord surgery, radiation and chemo, which I’m still taking.

I keep wondering if my stubborn attitude got in the way of a better outcome but I don’t regret any decisions that I’ve made.

The surgery eliminated a persistent spinal tumor that I don’t believe chemo could have touched.

[Cynthgob in reply to ITCandy]

Thank you for sharing. I appreciate it.

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

Just think of this.... some guys are just born with a stub...... (and the rest are lucky)...

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 08/23/2020 12:27 PM DST

[monte1111 in reply to j-o-h-n]

Attitude, attitude.

[NOCanceros in reply to ITCandy]

Hi

I wonder how eliminated a persistent spinal tumor in which hospital if you don't mind please write the name of hospital.Thanks

wish you a healthy life.

George

[ITCandy in reply to NOCanceros]

My surgery was done through the Canadian health care system after I had spinal cord compression with bone marrow involvement.

I made several contacts with Heidelberg regarding psma treatment and they kept asking me for more and more information and it seemed like I was getting nowhere. After sending an email to another university hospital, the lead professor replied, blowing a bunch of sunshine up my ass and I wired the money and booked my flight.

My first treatment of Lu-Ac caused my tumor to swell immensely which led to the compression and I was done there. Apparently, Heidelberg knows how to control the flare up and I wish I had gone there but it just didn’t work out that way.

Overall, I’m glad the surgeon was able to drill off the tumor and clean up the area without any hardware and was really impressed with her skill and she didn’t even leave a scar. Very pleased with the end result, although I don’t recommend going through what I did in order to achieve it.

[Hidden]

It worked for me, but I always suggest looking at the clinical trials vs. one person even if the person is me.

My doctor was not too enthusiastic about it, telling me that only one out of three he tried it on worked. I was telling my wife that the success rate is close to 50% and she told the doctor, "Well, Gregg will make it 2 out of 4." Sure enough, she was right. That was over 6 months ago since my PSA had briefly risen before the switch.

On my last visit in early August, my doctor commented on my undetectable PSA as we were walking to the infusion area to get my Zometa and Eligard. This time he was enthusiastic.. He said excitedly, "Hey, I just started another guy today on Dexamethasone."

So my PSA rose from undetectable to .79 almost 7 months ago, then I switched and undetectable ever since.

And I am still on Zytiga today.

[Cynthgob in reply to Hidden]

What dosage of dexamethasone are you on? 1 mg is what we have and there is weight gain and some bruising

[Hidden in reply to Cynthgob]

I'm on .5mg per day. I have gained weight, but don't think it's because of the switch.

[Cynthgob in reply to Hidden]

It seems like the normal strength D is .5! I think 1.0 is too much. Wonder why they started out on 1.0?

[Tall_Allen]

Here are the success testimonies of 27 of 48 patients who made the switch at the time their PSA started to rise. They got 11 extra months out of Zytiga:

bjui-journals.onlinelibrary...

[Cynthgob in reply to Tall_Allen]

Thank you!

[6357axbz in reply to Tall_Allen]

Is it known why changing from pred to dex works?

[Tall_Allen in reply to 6357axbz]

It's a bit of a mystery. Dex is a much more powerful glucocorticoid, and glucocorticoids have a very complex relationship with prostate cancer. They have independent anti-cancer activity until they don't. You may be interested to read about it:

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

We also don't know if it would have been better to start with dexamethasone. It is interesting that the best-responding switchers had:

1) the longest time on ADT before castration-resistance

2) the shortest time on abiraterone before PSA started rising

3) lower PSA

But it was only a small study. It's hard to argue against switching. There is nothing to lose and everything to be gained.

[6357axbz in reply to Tall_Allen]

Thanks. Looks like a good beach read.

[MateoBeach in reply to 6357axbz]

Beach read indeed, but only if you are well up on your cellular biochemistry! “Damn you, Nuclear factor Kappa B. All hands in deck. Man your GC battle stations. “ 😆😆😆

[Hidden in reply to 6357axbz]

It may be related to the Glucocorticoid Receptor. There is ongoing research into this currently.

[The_Dude]

I switched but it had little effect. You may also want to ask you MO about taking Zytiga with food. That has been helpful for me, although it’s probably not a long-term solution.

[PAQFAS]

Was on hydrocortisone vice pred and Zytiga when PSA started rising. Switched from hydrocortisone to dexa for a few months but PSA kept rising. Switched to Xtandi and being PSA tested every 2 weeks. PSA startling to go down (knock on wood). Had withdrawal symptoms from stopping dexa to quickly and in midst now of doing a slow taper. Good luck to you.

[Cynthgob in reply to PAQFAS]

Thank you!

[Cynthgob in reply to PAQFAS]

Isn’t it unusual to go from Zytiga to xtandi as they are both hormone drugs? I thought most people had to go back to a chemo?

