Standard protocol vs integrated Oncology Chemo Dosage

[Gec659]

Hello Bloggers.. my name is Ken & I am new to the HealthUnlocked scene though my Wife & daughter have been sending me articles for the past year. So I’m posting this under her name ..

I am 66 years old & have stage 4 APC & diagnosed with a 4cm malignant tumour in prostate (near rectal wall) in October 2019. Gleason 9 and bone Mets basically all over ..

They started me on ADT immediately so I was getting a Firmagon Shot in the stomach once a month for about a year & was on Erleada. (2nd ADT))

For about 5months, & thought it was doing ok

My PSA number dropped from over 500 at diagnosis down to 25 , then the inthink Seem to stop working and I went upwards 255 290 to about 110

I am also on Tamulosin

Twice a day and Avadart Before I go to bed

So started

Recently I was diagnosed as anemic

My hemoglobin count went down to 680 (no apparent bleeding anywhere )& gave me two infusion of iron which is brought the iron level back up

Now they are talking about wanting to do chemo and there is a discussion about doing 20 mg of JETVANA every three weeks

(however my daughter who has been heavy and research feels that after all the studies she has read JetVana is a second-tier drug and that is a pretty big hit and she said it can cause other complications after all the studies she has been reading it seems that lower-dose like for example:

Metronomic chemo- docetaxel 15mg/ weekly

Clinical studies show it’s just as effective as the standard schedule, with a significant reduction in negative side effects and also helps to prevent your cells from becoming chemo resistant. And studies have even shown weekly low dose chemo to even be immune stimulating

My oncologist was pushing for the JetVana

My daughter is still insisting the lower dose is the way to go ..with the other chemo

I know she is not a doctor but she has really dug deep in spoken to my urologist and other doctors who seem significantly impressed with her knowledge and research data.

I am looking for some feedback from people you can offer views from experience this is still new to me and a little confusing, no one

Wants to make the wrong call and we’ve talk to 2 integrated oncologist who agree with my daughter and even have offered some alternative redirect to drugs to bring down my PSA numbers as of today they have come down to 160 from the higher number

I feel strong and good but my daughter seems to think that JetVanna will change that and blow me away & possibly cause other issues .. without any reassurance of how long it will be good and work

Thank you for your input .I am interested in hearing your valuable feedback from experience

[Gec659]

*Dont want to make the wrong call !

Dang AUTOCORRECT!

[LearnAll]

First of all.. Your daughter is God's blessing to you as she cares so much about you to spend time and energy researching info to help you the best way.

Your PSA is behaving badly...not good. It has not gone down enough and worse has rebounded back up. So something certainly needs to be done ASAP. Generally speaking, Docetaxyl is given first unless there is some specific reason to go straight to JevTana.

I have never had Chemo so I will leave this to men who have gone thru the experience of chemo. They have more knowledge and will be able to provide good answer about choosing the type of chemo.

[Hidden]

Your daughter appears to be correct, Docetaxel to the rescue. I did six courses, 75 mg a course. I'm surprised your MO hasn't brought a heavy hitter to the fight yet.

[Tall_Allen]

Currently, Jevtana is only approved after docetaxel has been tried. Because many of the published trials of Jevtana are after docetaxel use, patients getting Jevtana in those trials are more progressed in their cancers and more physically debilitated by their cancers. So, of course, the reported adverse side effects are worse the more the patient's status has deteriorated. Your daughter may be trying to compare apples to oranges.

As far as docetaxel dosing goes, 75 mg/mm2 every 3 weeks was found to be significantly better than weekly dosing:

ascopubs.org/doi/10.1200/JC...

Jevtana as a first round chemo has been tried in a randomized clinical trial where patients were randomized to get either 20 mg/mm2 of Jevtana, 25 mg/mm2 of Jevtana, or 75 mg/mm2 of docetaxel. They found that the oncologic response was similar for all 3, but "Cabazitaxel and docetaxel demonstrated different toxicity profiles, with overall less toxicity with Cabazitaxel 20 mg/mm2."

ascopubs.org/doi/10.1200/JC...

Recently, an early clinical trial adding carboplatin to Jevtana had better results than Jevtana alone:

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

The combination has entered Phase 3 trials.

If you can biopsy a metastasis, it may provide clues for a more tailored therapy.

[Gec659 in reply to Tall_Allen]

Even if DNA studies have found no path in .. are u saying It would be beneficial to biopsy a Met

[Gec659 in reply to Gec659]

??

[Tall_Allen in reply to Gec659]

What do you mean by "DNA studies?"A germine test? Did they already biopsy a metastasis?

[Gec659 in reply to Tall_Allen]

No biopsy of any Mets but did have DNA Genetic TEST that does look for mutations to attack, BRACHA ect

[Tall_Allen in reply to Gec659]

Was it a germline test? Were they looking for an inherited mutation? Do you remember the name of the test?

[Gec659 in reply to Tall_Allen]

Yes they were looking for inherited mutation but I will pull up his “my chart from MD ANDERSON”. DEC2019. Maybe name of test but showed no mutation

[Tall_Allen in reply to Gec659]

"Inherited mutations" is what is known as "germline." But there is another way that mutations can occur. In metastases, the DNA of the cancer cells is constantly degrading. So there is another source of genetic mutation that only occurs in metastatic cancer cells - it is called "somatic mutations." In about half of the men who have BRCA mutations, they are germline and about half are somatic only. If they biopsy a metastasis, they can tell very quickly if your metastases are susceptible to treatment with carboplatin and PARP inhibitors. There is also other useful info they can find by cell histology and immunohistochemistry analysis. It's something to discuss with your oncologist.

BTW, if you are being treated at MD Anderson, they (Paul Corn) are the ones doing the clinical trial of the combination of Jevtana and Carboplatin.

[Gec659 in reply to Tall_Allen]

We went there for 2nd opinion After initial diagnosis..Dec 2019

Initially they just thought it was in enlarged prostate until severe bleeding episode, colonoscopy, & then biopsy .. THATS when tumour was discovered ..IMMEDIATELY went on ADP. .. weird that they didn’t suggest too much to us other than what our initial Urologist at the time was doing ..

I THINK They were a little put off that we had already had some ADT So said we might not be eligible for some different trials .. Also wanted us to come once a month to Texas, & we live in Florida And was nervous about placebo and no treatment sooo am being treated here in Fll . Still searching for our BEST MO or Integrated Medical Oncologist..

[Gec659 in reply to Tall_Allen]

Thank you soo much for your knowledge