DORA Trial Docetacel vs Docetacel&Radium 223

[WifeofD]

wife of David- Sept 18, 2018 to Jan 21 2019 Chemo-Docetaxel, ADA-Eliguard, x-Geva for bone health Advanced Prostate Cancer, Mets to bones shoulders Ribs legs etc. slight climb in PSA - Dec 2019, ketocortisone Jan 2020 to August 2020, husband turned 65 on Medicare, Genetic/Genomic testing. PSA 30 rising again along with ALP on the rise mCRPC . Started Xtandi September-November 2020, continued rise in PSA (65) & ALP(306). Met with Oncologist today-DORA trial-Phase III of Docetaxel vs Docetaxel & Radium 223. The downfall of the trial is we won't know until we are in the trial if my husband will be selected for the Docetaxel & Radium 223 or only Docetaxel. ( He is having Back/Bone pain.) Does anyone know how you are selected for the trials? or is it randomly? or if we would want the Radium 223- could we pay for it on our own? or could the Radium223 be a treatment plan option after the chemo is completed? We are being treated at IU Health Simon Cancer Center Indianapolis, IN. We previously were with UOI Advanced Prostate Center Greenwood, IN ( Changed to IU 2020-felt bigger hospital/teaching hospital would serve us better.) Appreciate any info you can offer.

[Tall_Allen]

I haven't seen the Phase 3 specs yet, but Phase 3 means it is a random allocation. If they are using the doses used in the Phase 2 trial, it could be duplicated if your insurance and your oncologist are willing. The Phase 2 results looked pretty good:

ejcancer.com/article/S0959-...

However, it is worth noting that the Phase 2 trial of Xofigo+Zytiga looked good too, but the Phase 3 trial showed real problems with the combination.

He can always get Xofigo after completing 6 infusions of docetaxel, 3 weeks apart.

[WifeofD in reply to Tall_Allen]

Tall Allen-Thanks for the info. the one problem with the trial is the time to get started- it would be almost the middle of December for the start of the trial to begin. We feel this is wasting a lot of time. We asked if we opt'd to start chemo instead and not be in the trial- they could start chemo ASAP like before Thanksgiving.. Also, not knowing which arm of the trial we are in-concerns us. 50% chance...We are on Medi Care/ have great supplements and ability to pay is not a problem for us. ( thank goodness we are blessed). Do you think we are on the right track? We should be able to follow up with Rad 223 after Chemo?

[Tall_Allen in reply to WifeofD]

The nice thing about the combo was that they were able to reduce the chemo dose and still achieve a synergistic effect. Another option is to do chemo now and follow with Xofigo+Provenge as in this trial:

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

I think you should discuss your concerns and all the options with his MO.

Did he have any of his metastases biopsied? There seems to be a synergy between Xofigo and certain genomic defects.

[WifeofD]

Thanks Nalakrats! We were with a MO-Urology of Indiana Advanced Cancer Center and were unhappy with their service, billing, no compassion, we were only a # to them, etc. We had requested options for treatment and they would not offer. That is when I researched IU and found an oncologist that specializes in Adv Prostate Cancer. We can email this oncologist anytime. They can do all treatments at their site along with their other sites here and near Indianapolis/Carmel/Greenwood.