Stampede Trial?

[Burnett1948]

Burnett1948. Does anybody know about what the Stampede trial and how many extra years Chemo with Hormones will give a metastatic prostate cancer sufferer?

found?

[pjoshea13]

Here is a paper published in December:

annalsofoncology.org/articl...

"Addition of docetaxel to hormonal therapy in low- and high-burden metastatic hormone sensitive prostate cancer: long-term survival results from the STAMPEDE trial"

-Patrick

[6357axbz in reply to pjoshea13]

How would Docetaxel do compared to abiraterone acetate in a comparison under these circumstances

[pjoshea13 in reply to 6357axbz]

Docetaxel monotherapy in metastatic hormone sensitive PCa up front? Has that been studied?

(There was a trial of adjuvant docetaxel monotherapy following radical prostatectomy in high-risk PCa.)

-Patrick

[Concerned-wife in reply to 6357axbz]

We have read a lot about these choices and my husband has had second opinion consultations. I don’t believe the choices have been studied against each other. It appears the important thing is to add a treatment in addition to ADT. It seems clear for men with high volume Mets that docetaxal is the first choice. We find reading 2019 ASCO and APCCC conferences info online very helpful. This was excellent video urotoday.com/video-lectures...

[pilot52 in reply to Concerned-wife]

Could he travel ? I just got back from my first round of Lu-177 . ( India) Google Lu-177 and chemo naive prostate cancer. I first had to go to UCLA for PSMA test . If this is feasible we can get you through the paperwork. My OC at Duke was all on board and works with the doctor in India...Just a suggestion. Blue Skies

[Tall_Allen]

Early use of docetaxel increased survival by about 20%.

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

[maley2711 in reply to Tall_Allen]

survival at x Years ?

[Tall_Allen in reply to maley2711]

Median survival was 5 years with docetaxel.

[6357axbz]

The report TA provides a link to states,

“Our previous analysis of patients randomised contemporaneously within STAMPEDE to a docetaxel group or an abiraterone group did not show any difference in overall survival. Whilst that was acknowledged as under-powered, opportunistic comparison, it remains the only direct randomised comparison of docetaxel and abiraterone, and the results are in keeping with both agents being valid first-line options when combined with ADT [22].

[Hidden in reply to 6357axbz]

I see some advantages to doing early Docetaxel over early Abiraterone.

You are done in 18 weeks with the chemo and can move to Abiraterone whereas with Abi first, you might have to wait years. The younger you do the chemotherapy, the easier it is to tolerate as a general rule. I also like early chemotherapy because it kills a wider spectrum of cancer cells, not just the hormone sensitive ones that ADT alone does a good job at in the beginning.

Early Docetaxel is an underutilized treatment, I think there are less than 10% receiving it. People are afraid of chemotherapy, but Docetaxel is tolerable for most. Based on my experience with it, I'd do it again.

[6357axbz in reply to Hidden]

Thanks Gregg. You’re probably correct. But why do you say, “with Abi first, you might have to wait years”?

[Hidden in reply to 6357axbz]

The reason I say for Abi for years is that most doctors will not give you both at the same time so you are probably going to continue Abi until it stops working before doing something else. That can be years, whereas the early chemo is generally for 6 cyles (18 weeks) and then you are done.

[DarkEnergy in reply to Hidden]

I was using Abiraterone for about 6 months, then started Docetaxel, in fact, I asked for the chemo, my doc said great idea! Also, kept taking Abiraterone during the infusions...

[51na1a in reply to DarkEnergy]

Where was your Dr ??

Isn't that his/her job to assist you ??

Or have I been wrong in just having a meaningless chit-chat and paying ridiculous money for same.

Maybe Dr Trump has REALLY succeeded

[MarkBC in reply to Hidden]

Your views on doing chemo first are exactly what my oncologist said when I was diagnosed. I took her advice and did chemo right away. It has been almost two years since my chemo finished. I am doing well. Still castrate sensitive, PSA 0.5, scans show no additional cancer growth. We are holding abiraterone in reserve for when my initial ADT treatment starts to fail ... hopefully not for a while yet. Like you, I did not find chemo to be as bad as I expected.

