Zytiga and Xtandi combo treatment

[Zolababs]

Has anyone been on the combo of Zytiga and Xtandi? Good results?

[GP24]

Here is a study which tested this combination. It did not provide significant additional benefit.

urotoday.com/conference-hig...

[Zolababs in reply to GP24]

Thank you for your response. Our situation is a little different than the participants allowed in that particular trial. My husband has already been on both drugs separately and has had two different chemo therapies since. My bad for not addressing those facts in my question. I guess I was expecting someone to read my mind. Sorry.

[GP24 in reply to Zolababs]

After chemos you can take Zytiga or Xtandi and you will often see some benefit. The resistance you had developed before the chemos is reduced again. I am not aware that the combination you mentioned has been tried in your current situation already. If you plan an Ac225 treatment I would choose Xtandi now:

eurekalert.org/pub_releases...

[Zolababs in reply to GP24]

He started the Zytiga + Xtandi combo today.

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

I read minds....... but only for a price.......

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 12/03/2020 5:32 PM EST

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

👍

[immunity1 in reply to GP24]

Yes, unfortunate result! THe combo sounds so logical, but the additional side effects are a bit of a killer.

[Tall_Allen]

It didn't test well. urotoday.com/conference-hig...

Is your oncologist recommending the combination?

[Zolababs in reply to Tall_Allen]

Yes. He is trying to buy some time with the combo before starting the actinium clinical trial in January. My husband was formerly on the two drugs separately and has since had two rounds of chemo.

[Tall_Allen in reply to Zolababs]

Even though the combination had no benefit to the group as a whole, there were some men who benefited from the combination. I hope it works for him. Can he try apalutamide instead?

[Zolababs in reply to Tall_Allen]

I will ask his oncologist. Does apalutamide have a clear benefit over Xtandi?

[Tall_Allen in reply to Zolababs]

Why not try a new med? - you already know that enzalutamide doesn't work.

[Zolababs in reply to Tall_Allen]

He did put him on apalutamide. I thought it was Xtandi. You are one smart dude!

[Zolababs in reply to Zolababs]

Found out the hard way the abiraterone/apalutamide combo was too difficult on my husband. The oncologist stopped the apalutamide. Hoping the rounds of chemo he endured will give the Zytiga a little extra boost.

[noirhole]

What is the recommended dose? Same as the label or half dose of each?

[Zolababs in reply to noirhole]

Full dose of each.

[Patrick-Turner]

This was tried a long time ago during trials of these two drugs. The outcome was so bad that no sane doctor was allowed to prescribe both for any patient. Here in Australia, if I get put onto Zytiga until it fails to work to keep Psa low, which took 8 months to happen in my case, then I am not allowed to move on to taking Xtandi with hope that would give some extra suppression of Psa. Of vice-versa, Xtandi followed by Zytiga is not allowed, and our medicare rules spell this out. But after Zytiga failed while on ADT Lucrin the whole time, I had chemo, and then when that failed I went on to Lu177, and a research doc specializing in Lu177 combined with Xtandi told my onco that I would do better if I had Xtandi during Lu177 doses because it boosted PsMa expression, so I got Xtandi after 3rd dose of Lu177. Whether that improved effect of Lu177 is not known, but I began Xtandi in April 2019 and Psa dropped from less than 5 to nadir of 0.32 in Nov 2019, and nobody knew if that was due to tumor reduction due to Lu177, or just reduction of Psa. Scans seemed to suggest Lu177 did a lot of tumor reduction, and reduced Psa, but Xtandi pushed Psa reduction further. Then in 7 months after November 2019, Psa increased 100 times to 30 in July 2020, so I had 2 more doses Lu177 and Psa is about 7 now, and Xtandi is now having zero effect and I can't have more Lu177 like I wanted because some new bone mets have popped up with very low PsMa expression, and appearing fiently in PsMa Ga68 scans. So some alternative method of killing Pca I have now has to be undertaken. I may be OK to take Ra223. The main 3 ad-on drugs to ADT to make ADT last longer are Cosadex, Xtandi and Zytiga, During time I have been on these 3 drugs, PsMa scans showed continued growth of Pca mets and the only thing that reduced mets was Lu177, and all soft tissue mets seem to have gone, and my Pca is now just bone cancer. An FDG PET scan last July showed no bone mets that do not have PsMa expression, but that may have changed and its not unlikely that now have mutated form of Pca that is re-populating mets damaged by Lu177, and to have any more Lu177 may antagonize the whole situation and if I had a 7th Lu177 dose there may be no net benefit. But Radium 223 acts where calcium traffic in bones at mets is high, so maybe that works on all bone mets that still do have high PsMa expression or very low expression.

