"Following disease progression with abiraterone (Zytiga), treatment with bipolar androgen therapy (BAT) or enzalutamide (Xtandi) led to a median progression-free survival (PFS) of 5.7 months (clinical or radiographic progression). A similar proportion of patients in each treatment arm had at least a 50% reduction in baseline PSA level (PSA50 response), and overall survival (OS) did not differ significantly between the groups, reported Samuel R. Denmeade, MD, of Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins in Baltimore, and colleagues.
The median time to PSA progression (PSA-PFS) with enzalutamide increased from 3.8 months after abiraterone to 10.9 months after crossover from BAT (P=0.008). The results suggested BAT might have a role in altering the adaptive process that transforms hormone-sensitive prostate cancers into CRPC, they stated in the Journal of Clinical Oncology."
My interest in BAT is as a protocol for managing hormone-sensitive PCa in order to forestall progression to CRPC.
It's easy to rapidly accrue CRPC cases for any sort of intervention, but I wish Denmeade would tackle the big study - BAT from the start of androgen axis targetted therapy for metastatic PCa. Sure, it would be costly, since the timeframe would be much longer, but what if it added >5 years to the current mean time to CRPC? Could be a game changer.
That is in fact the big question. I am surprised Dr. Denmeade not giving smallest hint or suggestion at the HSPC stage. I am also very interested in BAT. I asked my MO at MSK (who is open to new methods), and he's been sort of ambivalent about it. I trust his instincts. I might be able to persuade him.
After months of leaning on my MO and showering him with all of the preclinical and clinical studies on Testosterone and BAT in PC, and finally getting an opinion from Dr. Schweizer (of the BAT trials) that was cautious but not a hard “No”. So my MO has finally agreed to a one month initial trial of medium-high testosterone to see how my PSA responds. And I want to see how my body responds. More muscle please! Results to follow in a month.
They did do one study of BAT in HSPC published in 2016. Phase II BATMAN
Well... The interesting concept of delaying resistance by keeping things off balance is something I think would be very interesting indeed. Instead of staying on a regimen until it fails, why not cycle 3 months of ADT & Zytiga, then BAT 3 months, then Chemo, then ADT alone, then BAT, etc... Lol. Keep throwing curves at it so it doesn't know what's coming and cannot adjust. What's the worst that happens? They all fail at the same time, 10 years later? Or tomorrow? In all likelihood, a result that would've happened in any event. Has a minimalist approach ever been tried? For example, how little ADT to use, to be undetectable... And why, WHY, does everyone get the same dose? So anyways, keep it low, and see how long until a blip... Not 3 month but monthly testing. PSA blip, switch it up, knock it down, keep it low... Etc. But at 3 months change course regardless.
I’m inclined to do slow cycling for slower growing HSPC. Such as one month of high Testosterone every 6 months for example. I’m actually starting my first one month trial this week to see how my PSA and body respond. Took some persistence to get my MO to go along with it.
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