Cabazitaxel?

Cabazitaxel - PSA continues to rise. Currently at 68. I know, I know PSA does not tell the whole story but it sure is a good indication that we have a problem. Dr Bryce discontinued my Zytiga and prednisone treatment and wants to start New. chemo in the next couple weeks can y’all just give me your thoughts on what to expect with this new chemo?

[GP24]

Some patients say the side effects are not as bad as Docetaxel. It usually helps.

You got a very bad cancer. You should get a gene test. Maybe this points to a new drug which can help you.

[Patrick-Turner]

I had Docetaxel for 5 shots at 3 weeks apart, and Psa went from 12 to 50, so I quit chemo and went for Lu177 which worked so much better.

I did read up about Cabazitaxel and concluded it really was only slightly better than Docetaxel. Mean life extension with Docetaxel is maybe a year, with more with Cabazitaxel, but if you don't get any real benefit from Docetaxel like me then maybe Cabazitaxel would also be useless.

My oncologist said chemo would not work for me, and I didn't think it would, and we were both right because of Psa rise. We agreed Lu177 might be a lot better, but I am now into having a few more shots of LU177 because it does not kill all mets with 4 shots. It killed all soft tissue mets, but bone mets always take more to kill.

Last week I cycled 233km at good speed at age 73, and no aches or pains so I am doing well, despite diagnosis Gleason 9, Psa 6, in 2009, inoperable. I've had ADT since 2010, plus Cosadex, Zytiga, for while they worked a bit, and salvation SBRT for PG in 2016.

Patrick Turner.

[SatuitMike in reply to Patrick-Turner]

Docetaxel did not work for me. Switched to Cabazitaxel and PSA dropped from 560 to 160 with one treatment. Alkaline phosphate dropped from 1600 to 1000. Had my 2nd infusion last week. Have not felt this good is six months. This is my story, side effects are basically some chemo has and GI related

[Hidden in reply to SatuitMike]

Hope this continues to produce good results for you, Doxetaxcel Worked during infusion but PSA quickly rose afterwards. Started Zytiga and Prednisone Afterwards with no relief, PSA continues to rise.

[Patrick-Turner in reply to SatuitMike]

It seems like you have Pca in bones and you are getting Psa drop along with alkaline phosphate drop, so maybe Cabazitaxel is working well for you, but you have had only one shot so far. My Psa at start of chemo was only 12, and data I read about chemo for Pca indicated some "flare" of Psa after first shot was common. Where the flare was 400%, ie, Psa rises 4 times the outcome if good won't last long, and if there is no flare the outcome will last up to maybe 20 months. But my Psa rose to 36, and then to 50 during 5 cycles of Docetaxel, and my onco never mentioned Cabazitaxel would be any better.

I had a friend who had very poor response to RP, ADT, Cosadex, and he had Psa at 40 at start of Docetaxel. His Psa went to 2 for 2 months in, and no flare, but back to 40 after 10 shots. Then he had a choice to go with Lu177 or have DNA tested and have PARP and he chose the latter, and the DNA analysis took 8 weeks, his Psa went to 60, Xtandi didn't work at all, and during a couple of months on PARPs his Psa went to 430, and he developed a pile of mutant mets in his liver and he soon died. He lasted less than 3 years after diagnosis. He may have done better to get Lu177 as soon as Psa began to rise after first few shots of chemo. I really thought I was lucky not to be treated by the doctors he had. But it seemed he had many different mutated forms of Pca. Mine seems has not mutated at all since Dx in 2009. Well, that's what scans tell us.

So response to chemo varies, and outcomes vary, and fix from chemo might not last long. My sister had 4 shots of chemo for Oa, and after each infusion, her blood test numbers went down, only to rise back above where they were before next chemo. She just got so sick with multiple mets in soft tissues she could not eat, and she became so sick so fast she died.

Good luck with Cabazitaxel. But you ought to b prepared to jump to something else if it does not work over a longer time.

Patrick Turner.

[Hidden in reply to Patrick-Turner]

Thanks for the input, we haven’t begun the cab yet. After the 25th we’ll have a plan. However Dr. Bryce is hoping LU177 will be available in 2nd quarter of 2021 so need to get to that. Also waiting on dna test of tumor.. this disease is a beast 😞

[Patrick-Turner in reply to Hidden]

Your Lu177 is thus 10 months away at least it seems.

I knew about Lu177 being available here in Australia in 2015. All I had to do was have a PsMa Ga68 scan showing it might work, and have chemo fail. It was only first available in Perth, 4,000km away, but then it also became available in Sydney, only 300km away, before my chemo failed, so I didn't have any need to do any trial, and the trial given then was Lu177 or Cabazitaxel, one or the other, and I didn't like the chance of being given Cabaz, because I suspected it would waste time, and leave me more damaged by chemo, I paid for the Lu177. Cost for 4 shots was usd $29,000 including 3 PsMa scans and initial consultation, all from my own pocket. I'd be very sick now if I didn't buy the Lu177. I was able to go from failed chemo to first Lu177 shot in a month. No time was lost.

I just got email confirming my 6th Lu177 on 2 October. 5th was on 24 July, and Psa went down well from 30 before.

Patrick Turner.

[cbgjr]

I had six Taxotere infusions about two years ago and it was not very effective, started failing before the last infusion. After that I went on Zytiga and that lasted about 4 months before failing. Then participated in a clinical trial of a new PARP inhibitor which stopped disease progression for about 15 months before it lost efficacy.

After that, my MO suggested trying Jevtana (cabazitaxel) and after the first two infusions the SE are not as bad as with Taxotere (some anemia, mild GI issues). However, the PSA and ALP numbers were not good at all, both still rising fast.

Based on good early results of a clinical trial combining cabazitaxel + carboplatin, my MO suggested trying that combination, which promises to be better than cabazitaxel alone.

So today was my third infusion of cabazitaxel, but now carboplatin was added to the treatment. this is a link for an article on that clinical trial:

thelancet.com/journals/lano...

Stay tuned.

[Hidden in reply to cbgjr]

Interesting read, I’m going to message Dr. to discuss further - thank you!

[RalphieJr64]

Have you already gone the route of Docetaxel? If you have I would explore anything else before you go the Chemo route again. There are other treatments available if Zytiga stopped working. Did the same to me. I'm on my second clinical trial. I'm going after anything but chemo again.

[Hidden]

Yes, already had Docetaxel. Really hoping the dna test will provide information that will take us in another direction.