Stage 4 metastatic with several bone mets For my Dad abiraterone worked like 3 years which I consider good response but I just want to know by chance if someone got success with xtandi after abiraterone stopped working ?
By chance anyone got success with En... - Advanced Prostate...
By chance anyone got success with Enzalutamide after abiraterone ?
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Nirman
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It's better to look at trial data involving many patients than a few anecdotal cases on the forum.
Switching from Abi to Enza or the other way around is seldom beneficial for more than a few months. There's a much better chance of longer-term success if chemotherapy is done between the two. Here's an article about one of the more recent trials proving this:
nejm.org/doi/full/10.1056/N...
Nirman in reply to
Okay I understand but my dad is like bit afraid of chemotherapy so I asked
in reply to Nirman
I understand, I was also afraid of chemotherapy, but the chemotherapies for prostate cancer (Docetaxel and Cabazitaxel) are very tolerable for most. I was apprehensive at my first infusion, but it was not really that bad. Like most people, I felt crappy for about 5 days like a bad cold, then started getting better and back to normal after about a week to 10 days. You can always stop if you can't handle it. You only have to commit to one cycle at a time.
I'm currently on Abiraterone and it's still working for me. I've talked to my doctor and he won't put me on Enzalutamide when Abiraterone becomes ineffective. He knows it won't work for long if at all so wants me to go on Cabazitaxel first. I am completely in agreement.
Nirman in reply to
Okay thank you for your valuable advise even I learned from Internet research that the most beneficial sequence would be first abiraterone then docetaxal or cabizataxol so it will re sensitise cancer cells then xtandi after that you can use another chemo and xofigo and lu177psma follows but I hope he tolerate all of them and everything goes well and work well and longer periods
in reply to Nirman
I wasn't going to do chemo and my doctor kept bugging me about doung it. So glad I changed my mind. Don't know if it helps, but I would do it again if I had to do it over.
It sounds scarier than it is. I had the flu a couple years ago and remember thinking about how much worse it was than chemo.
Nirman in reply to
You’ve relived me a lot so how’s your after chemo life? As per now my dad is even far more healthier than me he walks almost 3 hours day with fast pace every blood parameters are in good condition even alkaline phosphateESR CRP LDH lipids blood pressure sugar liver and kidney functions everything excellent condition
in reply to Nirman
My after chemo life has been great, no lingering side effects. They are seeing that early chemotherapy is having more long-term benefits now that the trial data are more mature. Its interesting because although I did feel crappy during the first 5 days, I was feeling better and better at the end of the last part of each cycle. I was also pain-free for the first time during chemo. It's easy to focus on the side effects, but it really does kill the cancer too.
dhccpa in reply to
Cabaxitaxel is a stronger form of chemo than docetaxel?
in reply to
Hi GregThanks for your thoughts about chemo. I too am wary about starting Docetaxil. How did you feel after all so sessions were completed? Did your psa go down???? I am really disappointed with the Abiraterone, my PSA has never been over 4 in 18 years but I started Abir 90 days ago and my psa went from 4 to 15 as of yesterday. Very confused what to do next. Meeting with my MO today.
Thanks,
Tom
in reply to
I felt good after completing my 6 cycles. I was definitely tired of it by then, but that's different than feeling like I couldn't tolerate it. I had some lingering side effects: tearing eyes and some edema in my lower legs and ankles, but those went away fairly quickly.
The first time I was pain-free was during chemotherapy which likely was working in conjunction with ADT. Early Docetaxel chemotherapy is an option, but ADT alone works quite well in newly diagnosed stage 4 patients. Early Zytiga got approved during my 2nd or 3rd cycle so that was not an option for me. But if I had to do it again, I would still do the Docetaxel. I may be getting a long-term benefit from it now seeing how Zytiga has kept my PSA undetectable for over 2 years now.
Mascouche in reply to
I know that not everybody feels like they can do it but it has been explained by Dr Valter Longo, Pr Thomas Seyfried and others, that fasting 3 days before the chemo and for another day after the chemo not only diminishes greatly the side-effects but that it also makes the chemo more efficient. If I understand the science properly, it is because the chemo targets rapidly dividing cells and when you are fasting, your cancer cells keep dividing while your regular cells stop dividing and enter some kind of protection mode. Hope this helps.
