Opinions about chemotherapy. Running out of options

[abmicro]

Please help me with your personal experience and knowledge.

Doing carboplatin. Mets in pelvis stable, but spine progressing. Blood counts getting very low. Dont know how much more chemo I can do. Here are some of my Oncology notes. (A good oncologist):

"We can also consider changing Carboplatin to Cyclophosphamide or Mitoxantrone. Or we can consider adding Docetaxel to Carboplatin. "

"There are two schedules for this that have been studied, and both are on a 28-day cycle:

- One schedule (used in a smaller retrospective study) uses the current dose of Carboplatin you are receiving (AUC of 4) and gives this one Day 1, and then you receive Paclitaxel (60-80mg/m2) weekly for 3 weeks (days 1, 8, and 15), and then have a week off.

- The second schedule (which was actually used in a more formal clinical trial; thus more reliable evidence that it works) uses Carboplatin at a slightly lower dose (AUC 3, which was the dose you received with Cabazitaxel previously) on days 1 & 15. Paclitaxel is also given here on days 1 & 15 at a higher dose (135mg/m2).

I think the second plan (chemo every 2 weeks) is probably better supported by evidence.

[ron_bucher]

My case is not as advanced, but Taxotere was easier for me than Lupron, and was easier than I anticipated.

[Tall_Allen]

Paul Corn at MD Anderson is currently running a clinical trial combining Jevtana (cabazitaxel) with carboplatin. They found that doses of cabazitaxel of 25 mg/m2 and carboplatin of AUC 4 mg/mL per min were well-tolerated. Your MO may want to give him a call.

clinicaltrials.gov/ct2/show...

pubmed.ncbi.nlm.nih.gov/315...

[abmicro in reply to Tall_Allen]

I started that protocol here at UC Davis, not under a trial, but because of bleeding bladder from Radiation Cystitis (from a radiation 10 years prior at Kaiser) had to stop after 2 rounds. Stopped cabazataxel but continued carboplatin. No argument about the combo. It worked the best, and it worked very fast, but now have to go a different route. My note summarizes the different routes that my oncologist recommended.

As for Dr Corn at MD Anderson, if you see him, run away as fast as you can. He overdosed me on ketoconazole in 2008 and I almost died. He gave me no warnings about conflict with herbal shakes, even after asking him about my blender shakes. Dr Charles E Myers saved me and put me on UROSODIOL for my jaundice and I recovered. With Meyers help, I carefully worked up the doses a 3 drugs combo, including Ketoconazole, and it gave me a long 3 year remission--longest remission I ever had. Other 2 drugs were estradiol patches and Leukine. UROSDIOL continued thru those 3 years to help protect my liver.

[Stevana]

In three days will be receiving the fifth of six rounds of Docetaxel administered every three weeks. Have not suffered substantial side effects except for thrush which I control with medication and the usual bouts of fatigue which seem to be increasing with each round. I’ve avoided neuropathy of hands and feet by using ice packs on both. Lost hair in my head but not rest of body and have diminished taste of my usual foods. I’m told these symptoms will subside and return to normal over time. I have two more infusions to go so SEs might get worse before the end. So far I’ve experienced none the more severe effects that others have encountered. We’re all different so it’s hard to predict this, but I believe the majority of us have had my same experience with varying degree. Good luck if you decide on Docetaxel. I can’t comment on any of the other treatments under consideration.

[abmicro in reply to Stevana]

Thanks for sharing your experience. Did that one already 2 years ago. Was mildly effective.

[DarkEnergy]

I had Taxotere, it was a breeze, hair lost, rubber skin and useless taste buds was nothing for the benefit of sweeping cancer, all the best...

[Hidden]

Everybody is different. I would not fear the trial with more frequent infusions. Just kill the little bastards. To wit: in 2004 over a six month period, I had three cycles of Chemotherapy consisting of ketoconazole and doxorubicin for weeks 1, 3, and 5 and estramustine and docetaxel and for weeks 2, 4 and 6. During weeks 7 and 8, no treatment was received. I also was given ADT and a daily dose of 30mg of Prednisone.

If your body is strong absent of co-mordibties, hit the cancer hard. There is plenty of time with the newer generations of drugs if needed after chemotherapy. I was most fortunate.

GD

[Easey]

You might consider gene mapping of your tumors before deciding on what chemo is best. I've had taxane and platinum based chemo which came to nought and a subsequent gene summary of the liver tumor told me as much. Seems I'm now resistant to both - now trying mitoxantron and seeing how that goes.

There is another chemo that has resurfaced latety in combinations ie doxorubicin. If anyone has experience with this one I'd like to hear about it.

[abmicro in reply to Easey]

Stanford did an analysis of a past biopsy, a guardian360 on my blood, and another genetic analysis and found nothing. I am going ahead with Paclitaxel and Carboplatin if I dont hear of anything better. I am going to continue the Nueasta onpro patch for immune, and self injected Zarxio injections to fill in the time after 14 days when Nuelasta onpro wears off. Will check if apalutamide is a conflict. If not, I will run that at the same time.