[Hidden in reply to MarkBC]

It's interesting because even though I was really tired of it when I finished, I noticed that there was this phycological aspect to chemotherapy that I missed. Getting through each cycle gave me a focus, a goal, a sense that I was actively doing something to fight and some sacrifices made on each cycle also had value. It felt like, yes I'm taking a hit but the "guys down there" in cancer world were going to be hurting a lot more. And like you said, the side effects really aren't that bad. People are much more afraid of it than they need to be IMO.

[MarkBC in reply to Hidden]

I've never really thought about it that way before but I agree with you completely. Having to go to the cancer clinic and sit through the infusion once every three weeks. Having to endure the extreme fatigue and other side effects. It really did feel like I was actively battling the cancer.

[maley2711 in reply to MarkBC]

Sorry for perhaps a silly question.... you did chemo as a first response to what? Rising PSA? Other conclusive evidence of metastasis? Before any ADT had been used? Thanks for your clarification!

[MarkBC in reply to maley2711]

I was diagnosed stage 4 with a PSA of 103 and a few mets on bones. Right after the biopsy and initial scans, my urologist started me on ADT (Degarelix) and sent me to see a medical and a radiation oncologist. The MO explained my options and recommended chemo. I started that two weeks later while still on ADT.

[maley2711 in reply to MarkBC]

Thanks you!! Was prostattectomy or prostate radiation discussed for your scenario?

[MarkBC in reply to maley2711]

Surgery was ruled out as my cancer had already spread. Initially I was supposed to have debulking radiation after the chemo was finished in December 2018. I consulted with both the medical oncologist and the radiation oncologist at that time. Both told me about two studies that had just been published. Both studies demonstrated that debulking radiation did not increase survival time for men like me with distant mets. Both doctors changed their earlier recommended treatment plan because of those studies. We all decided not to do the debulking radiation unless future science indicates otherwise. We all know that I may need radiation for pain in the future but, fortunately, I am not there yet.

I really like that my medical team keeps up to date with all the prostate cancer research. I'm hopeful that more research will be published in the next few years that will guide my doctors' treatment plan and help me live a longer life.

[Burnett1948 in reply to maley2711]

No. My Latest PET scan showed 2 spots; one in my pelvic area and the other in my groin. I had the pelvic one radiated before. At this time my Oncologists told me my prostate cancer was throughout my body in low volume. I then had 3 hormone shots. My PSA then down from 4.4 to .6. My Medical Oncologist told me about combining chemo while I was still hormone sensitive. Thanks to my HealthUnlocked mates I have found out more about this combination treatment to help me make a decision to use this treatment. I still have to lock it in with my Oncologist. See My profile for my prostate cancer journey.

[Schwah in reply to Hidden]

FYI I did early all three. Chemo Zytega Lupron. So far so good.

[6357axbz in reply to Schwah]

Zytiga at the same time as Docetaxel?

[Schwah in reply to 6357axbz]

My MO thinks out of the box. I had 3 mets and he hit it hard. Lupron, 4 sessions of chemo immediately followed by Zytega. Plus I zapped the 3 mets with SBRT.

SCHWAH

[6357axbz in reply to Schwah]

What chemo? 4 sessions seems light...

[Schwah in reply to 6357axbz]

Doxcetaxel. Yes light but it was an adjunct treatment to my other treatments so we felt it was sufficient. Oh yea. I also did Zometa and Celebrex for a year after A study showed the combo to reduce deaths over 20%. I did the lupron Zytega for 21 months. Psa got down to .01. And I just got the cholera vaccine as a bonus. Ive been on a drug vacation now for a year. My psa is 3.6 but I have 60% of a supposedly healthy prostate that could create psa. So I’ve done three Psma scans in the year to look for possible progression. All negative to date so still Happily “vacationing”.

Schwah

[Bodysculpture in reply to Hidden]

So would I Gregg57

I found it quite tolerable and the results speak for themselves

I am very grateful

[tango65]

There is not difference in overall survival between doing docetaxel first or abi first, based in the results from the Stampede trials. The median overall survival was not reached for both drugs abi or docetaxel at 48 months.

