Next Steps after Cabazitaxel and Xtandi

[tomtom9148]

I was diagnosed in May of 2016, PSA 16 and Gleason 9/10. The cancer metastasized to 3 bones at that time and I underwent aggressive treatment at NIH with Docetaxel and PROSTVAC along with Lupron. When the PSA started rising again after 18 months, I switched to Standard of Care at home with Xtandi and Lupron. That worked for about 2 years, then PSA started rising and Scans showed slight increase in METS and 2 new ones. I went on a clinical trial at Sarah Cannon with ADZ4635 that only added to my PSA. I then went to Cabazitaxel for 3 sessions but PSA continued to rise to 32. I went on a 3 week trip and used Xtandi again, and now my PSA is at 65. My Oncologist, Alexander Menter in Denver, is giving me these options:

"I think Xofigo, carboplatin, Taxotere, mitoxantrone, and revisiting trials are all good options. "

Any suggestions? I lean towards Xofigo, and it has been suggested to add Provenge to that, but my insurance won't pay for the combination unless they see some studies as to its efficacy and safety.

Thanks for any experience that you guys have with these drugs.

[Tall_Allen]

Here you go:

ascopubs.org/doi/abs/10.120...

[tomtom9148 in reply to Tall_Allen]

Thank you, but I was hoping to hear from others who have been on this Radium 233. While I appreciate the study info, it often gets lost in translation for me. Is SIP-T provenge? My doc says that the study done was very limited in scope , and some of my research says Xofigo works best by itself

[Tall_Allen in reply to tomtom9148]

Yes,Sip-T is Provenge. I suggest you email the link to your doctor. Although the details may be lost on you, it hopefully will not be lost on him. It was a small study. Xofigo has been shown to combine well with with Radium 223 and with docetaxel. Medicines that kill a lot of cancer cells leave a lot of their special proteins (antigens) in the bloodsteam where the immune system can get activated by them. Here is a more patient-based explanation:

prostatecancer.news/2016/08...

[ctarleton]

Your insurance might pay for doing Provenge first with asymptomatic or minimally symptomatic disease, to then be followed by Xofigo when bone mets may become symptomatic (in the absence of visceral disease). These "Indications" are already in the FDA Full Prescribing Information for these treatments and the corresponding prior approval policies for most insurance drug formularies.