Reducing dosage of Xtandi

[ken12491]

Hello -- thoughts and comments would be appreciated.

Last month I asked my MO (a good one) if I could take a break from taking xtandi - his response was YES, 5 / 6 months would be ok. He also said, should the PSA go up rapidly, he could always ' find a drug to bring me back '.

This month I asked him if I could reduce the dosing on it --- he responded, no, it's all or nothing. This didn't make sense to me, but I did not question him on it. I also believe even if the PSA does go up - there are no guarantees that where it went can be found.

If any of my assumptions are incorrect, please tell me....

My question:

Has anyone cut back to just a 1/2 dosing and found that to help in a better QOL? We're all different fighting this beast - I've always valued comments for the many members.

Thanks..

[tango65]

The clinical trials were done with continuous administration of the drugs until failure. A different regimen is outside of the SOC and its efficacy is unknown.

If you can not tolerate the full dose, and your PSA is low, the mets are asymptomatic, your previous PSADT was 10 or more months, you could discus with your MO reducing the dose in half and monitor the PSA every month.

[ken12491 in reply to tango65]

thank you...

[tango65 in reply to ken12491]

Best of luck!!

[WildRose6]

Here is my post about my husband's experience with the full dose of Xtandi:

healthunlocked.com/advanced...

He described the situation as "losing my will to live." Since the Xtandi was ineffective, he did another course of Docetaxel instead of continuing down the path of increasingly debilitating fatigue and cognitive impairment.

His oncologist said "the dose is the dose" but alert member Shooter1 said to check the full prescribing info for Xtandi, and indeed it mentions reduced dose (with caveats, of course):

"2.2 Dose Modifications

If a patient experiences a ≥ Grade 3 toxicity or an intolerable side effect, withhold dosing for one week or until symptoms improve to ≤ Grade 2, then resume at the same or a reduced dose (120 mg or 80 mg), if warranted [see Warnings and Precautions (5.1), (5.2)]."

[ken12491 in reply to WildRose6]

Very helpful and I thank you and wish the best for you both ----- two days off and his old self ----WOW!!!!!!!!!

[landcrab]

I asked my oncologist if I could reduce the dose of Xtandi, her reply was why change a winning team. However I decided to take half dose twice a week. Not sure if this really helps due to the half life.

[dhccpa in reply to landcrab]

Half life of a larger dose means more is in your system after the half life, so a lesser dose should still reduce SEs (and potentially effectiveness).

[ken12491 in reply to landcrab]

thanks....

[dhccpa]

On Zytiga there is a current debate about that topic. Don't know about Xtandi.

[ken12491 in reply to dhccpa]

thanks...

[EdBar]

My MO, Dr. Sartor, recommended 2 years ago that I go from full dose to half dose - 80mg to help alleviate side effects which seemed to be cumulative since I’ve been on Xtandi for over 5 years now. It is still keeping PSA at undetectable levels. Side effects have improved but still there, they are tolerable.It’s definitely not all or nothing.

Ed

[ken12491 in reply to EdBar]

Thanks, Ed --- didn't seem like a logical answer to me --- when he said, it's all or nothing....

[EdBar in reply to ken12491]

You can check out Sartor’s credentials on line he’s a PCa specialist, one of the top docs in the field.

[Shooter1 in reply to ken12491]

Been on 1/2 dose for 2 1/2 years life is again worth living and aPca in remission. Yep 2 pills and I have my life back....

[David20451]

I've always taken the full dose. But I never really had any bad side effects. Been on for nearly 7 years. I'd be reluctant to come off of it while it is being successful.

[ken12491 in reply to David20451]

Wow - 7 yrs.... side effects? Mine are tolerable, but perhaps I'm reaching/asking for too much back as it relates to QOL...congrats, and I wish you continued success....

[33947]

I started Xtandi this past October when PSA reached 4.4. I've been on ADT for 4 years and my PSA had slowly increased until a jump this past fall. In the first two months of Xtandi my PSA dropped to 0.54 with increasing fatigue. At that time (Dec 2020) my MO suggested we try reducing dosage to 120 mg (3 pills). PSA dropped to 0.365 in past month but fatigue has become a significant issue. We are now going to try a half dose (80 mg (2 pills). MO says she would be pleased if PSA stated at present levels and side effects diminished. If our little experiment doesn't work (if PSA rebounds) she will try to get insurance to approve darolutimide.

[ken12491 in reply to 33947]

Thanks and good luck at 2 pills - pls let me know how you make out on 2 pills..best