What to know before chemo

[Neuroendo]

About to start chemo with carboplatin and cabazitaxil.

Interested in opinions about icing feet and hands to ameliorate neuropathy.

Also interested in fasting prior to chemo to reduce side affects.

[tango65]

This is some info about chemo from a real expert in PC:

grandroundsinurology.com/dr...

[Neuroendo in reply to tango65]

This article was very useful to me. Thanks neuroendo

[tango65 in reply to Neuroendo]

Best of luck and a Happy New Year.

[DarkEnergy in reply to tango65]

Hi Tango,

Happy New Year Senor!

This is one my favorite articles, in fact, helped convinced me to get Taxotere, even though Abiraterone was working fine.

[tango65 in reply to DarkEnergy]

Happy New Year. She has a lot of clinical experience and basic knowledge about chemo for PC.

[Howmuchisthefish in reply to tango65]

It mentions this,

"Dr. Dorff: Combinations with Taxotere (docetaxel) have never yet been successful in prostate cancer. There was Taxotere (docetaxel) with a high-dose Vitamin D, which was not only negative in that it failed to improve outcomes, but patients who received the combination actually fared worse."

Anyone have a source for that one?

sciencedirect.com/science/a...

I was reading this and it never mentioned anything about vitamin D during chemo being harmful.. Maybe not helpful but certainly not making for worse outcomes.

Thoughts?

[Howmuchisthefish in reply to Howmuchisthefish]

Anyway just an update for those who were interested. If she was quoting the ASCENT-2 trial then the statement she made was simply not accurate about men taking vitamin d with docetaxel. Only reason they fared worse because they were given the inferior docetaxel dosing regime.

''Therefore this standard therapy of every-3-weeks was chosen as the control arm of ASCENT-2 combined with placebo and was compared to weekly docetaxel plus calcitriol.''

''The inferior survival in the calcitriol arm was surprising. While this result may stem from the lack of activity of calcitriol in potentiating docetaxel in men with castration-resistant prostate cancer at least two other concerns must be considered:

Since weekly docetaxel has been proven to be inferior to every-3-weeks docetaxel, the failure of the experimental arm in this study was clearly confounded by the inferiority of the docetaxel regimen.

Another factor that must be considered in evaluating this study is the lack of convincing data that this calcitriol dose and regimen is optimal or appropriate. The dose employed was ~ 1/3 of the MTD of intermittent calcitriol. Therefore, one must wonder whether the failure of this trial was influenced by the dose of calcitriol employed.''

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

[dhccpa in reply to tango65]

She seems to favor some forms of fasting. Did I read that right? Seems to contradict an earlier poster's comments.

[tango65 in reply to dhccpa]

Yes, she does,

[SatuitMike]

Drink, pat attention to yore fatigue levels, carefully monitor your GI, and mostly be prepared to reduce work

[Neuroendo in reply to SatuitMike]

Thanks

[MyWifeMyLife in reply to Neuroendo]

Hi, just wondering will you be taking Prednisone oral twice a day? If yes, keep taking it, except for chemo day..My side effects were much worse when I ran out of it. I just stopped the combo you’re going on. I didn’t have severe side effects until #6 and # 7..I believe it builds up in the body. I don’t think all my efforts paid off..I’m stable apparently, but my bone Prostate cells are still progressing. Wishing you the best!

[Neuroendo in reply to MyWifeMyLife]

I will be taking prednisone I suppose orally. Bone metastasis still progressing is disappointing. Is your diagnosis neuroendocrine too? Thanks for the advice on prednisone.

[MyWifeMyLife in reply to Neuroendo]

No problem, I’m lucky it’s stayed in the bone and marrow thus far..if you call that lucky right? My numbers alkaline phosphatase did go down, and PSA but not at the levels we wanted..everyone is different. Wishing you the Best!

[Neuroendo in reply to SatuitMike]

Thanks

[spouse21]

Hi, Neuroendo. Sorry you're having to get chemo. Good news. If you have pain, chemo definitely helps. During Covid times, the experience may feel more impersonal than it would've a year ago. My husband, who had ten Docetaxal infusions, began his chemo four months before the hospital locked down. I was able to accompany him to all the pre-Covid infusions as were other patients' loved ones and caregivers. So there was kind of light, social, friendly atmosphere in the center. Plus a wonderful volunteer brought blankets, snacks, and good cheer to everyone, Pizza Fridays! Animal Crackers! The staff was open, accessible, and so warm and supportive. We could see their faces. Fast forward to last March, and all that went away: volunteers, caregivers (your mileage may vary) and many restrictions. No more bantering with different staff and other patients. Everything got pretty quiet and all business. The staff was completely covered and no one was really available for the extra niceties. Here's my account of the post-Covid infusion experience per my guy.

healthunlocked.com/advanced...