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

[Bodysculpture]

I did the stampeed trial and I am very gratefull

There many of us here in the UK who will confirm one of the better trials in quite some time

Many are still alive as a result

My oncologist told me 5 years and beyond

I know 2 guys who have are here 8 years after diagnosis both Gleason 9 and 10

Burnett hang in there they will find a way

Just like HIV

A medication that will keep us alive that we live with cancer untill we die from some other illness

I believe this my brother

Stay strong stay as fit as you can eat well

Love yourself and others

I will add you to my prayer list

Stampeed trial 100%

Thank god this was available to me

I was in pain unable to work or exercise crying my eyes out for weeks drove my wife mad with worry

Here I am today

I filled back out

Hitting the gym twice a day

My hair grew back curlier than ever

Eating like 2 horses

I feel strong capable and in charge

This is my experience

God be with you

[Burnett1948 in reply to Bodysculpture]

Fantastic: inspirational: Thanks

[Bodysculpture in reply to Burnett1948]

Just read you profile Burnett

It's very unlikely you die from this disease

Turn your thinking around

Your effort right now is to make sure you dont get the flu lol

Burnett in Barbados where I lived for 35 years those with our diagnosis are the most active they swear by it

Whatever movement you have stress on it if you can only walk right now

Try walking further or faster but exercise is a nugget that keep us strong

Many in Barbados who dont have access to what we have are using exercise to prolong progression and many have experienced many many years

Rooting for you Burnett

DONT CATCH THE FLU LOL

[Burnett1948 in reply to Bodysculpture]

Thanks.

[Burnett1948 in reply to Bodysculpture]

Just read your post again. Again many thanks.

[Irun]

I was diagnosed 2014, docetaxl within 3 months of diagnosis as although I was not on the stampede trial my onco had patients who were and saw what difference it made to have it early . Prior to that dovetail was given later on the pca journey .

My PSA went from 342 to 0.5 but within 6 months it was off again and doubling every 3 weeks. I also had 6 shots of radiotherapy to the prostate again not protocol at the time but onco has seen promising results in trials.

When psa got to 4 I started abiraterone , jan 2016, am still on abiraterone now , PSA has been 0.12 for over a year . Also zoladex every 3 months .

I still run ultra marathons and live life fuller than I ever did before I was ill . I am 55 now .

Never give up , stay or get fit and eat sensibly . Every day is a privilege not a right . Take care

[Bodysculpture in reply to Irun]

Wow Irun Amazing

Very inspiring

[Wongle1]

My husband by was on stampede trial in 2016 you do not get to choose the treatment there are i think 3 o 4 different options and the computer calculates which you receive my hubby got the watch and wait unfortunately but he did get the treatment in the end but he only made him ill the he got sepsis and sadly passed on the 10th of January last year after just over 4 years of having the illness good look in what treatment you get and it helps others hopefully in the future xx

[Burnett1948 in reply to Wongle1]

Thanks. My condolences.

[john205]

The overall survival depends on the extent of disease, but whether or not there are few or many metastases, adding chemo makes a difference of somewhere in the range of 10 to 17 months better than without chemo. A good summary of STAMPEDE and the similar CHAARTED study can be found here:

bmcmedicine.biomedcentral.c...

There have been other reports based on those studies since then but the basic findings hold up well. Also, since then there have been other treatment options found that may provide more opportunities for treatment after the initial androgen deprivation and chemo, like enzalutamide or apalutamide. And there are others that are now available, like pembrolizumab (Keytruda), or like olapirib. Those may depend on results of further testing for mutations in the tumor and other biochemical factors to determine if they are appropriate each person.

[Burnett1948 in reply to john205]

Many thanks.

[Burnett1948 in reply to john205]

I had a job to convince my MO to start Chemo with Hormone (Stampede). He told me (1) I had started hormone over a month ago & (2) My Prostate Cancer was Low Volume. He said Stampede was trialed for High volume prostate cancer. I thought under the trial you had to start Chemo 3 months after you started hormone. Comments please.