Its worth a try IMHO.

So those taking Cosadex, Xtandi or Zytiga need to know they don't cure your Pca, and more likely just kick the can further down the road. I found the idea that having ADT with a pile of EBRT as initial treatment hardly worked at all, and when I had salvation IMRT to PG and Cosadex added to ADT, same result, Pca remained alive in my PG.

Docs said all that RT would kill Pca at PG, but later PMa scans showed them to be wrong.

I've had 9 PsMa Ga68 scans. These are regarded as good, and better than CT scans but depend on PsMa expression at Pca tumors.

So I am the point where I need a new plan, and there's another month to go before I see my onco, and I don't know what Psa is doing.

But I am cycling very well with no bone pains and doing 230km per week now with some 100km rides at age 73 with all blood test numbers looking just fine. This could so easily change for the worse if I do nothing.

So don't place great hopes on Cosadex, Xtandi or Zytiga. These drugs seem to be what is treatment for Pca, and they make huge profits for Big Pharma, but they didn't act long for me, and during Psa suppression, mets just grew bigger, although maybe at a slower speed.

If all I have now are bone mets, then Lu177 has been an overall benefit. But I have to wonder what effect on lymph nodes occurred after Lu177 got into them to kill all Pca found there? What stops Pca from getting into organs if my lymph nodes are partially destroyed by Lu177? Lymph nodes are supposed to block cancers getting into organs, but of course they can only stop this process for so long, and Pca can progress within lymph nodes. Nobody has said my lymph node system is disabled yet. But as time goes, the possibilities and complexity increases, and uncertainties are trying to worry me, while I try to not worry.

Patrick Turner.

[Zolababs in reply to Patrick-Turner]

Very interesting post. Thank you for your response. Temporarily tricking the cancer cells is a full time job.

[Patrick-Turner in reply to Zolababs]

ADT and add-on drugs Cosadex, Xtandi and Zytiga are not really tricking Pca cells, but act to put them into a sleepy state where they grow slower, thus the day when they achieve ultimate victory by killing a man is delayed. Pca craves testosterone, and without any at all, some will die but often hardly any, they just slow down. And while slowed down, they can mutate t become able to make their own testosterone. Pca tends to mutate in ways to oppose any kind of treatment. In my case, it seems the use of Lu177, ie, a mild exposure to atomic bombing does kill quite a few Pca cells but then it learns to not let the Lu177 know where it is located in the body by not making PsMa so any more Lu177 is not able to do anything. I fear this is what's now happened to me so I could not have a 7th shot of Lu177, so now I have a mixture of mets that could be killed by Lu177 and some that cannot be, so Theranostics Australia have decided not to continue treating me with Lu177 and they have no suggestions at all for what might work, and this seems like a statement where they are saying "you are stuffed mate, ain't nothin youse can do" .Well OK, I get their message loud and clear, but thanks for the 2 years delay on dying that I bought for aud $ 60,000. We are tricking the cancer repeatedly, but cancer seems to be fairly intelligent, and an expert survivor.

I see my onco in a month, enough time to see just what bad trend has been established by my Pca, and hopefully I get Ra223 to work on cancer in my bones where calcium traffic is high, and without any needed guidance by PsMa chemical generated by Pca cells. The PsMa is not always produced by Pca cells, sometimes is, and sometimes is not, depending on conditions, so its a kind of fickle thing Pca does, but it does seem "PsMa expression" is strong enough for long enough to let Lu177 take out most soft tissue mets if not all of them, after 7 doses, but of course I wonder that Pca could return to soft tissues. Are my present bone mets spreading? Like all cancers, the spread is not just from the primary tumor; spread happens from cells that have spread from mets...... so its difficult to treat. Many ppl have a simple imagined idea of the nature of cancer they need to be aware their cancer is usually just not ever able to be simply understood.

Even the doctors have no full idea of what some Pca might be doing in any man's body.

Seems like its lunch time here, I must away to cafe, sandwich and coffer awaits me.

Patrick Turner.

[Zolababs in reply to Patrick-Turner]

I wish you the best.