Sound interesting but has anyone tried and got great results?
That’s a very valuable evidence based advise but I need to find someone here in India who’s willing to do this because here MO’s are bit right and they generally try to stick with gold standard old methods
Okay I’ll try my best to find out some way
Congratulations on three years with abiratorone. I got three and a half years. And yes, from there I went on xtandi (enzalutimde). I got close to four years on xtandi. These two drugs work in different ways so taking one should not affect taking the other.
Info like yours, Nal, Greg etc. posted here is especially uplifting for us guys here in the group that are still hormone sensitive ... just the prospect of the possibility of adding more “ effective “ time on ADT is very encouraging. Makes me, for example , able to relax a little bit better knowing that the possibilities have real substance. Thanks for that.
💪💪💪😊😊😊❤️❤️❤️
No chemo in between? Seems contradictory to what Gregg just posted.
In some situations I can see where chemo before transitioning from zytiga to xtandi would be beneficial. Chemo acting as a reset. But I think Provenge or radiation could do as well.
in reply to Magnus1964
Zytiga has raised my psa from 4 to 15 in 90 days. Have long were you off Zytiga before you started on the Xtandi???Thanks
Magnus1964 in reply to
I was off zytiga for at least seven months.
in reply to Magnus1964
Did your psa go up even more????
Magnus1964 in reply to
No I was on salvation radiation.
in reply to Magnus1964
What exactly is salvage radiation is that for bone mets?
Magnus1964 in reply to
It is radiation applied to a met that has appeared some distance from the prostate bed that has already been been, irradiated.
Were you ever tested for the AR-V7 androgen splice variant? They say men switching to Enzi w/o AR-V7 will get more time on Enzi. I am coming to the cross roads Enzi or Doci, my psa is doubling. Have been on Zytiga for 37 months.
I have no gene abnormalities.
The guidelines now recommend to make a genetic test for a BRCA mutation. If this mutation is present, the drug Olaparib will work well. You can do that before Chemo.
Well we did that came negative Msi brca1 brca2 so no olaparib option
Well if you had a BRCA mutation you had an aggressive cancer type. Its better to have no need for Olaparib.
Hi, in my case, I started Abiraterone a year ago in 01/2020 and by 10/2020, the PSA started rising. Two months of Xtandi and the PSA was still increasing. Have my 3rd of 6 planned Taxotere during this chemo rechallenge. Had 15 Taxotere sessions in 2015 and PSA went from 840.2 to a nadir of 0.1 in Summer of 2017. I hope that the chemo resensitizes the PCa to the anti-androgens
Fight On
Randy
Getting 3 years of Psa suppression with Zytiga is nearly 4.5 times the mean time of 8 months and happens to be all I got. Both Zytiga and Xtandi are free on our Australian Medicare,
and their use is governed by strict rules which compel oncologists to not prescribe Xtandi after Zytiga stops working of vice versa.
I can only guess that using one after the other means the following drug will not give much Psa suppression time, so its a waste of money, as these drugs are not cheap for Govt to fund.
A man is not allowed to have both together and trials proved big problems if they are taken together.
The protocol here is to have ADT where Psa goes up after an RP or EBRT does not work, and when ADT alone stops working, then add Cosadex until it stops working, then cease Cosadex, then add Zytiga, and when that stope working you get chemo, which often just won't work for Pca.
I watched as my mets and their size and number increased after I began Cosadex in July 2016 when my first PsMa Ga68 scan showed the first two lymph node mets appear. By the time I began chemo in mid 2018, I had countless lymph node and bone mets.
So after my chemo was declared failed after 4 doses, I had 6 doses Lu177, and no soft tissue mets have been seen since August 2019. I've had 10 PsMa scans so far.
But I seem to have only bone mets, so I begin Ra223 ( Xofigo ) in 2 week's time.