[john205 in reply to Burnett1948]

It is my understanding that chemo should be started within 3 months of beginning Lupron to show the benefit. Regarding high vs low burden metastatic disease, the initial results from STAMPEDE did not differentiate. On the other hand, the similar CHAARTED trial did diffentiate and could not show benefit for low burden metastatic disease because there was not enough data, at least in the early reports. There have been many updates of those and other studies and some appear to show that there is benefit even for low burden metastatic disease, just not as impressive as for high burden. There's a lot of stuff out there and it may be confusing. If you are in a position to do so, consider another MO opinion at an academic center that has a medical oncologist who is a prostate cancer specialist.

[Burnett1948 in reply to john205]

Many thanks. I will go with this treatment. Appreciated your advice.

[MateoBeach]

Early docetaxel. RARP in 2007. Positive margins and SVI. G 4+3. N0 M0. PSA 0.4

My progressive urologist said “If it was me I would do docetaxel right away. Perhaps it might double your survival. (Which was completely unknown for early disease.)

So I did. And followed it with SRT. All in the same year. No ADT. No trial.

I hated chemo at the time because of fatigue. But there were many gifts. Lost my hair and I was proud of it. Liked being in the community of cancer fighter/survivors. Still do. When I go to the infusion center for my Prolia now I see the others bravely getting their chemo and think, “These are my people.” Nice to check off each dose on the calendar and see the end. Makes it much easier to accept. Same with a radiation series. These made me a more compassionate and open-hearted human being. And 13 years later I live! Boy do I live: a full active adventurous and happy life. 70 now.

I would do docetaxel first also if I had to do again. But would add the ADT as that is known now to help.

[Pianodude]

I was diagnosed in the beginning of this past June with stage 4 with extensive mets. PSA 685. I was started the next week on docetaxel /w prednisone and firmagon. I made it through 5 infusions and the MO stopped the last one because my lower extremities started getting very numb. Other than that, I experienced very few side effects. I will be on the firmagon long term. I stopped prednisone, but started noticing pain in my bones after a few days. I am back on 5 mg of prednisone again. I tolerate it very well. My PSA is now 0.6. My latest scans show a mild decrease in mets in a few bones. No new mets.

[Hidden]

I don’t know about STAMPEDE or any of the other fancy names given today....l I do know that with metastatic prostate cancer that one should hit it early with chemotherapy along with hormone therapy while the tumor burden is minimal and the body strong. In my opinion the fear of chemo is brought about by those who wait until late stages of life in a last ditch effort.

My experience - six month long chemotherapy with hormone therapy trial in 2004. I have posted the regimen but essentially it was 9 infusions of Taxotere alternated with 9 infusions of Adrimyacin; a couple of orals.....

I admit that I am biased at age 73, but growing up I remember the horror stories. Stories that have not died away. Please don’t let the distant past dictate systemic treatment today. My best friend did several years ago. He was happy with his oncologist until the doctor told him one September to get his affairs in order as he would not see Christmas. He flew down and eventually moved. My guy was able to give him another 4 years with his young family....... I just wish that he had done this in 1990.

As we age, we all face our mortality. Do it on your terms. Our Creator will call when he is ready.

Gourd Dancer

[Bodysculpture in reply to Hidden]

Great post Dancer

[Burnett1948 in reply to Hidden]

Becoming my thinking: thanks.

[Burnett1948 in reply to Hidden]

Burnett1948. I was told my PC metastasised (with one met gland in my groin)last August after a PSMA PET scan. I had one Chemo infusion. Got very sick with a boil on my testicules after my in continence got worse. I am sorry this happened. I had started hormones and my PSA came down from 4.6 to .6. So I am now just relying on hormones which reduces my life expectancy to who knows? I would like to wait a few months and try chemo with another medical Oncologist. Any advice please?

incontience got

[Hidden]

Very doubtful chemo caused the boil. Urine is the culprit in my opinion. One technique to empty your bladder is by taking sitz baths. I use to take 4 or 5 a day. Just sit back and pee away. If the problem is too much flow, then work on your exercises. Above all change your pads frequently. Carry wipes with you. If not, instead on books you will end up with a massive urinary infection.

Through out my life I had boils in the groin area and several times on my testicles. Usually hot and sweaty. I had to carry wipes and a change of shorts. I made time for extra baths or showers.

My suggestion is to get back on chemo and have a serious talk about your urinary difficulties.

Good luck.

[Burnett1948 in reply to Hidden]

Thanks.