Planned Chemo tomorrow need suggestion and information

[Vasanta]

Short story: My father had PSA 16 in Oct 2016 and we were not aware of it for 2+years as he was fit and he did not inform us and we also missed the report. My father is diagnosed with prostate cancer in Mar 2019 with PSA 3026. Bicalutamide helped to drop PSA to 10 in 6 months. in Sep 2019 PSA started increasing so the doctor asked to go for Abireteron acetate. we were on Abireteron acetate for 1 year(due to covid there was a gap of 15-20 days twice in 6 months, I was not able to send him medicine ). As PSA(200) started increasing doctor asked to go on Enzalutamide, initially for 1 month it worked, and thereafter PSA started increasing. for the past 3 months, we were on Enzalutamide.

Now PSA is 517.

Doctor asked to go for Chemo I have attached his prescription. The cardiologist said moderate to high risk avoid cardiotoxic agent.

Decotaxel 50mg/m2 in 500ml NS over 1hr freq 2 weekly 6 cycles

I asked the doctor for Enzalutamide he said it is not working so don't waste money on it and was not ready to prescribe it.

My feeling was we can do chemo and keep Enzalutamide as well.

please let me know your suggestion.

This is the best forum we have where I could get suggestions/information.

Honestly, my world has frozen I could not think, so seeking your suggestion and help.

Apologies, if I asked a question that is answered before.

[Shooter1]

I had enzalutamide and docetaxel concurrently. Killed cancer back but combined side effects were awful. 9 cycles instead of normal 6, should have stopped after 8 acct increasing peripheral neuropathy which became permanent. Best of luck to you. Ice hands and feet helps and can Ice head if you want to save his hair.

[DarkEnergy in reply to Shooter1]

I had Abiraterone and Docetaxel (6 cycles) concurrently, minor side effects with mouth cheeks soreness and taste buds went useless for a few months.

So sorry you got peripheral neuropathy, what was your treatment protocol? For me, after each cycle - a blood draw was taken and physical examination to qualify continuing chemo.

Shaved my hair bald after second cycle as hair was beginning to fall over my laptop. And my wife loved it, said looked younger. The hair grew back, albeit with less white hair, so my experience went well.

[LearnAll]

Docetaxel Chemo might be sufficient for now. Docetaxel kills both androgen sensitive and Androgen Resistant cancer cells. Wait for results of Chemo and then, think of adding other meds. Shooter has given good tips to minimize chemo side effects. Good Luck.

[Tall_Allen]

There was a small trial where docetaxel+enzalutamide was compared to docetaxel alone:urotoday.com/conference-hig...

The combination did lessen progression as of 6 months, but with limited follow-up, there was no benefit to overall survival.

However, sometimes chemo may reverse enzalutamide resistance, so it may be worth trying an enzalutamide re-challenge after he completes the chemo.

[Schwah in reply to Tall_Allen]

When you say “but with limited follow-up, there was no benefit to overall survival.” Do you mean there was actually “no benefit to survival”? Or do you mean that because there was limited follow up, no overall survival benefit could be determined, meanIng there may or may not have been a survival benefit but not enough data to know Either way ?

Thx TA

Schwah

[Tall_Allen in reply to Schwah]

Well, both. The trial was designed to detect 6-month progression as its primary endpoint. However, they did look at "overall survival" as a secondary endpoint. As you can see in the survival curve, there was no difference (the two curves overlap). Now, it may be true that with longer f/u and with a larger sample size, a difference could be detected but so far there is no suggestion of that. Usually, if there is a survival benefit, the curves start separating at some point.

[strummer]

hubs did chemo only, along with firmagon and zometa. -for bone mets.

Icing, and taking zyrtec and claritan few days before, day of and few days after seemed to help

[Vasanta]

Thank You all for your suggestion and comments, I have followed your suggestion shooter1 ad tall_allen.

Sorry for not replying to individual comments.

Had Chemo 8hrs back, my father eat some food and is now sleeping from past 6hrs

We need to give him Dexam 4mg for 3 days (D2-D4 2 times after lunch and dinner)

We are also asked to give Inj G-CSF 300mcg D3 to D7

The doctor suggested to monitor him and reach out to them in case of emergency.

Any suggestion for me?

[MateoBeach]

Good plan at this juncture for him it appears. Since he is now refractory to the enzalutamide there is no benefit to keeping it during the chemo regimen which will very likely control and reduce the cancer at this time. The docetaxel kills cancer cells when they go to divide so it doesn’t make theoretical sense to suppress that hormonal at the same time. Have to mix it up for a time. The lower dose should have easier SEs and lessen cardiovascular risk.

[Hidden]

I have read that sucking ice chips during infusion can reduce taste bud damage. Also eye drops during infusion can prevent damage to tear ducts. Good Luck.