Despite the best efforts to ice hands and feet, my husband does have neuropathy even seven months later. He didn't wear a cooling cap and lost his hair, eyebrows, eyelashes, but they're growing back now. He always sported the "cool baldie" look anyway. He ordered cold pack mitts and socks, which we kept in the freezer then transported under multiple ice packs in a cooler right before departing for the hospital. The infusion takes about an hour, so I changed out the mitts and socks about thirty minutes in. (Oh, he did get a mediport installed before chemo began. That makes the infusion of the Docetaxel and Neulasta lot easier.) He always brought his iPad, but dozed off for the last half hour. He tried the fasting thing for one infusion and felt so awful he went back to real food, Animal Crackers, and more!

After each infusion, my husband was tired then felt okay for the next couple days. Day three, though, he felt lousy for the next three days--poor appetite (no nausea, though), really tired, just punk. Then the next couple weeks of the "off cycle" he felt better, able to exercise like a demon though needing to nap each afternoon. Since he went ten cycles, not the standard six, side effects from infusions 6-10 worsened (dry mouth, diarrhea, deeper fatigue, poor appetite, bloat) . The bad three days became five or so crummy days. So essentially the first week of each three-week cycle towards the end kind of sucked. A few months after chemo ended, he weaned off the prednisone and lost about 15 pounds of bloat in about two weeks! He also felt so much better once the prednisone went away, though he's still on Lupron and Xgeva. So far, the chemo seems to have stabilized his cancer if you go by blood work and PSA and the scans he had when the infusions were over. He's getting more scans at the end of January, so we'll see. We're wrecks about the next scans even though his blood work last week was pretty perfect. But this has always been the case. He once had all great numbers though scans at that time showed mets all over the place.

I wish you a good and enduring outcome from your particular chemo. Take advantage of the good parts of the cycles by getting outdoors, exercising, eating well, and enjoying life. Good luck!

[Shooter1 in reply to spouse21]

Very much like mine..iced hands and feet...9 cycles until side effects halted treatments...neuropathy in hands and feet 2 yrs+ later. Added xtandi after #4 as PSA stopped dropping and actually rose a little...xtandi until I was an invalid, cut dose, recovered. Cancer on hold with low dose xtandi (80 mg daily) and low PSA. Life is good, new normal not so much.

[Neuroendo in reply to Shooter1]

Yikes, do you think the icing lessened your neuropathy?

[Shooter1 in reply to Neuroendo]

It did seem to slow it's onset. If I had quit at 6 or 7 cycles, I probably would have been ok.

[Neuroendo in reply to Shooter1]

Thanks

[MCDaisy1972 in reply to Neuroendo]

My husband did not ice his hands or feet. Despite my buying ice mittens and socks. He received 5 cycles of cisplatinin/Etopiside for 3 days,every 3 weeks this summer. In May,he had 25 radiation treatments to the lesion that was growing on his spinal nerve. Then,after being off chemo for 8 weeks,the small cell spread to his femur and clavicle and lumbar spine. Went through 12 radiation to severe pain in his femur. He is also on drugs..IM,for bone Mets. His last pet scan of 2 weeks showed 75% reduction in all tumors. After 2 cycles of docetaxel and carboplatin,doctors are thrilled. His psa never rose above zero and remains below zero. His oncologist ordered docetaxel as she feels,while all 10 specimens from his sacral nerve biopsy showed pure small cell,that he has very likely some adenocarcinoma. Biopsy is the only positive way to diagnose small cell,neuroendocrine prostate cancer. We consult also with Dr.Aggarwahl at UCSF,who along with Dr.Beltran specialize in n.e.p.c. They both do video consults. Beltran is at Dana Garber in Boston. I called,they obtained all the records. We flew to Boston the next week and spent 2 hours with her. I read lots of inaccurate and wrong info on the internet. I strongly urge anyone with this diagnosis to consult directly with the experts. Fortunately,our local oncologist recommended her when he gave us this horrible diagnosis and we saw her within 3 weeks. Those 3 weeks scouring the internet for something positive were the worst days of my life. Seeing Dr.Beltran who we now talk with about every 3 weeks and as needed, have been our best.

[Neuroendo in reply to MCDaisy1972]

My neuroendocrine tumors are on my femur, clavicle, lumbar spine also, as well as pelvis, scapula, and several ribs. Dr. Beltran sounds like a godsend. Dr. Charles Ryan at the University of Minnesota, my Doctor, is , I think, on top of my cancer too.

[Neuroendo in reply to spouse21]

Thanks for the information. I have had a hard time finding this kind of specific information. Prednisone will be part of my treatment along with a growth factor and an antinausia drug. I hope the end of January scans show good results.

[spouse21]

Hope some of this helped, Neuroendo. I wish you the best.

These are the gel socks my husband got on Amazon--out of stock but others are suggested:amazon.com/gp/product/B07VG...

Gel Mitts: amazon.com/gp/product/B077R...

Anecdotal: A young woman getting infusions on the same day as my husband wore an ice cap on her head and still had her hair at the end of her six treatments.

[TNCanuck]

Hi,

I'll share the following, which I've shared before. Most of it was shared on another site and my husband and I found it immensely helpful.

