Treatment options after Olaparib; Docetaxel or Cabazetaxel

[HopingForTheBest1]

My PSA is rising, although relatively low at 0.68 from undetectable 4 months earlier. Recent CT and bone scans (8/20) were clear.

Trying to get PSMA scan in NY/NJ area, but only option so far is at MSK for $7000 cost. Applied for NIH and Weill Cornell trials, but no spots available. Hope that FDA approval will happen soon and PSMA scans will become widely available.

Have not been treated with chemo yet, unless Olaparib (started Feb 19 and still on it so far) falls under this category. Had also been treated with Zytiga (6 mos), RP, Provenge, and ongoing ADT. Originally diagnosed 5/19, Gleason 10, BRCA2.+, MSS, low tumor burden, clear surgical margins.

Thinking about next treatment options. Oncologist says chemo not in my immediate future. I may want to consider a new Keytruda trial specifically for BRCA2+ patients. Although I read that Keytruda can negatively affect thyroid and adrenal glands. Expect to have updated Auximin scan once PSA exceeds 1.0.

Just in case, I have read that Cabazetaxel is possibly better tolerated than Docetaxel, being less toxic and with fewer side effects?

[Tall_Allen]

Do you qualify for one of the PSMA radiopharmaceutical trials at Well-Cornell?

prostatecancer.news/2020/08...

The one at UCSF also includes Keytruda. If you have bone metastases, the one at MSK has recently opened up and may be especially good.

[HopingForTheBest1 in reply to Tall_Allen]

I recently met with Dr Scott Tagawa. lead investigator at Weill Cornell, about their PSMA trials. Waste of time as he said there were currently no available slots.

I do have bone metastasis. The MSK trial sounds like the same one available at CINJ, where I am being treated. Appreciate your guidance; will check it out. Thanks.

[Tall_Allen in reply to HopingForTheBest1]

They don't list CINJ as a site for it. Let me know if they are testing Th-227-PSMA there so I can add it to my list.

[HopingForTheBest1 in reply to Tall_Allen]

They are not testing PSMA.

[Tall_Allen in reply to HopingForTheBest1]

I didn't think so. But the trial at MSK just opened, so you may be able to get into it.

[HopingForTheBest1 in reply to Tall_Allen]

Below is the link to a Journal of Clinical Oncology (July 2019) abstract titled "Role for immune checkpoint blockade in BRCA2-mutant prostate cancer".

This abstract doesn't reference if it was part of any specific clinical trial. It appears to be a joint study between CINJ and Columbia. The result was - "Initial patient with BRCA2-mutant MSS prostate cancer had a rapid and ongoing response to pembrolizumab.". Definitely need more info about this. I will send an email to Dr Mark Stein at Columbia Presbyterian, with whom I have had several meetings.

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

[Tall_Allen in reply to HopingForTheBest1]

It was only a case study in one patient - not a clinical trial. If you can get a PSMA-targeted radionuclide along with Keytruda (like in the UCSF study) that would seem to be ideal.

[HopingForTheBest1 in reply to Tall_Allen]

Is this the UCSF trial - NCT03805594 ? Unfortunately, since I live in NJ and there are no other sites conducting this trial, I can't see this as an option for me. I expect it can't be done remotely.

As for the recently opened trial at MSK, is the one you are referencing a phase 1 open label trial for BAY 2315497 with Dr. Michael Morris?

[Tall_Allen in reply to HopingForTheBest1]

Click on the links in the article for more details. Raul Aggarwal is a really nice guy. He may be willing to work remotely with Scott Tagawa. But the Th-227-PSMA trial is very promising.

[Doseydoe]

Regarding your consideration of cabazetaxel over docetaxel, I can share that having experienced 9 shots of docetaxel, for me docetaxel was tolerable. If cabazetaxel is less toxic, all well and good. But the question I'd be asking is, which one of these chemo drugs would be best at attacking and killing my specific type of cancer cells? Once that is determined, the choice would be simple. All the best brother, 😎DD.

[donits in reply to Doseydoe]

Hi Doseydoe,

I would like to ask you what the work on a new cancer vaccine looks like (Translational Research Institute -Australia). Is it already being tested on humans?

Best Regards,

Donits

[Doseydoe in reply to donits]

Sorry, but I am not familiar with this new vaccine and not qualified to comment.

[donits in reply to Doseydoe]

OK, thanks, no problem.

[HopingForTheBest1 in reply to Doseydoe]

That is always the biggest question for all of us warriors -what would be the best treatment, with hopefully fewest side effects, for me. We are all well aware that what may work for one may not work for someone else.

I feel like many of us are guinea pigs, not knowing what will work until after starting the treatment, crossing our fingers, and praying. The holy grail is out there somewhere. We just need to be given enough time to find it. As it was said many times when the NY Mets won the 1969 world series, YOU GOTTA BELIEVE!!!😀

[COOP8 in reply to HopingForTheBest1]

My husband has done two cycles of docetaxel - 5 rounds 18 months ago, and 4 rounds this past July-Sept. From my understanding, it usually has worse side effects than Cabazitaxel. But my impression is that he was given Docetaxel now, since he can likely tolerate it at his younger age and earlier stages of treatment (52, diagnosed 1/2019, mets in bones). Cabazitaxel can still be used later on, when his body might be more worn out from other treatments and disease progression.

[Doseydoe in reply to HopingForTheBest1]

Indeed, all my treatments have been a leap of faith. I have been fortunate in that I found this site early. So when a treatment was proposed and my Google searching concluded, the reviews I found here helped the confidence I placed in my decision. They say analysis paralysis, but at some point like Nike, you gotta Just Do it. 😎DD

[j-o-h-n in reply to HopingForTheBest1]

That's what the NY/NJ jets are saying..........

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 11/01/2020 6:01 PM EST

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

Hi J-O-H-N.

You are very intelligent with a great sense of humor so I have a question for you.

I woke up early in the morning and felt a pang of strong hunger, but I remembered my medication as well. I went to the kitchen and there in the refrigerator, I found yogurt, soy milk, pomegranate juice, and on the table were Bicalutamide (150mg), Metformin, Atorvastatin, vitamin D, and K2mk7.

The question is: what did I open first?

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

The refrigerator door.........

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 11/02/2020 12:12 PM EST

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

😳

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

His hand

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

Hi J-o-h-n

The correct answer is: First I opened my eyes

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

You got me there.....Darnit.....(writing that one down)

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 11/03/2020 2:39 PM EST

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

I thought he was blind to the truth

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

So was eye.....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 11/03/2020 5:25 PM EST

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

Or he closed his eyes and pick one

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

Yep, eyes closed and they were all hidden in a piñata....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 11/03/2020 5:31 PM EST

[Hidden in reply to donits]

Yogurt ?

[donits in reply to Hidden]

Hi, Whimpy,

The correct answer is: First I opened my eyes

[Hidden in reply to donits]

Ah ha! Very fine😳🤙🏽

[Hidden]

Still undetectable .. hang in there ..🍀