[MateoBeach in reply to Cynthgob]

Mechanisms of action are different though overlap in some aspects. So switching usually provides more time. One study showed that going from Zytiga to Xanti at failure was more long lasting than the other way around.

Also, chemo after Zytiga failure can restore its effectiveness. I am not sure if this requires a full course of docetaxel or if just a few cycles suffices. I think it may be due to correcting a resistant androgen receptor, AR7 Splice-Variant.

T_A has an excellent summary article on Optimal Sequencing strategies with all relevant references to the research.

[Cynthgob in reply to MateoBeach]

He really doesn’t want more chemo! It was hard on him

[ctflatlander]

I've been on Zytiga 33 months, started Dexa and psa risen from .3 to .49 ultra sensitive test.

Will be retested next week. Jury still out

[bone-mets]

Beware the relative strength of corticosteroids. This link may help understand.

uptodate.com/contents/image...

Generally the goal is to take as little steroid as possible to make the Zytiga tolerable. I've been on it for just over 3 years. My doc switched from prednisone me to hydrocortisone which I vary between 10 and 20 mg/day depending on how I feel. Dexamethasone is about 7 times stronger than prednisone, but with it comes a comparable increase in ill effects. If that's what it takes to survive, then so be it. But as much as possible keep the steroid doses as low as you can (assuming the only reason you take them is because of the Zytiga).

[Cynthgob in reply to bone-mets]

What are the ill effects I should be looking for?? I didn’t get any warnings. Blood test six weeks from switching steroid. Thank u

[6357axbz in reply to Cynthgob]

I haven’t had any I’ll effects from either prednisone or dexamethasone both which I have taken with abiraterone acetate (zytiga). Currently I’m on dex.

[Hidden in reply to Cynthgob]

Dexamethasone is a stronger steroid and also stays in the body longer. These two factors determine the dosage which is about 1/10 for Dexamethasone VS. Prednisone.

I went from 5mg of Prednisone to .5mg of Dexamethasone. The doses are replacement and small. There is no cause for concern. Side effects from these steroids occur at higher doses. Personally, I have not noticed any difference.

[ITCandy in reply to Hidden]

Do you know if dexamethasone can be taken with Jevtana instead of prednisone? I’m covered in large black bruises that I’m guessing is caused by the prednisone? Platelets are ok as far as I know.

[Hidden in reply to ITCandy]

I'm surprised that a dose of 10mg per day Prednisone would cause bruising. I'm guessing you aren't taking any else that would cause that like blood thinners.

I don't see why you couldn't switch, but I'm not a doctor. I do know they give Dexamethasone as a pre-med for chemo so I can't see why you couldn't use it. Best to talk to your doctor.

[bone-mets in reply to bone-mets]

uptodate.com/contents/major...

This is probably more than you want about steroid side effects. One of the biggest for prostate cancer patients is loss of bone mineral density (osteoporosis) which you will not feel until you fracture. Increased appetite, increased capillary fragility, increased skin fragility, water retention, and many others you may be able to notice if you pay attention. Bottom line is that you need corticosteroids to survive, but abiraterone messes with the body's production of them so we artificially take oral steroids to compensate. I got off them altogether for a few months and I was dragging ass so badly it was not livable. I go back to my original statement - take as little as you can to keep life good while on the abiraterone.

[Cleodman]

The steroids have no impact on the efficacy of Zytiga. The steroids are purely to help the body with a source of steroid since Zytiga suppresses the adrenal glands for making our body’s natural endogenous steroids. If Zytiga is no longer working then your husband is likely selecting out for cancer cells that do not rely on testosterone as much or at all. I’m there too. Talk to your oncologist about options and plan for castration resistant advance prostate cancer (I’m assuming he already had advanced disease).

[docbulldog]

I had been on Zytiga and 5 mg of prednisone since August with PSA at 14.16, but PSA continued to rise monthly: 17.17 to 20.11. So I asked for some advice on this site and it was suggested I try dexamethasone. In late November I started on 4 mg of dexamethasone and my December PSA was down to 10.07, which was so nice to see. But I am a bit concerned about the dosage of the dexamethasone since it is about 4 to 5 times more powerful than prednisone.

I am going in today to see if I can cut that down to about .5 mg. The effects of 4 mg of this steroid is way too much, keeps me pretty wired. My second opinion oncologist said the drop has to do with the cancer medication not the dexamethasone. Hopefully, he is so right and with Zytiga I will continue to see PSA improvement.

[Cynthgob]

Update : psa continues to drop on Zytiga plus 1.0 dexamethasone. 3.6 down from 3.9. Worried about lowering the 1.0 dexamethasone to a .5 D. I see the studies were done on .5D. He was at 9.0 in August. 2 years on Zytiga.