The chemo may not have worked to kill much Pca, but it is thought it makes Pca sensitive to either Xtandi or Zytiga again, either will work again and boosts the PsMa expression of mets to attract more Lu177 when its given.
Maybe it did, Psa went from 25 before Lu177 to 0.32 at 12 months later. Maybe Psa was mainly due to Xtandi, which stopped working Nov 2019. I'd had it from April 2019 to now,
but I think Xtandi only worked for 8 months. I'm only taking Xtandi because docs say I should, but its not doing anything. it could be causing my hypertension AND hypotension.
By July 2020, Psa was 30, and 2 more Lu177 doses got Psa to 7 by November 2020, but then I could not have more than 6 doses. Psa is now about 80, and I begin Ra223 soon.
So these hormone manipulating drugs seem to only slow down the Pca and put off the evil day when a man is forced to have chemo which has far worse side long term effects than all things mentioned so far.
Be that as it may, my lower leg neuropathy has gotten tolerable, and does not stop me cycling 200km+ per week ad good speed on local roads and tracks here in my city of Canberra.
I'm hoping Ra223 will kill all remaining bone mets. There have been good reports about it here, and I can only guess these men didn't let the Pca get so advanced in bones that it caused bones to crack and crumble. For me, I am going to Ra223 before permanent bone damage occurs. One can have a pea sized bone tumor in pelvis of a femur, and its tolerated, but if the met is golf ball or tennis ball size, a man is in Deep Donga.
Patrick Turner.
I wish you good luck
in reply to Patrick-Turner
Good luck to you Patrick
Thanks Nal:Seeing my MO today. Psa has gone from 4 to 16 in 90 days on Abiratone. Going to ask about the John Hopkins study with intense high T. Also will ask about gene test????
Thanks,
Tom
hey Nirman,Yes Xtandi has worked well for me. i am now in my 3rd year with Xtandi with PSA at
>02. Only recently has my levels started to rise. My last reading a month ago was at .2.
There are some side effects like tiredness, lack of appetite etc. But all you can live with.
Good luck and stay positive
Well is xtandi your very first treatment or you taking it after using abiraterone?
, after abiraterone which worked for about 3 years. Xtandi was added to abiraterone, which i still take every 3 months. Its been 6 1/2 years since diagnosed with 28.00 PSA and gleason 9. Stage 4 Cancer resting in my bones. Next step is radiation.stay positive. and hope thw xtendi works for you.
Sounds encouraging but abi isn’t mentioned in your profile. It says you started out with zoladex
Catsup: do you mean this, Xtandi was added to abiraterone, which i still take every 3 months. Or do you mean Xtandi added to injectable ADT? Most researchers do not recommend taking abiraterone and enzalutamide. I am interested to take the combination but side effects increase apparently.
Thanks NalWhat do you mean by short course?????
Does chemo typically reduce psa and mets???
Hi Nal:Saw MO yesterday. Scans indicated no mets in soft tissues but larger and increasing mets in the bones. Zytiga totally failed - quadrupled psa in 3 months - 4 - 15.
Asked about high t at Johns Hopkins. He said very promising but probably not for me because the Zytiga totally failed. MO said I am a good candidate for Radium 223 or 6 - 10 doses of chemo.
Appreciate your knowledge.
Thanks,
Tom
in reply to
Your MO may not think you are a good candidate for BAT because of your increasing bone mets, so he/she is suggesting Radium 223 or chemo instead. T can cause bone mets to be extremely painful, and once the T is injected, they can't take it back out.
in reply to
Starting chemo next week. I no idea what to expect.Thanks,
Tom
in reply to
Good luck! My husband is taking the BAT route (2 injections so far) but his mets are more soft tissue and lymph.
Nirman in reply to
I wish you good luck.
Nirman in reply to
Well he do have many mets but he’s still asymptotic no pain at all very strong and sturdy walks 3 hours a day
It only worked for me for about 1-2 months after Zytiga before PSA rise again
He will. What have you heard about Radium 225.Thanks
Yea that would be the best thing to do
Thanks Nal:Will do... Always so helpful.....
Tom
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