My husband followed most of the tips and was able to work full-time through his series of six infusions. He wore the cooling cap and suffered very minimal hair loss. His thinking was he'd feel more "normal" if he looked like he always had. He has a very thick and distinctive head of hair.

Wishing you all the best!

healthunlocked.com/advanced...

[Stevana]

Hi Neuroendo,

I just finished six rounds if Docetaxel on Dec 3rd. I tried an ice cap but lost my hair anyway. I did ice my hands and feet (held two frozen water bottles with thick gloves in for my hands; wore thick socks while using foot booties with ice inserts I bought off Amazon).

While it didn’t completely eliminate some neuropathy in either, it has kept it to a minimum to the point it’s not something I could complain much about. My main issue has been with my taste buds. I did chew in ice chips during chemo but it didn’t help much. I’m also experiencing issues with my saliva glands. I go from dry mouth to over-salivating. It’s pretty aggravating but I’m hopeful it will clear up as the drug leaves my body.

I also develop thrush of the mouth which has been kept under control by Nystatin. You may want to ask you doc for this mouth rinse if this happens to you. However, my mouth issues are a fairly low percentage side effect so you may have no problems with this.

Be sure to stay well hydrated because the chemo will make you feel like you have been sitting in a kiln. Fatigue is also pretty heavy especially as you progress to your last dose. I can’t say it was an easy time but I survived it without any major issues and hoping to get back to normal soon. Hope this helps. Best of luck to you.

[Neuroendo in reply to Stevana]

Thanks. I will have to figure out how to get my icing done this week. Chemo Friday. Good luck with your recovery.

[louschu]

Read the article. Fasting comes in different forms. Its not stavation

[dockam]

Hi, my two cents

In 2015 diagnosed with #stageiv pca with GL7 (4+3), PSA @ 840.2, mets to Left side ureter lymph nodes. MO said was Dx'd at right time as the CHAARTED results were coming out. Stating to do ADT with 6 chemo sessions simultaneously.

Did Lupron/Casodex in 01/2015 and then two weeks later the 1st of 15 Taxotere sessions -MO said he'd give me chemos until I said to stop or #s plateaued.

Saw research from Dr. Valter Long about fasting and chemo

nia.nih.gov/news/study-find...

So, I fasted two days prior to each sessions. Sipping on homemade veggie, tomato, curry broth.

In my case, I was spared the bulk of the symptoms, 'cept for my hair. Only had peripheral neuropathy after the last chemo, and that lasted only a couple weeks. Good thing, cuz was still working as a DDS at the time, and still am.

Unfortunately, the course of Abiraterone since 01/2020 and a few months of Xtandi have not reduced the two 1cm hot spots in the pelvic lymph nodes(Axumin scan).

Headed for a Taxotere rechallenge this month and I hope to get those two spots and maybe re-sensitize the PCa to Abiraterone and/or Xtandi.

medicalnewstoday.com/articl...

scientificamerican.com/arti...

osher.ucsf.edu/patient-care...

An article from 09/2020 for PCa Awareness month:

prostatecancer.net/living/c...

My best to y'all

Happy New Year

Fight on

Randy

[Neuroendo in reply to dockam]

Thanks and good luck

[elvismlv123]

no fasting ..nutrition is your best friend..if evidence proves the contrary then listen to that not me. I am no fan of chemo but I am not a fan of cancer.I believe nutrition cannot be overlooked.

[Hidden in reply to elvismlv123]

They go hand in hand. I'm eating better now then maybe ever and my overall health is better now than before treatment. A 16:8 IF keeps the blood glucose down and the insulin sensitivity up which is a win win when on ADT since T2D is a concern for most.

[Chazem]

You should be taking vitamin B6, 100 mg daily and Alpha Lipoic Acid daily to prevent or limit the neuropathy.

A cold cap preserved my hair, maybe lost 1/3 at most. Penguin Cold Cap, with dry ice from a ice cream wholesale supply shop for chemo days.

I was glad to keep some semblance of myself by keeping my hair. Highly recommended.

[Chazem in reply to Chazem]

Also remember, during chemo your job is to eat ... well not really because you will lose your appetite.

Your job is to get calories in, 500 to 800 each time you do open your mouth (think high calorie shakes; raw eggs, ice cream, protein powder, etc).

Don't sweat the fluids. That is what your chemo clinic will do for you on days 5-8 when you feel crappy.

You get calories in, they keep you hydrated with 2 liters of fluids for a few days.

[j-o-h-n]

Shoot for the moon..........Please tell us more about yourself.

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Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 01/03/2021 9:30 PM EST

[MCDaisy1972]

Oh,did not use ice. Has had no neuropathy after 7 rounds of platoons/Etopiside/docetaxel.

[Cooolone]

Just started my first round of 6 Docetaxel 2 days ago. Was aware of the icing for the neuropathy, but not fasting. Will look into this and appreciate all the information above. I'm my case though, with the PCa presenting in my Peritoneal (abdomen lining) I'll definitely be taking a deep look into the benefit or risk in regard to food intake.

Posting to follow and keep thread active