Xtandi after abiraterone

[Nirman]

How much time it takes to show wether xtandi working or not working after abiraterone

[Hidden]

As far as I know...they need 3 months to make the determination as there can be a PSA flare prior to decreasing numbers. More people need to chime in on this question because this response is based on my own experience.

[FinalBossMatt in reply to Hidden]

For me it was instant.

[Tall_Allen]

Better to alternate with chemo.

[Nirman in reply to Tall_Allen]

Our lu177 neuclear medicine doctor suggested to start on xtandi before lu177psma to increase Psma uptake before starting lu177psma therapy so chemo isn’t an option

[Tall_Allen in reply to Nirman]

So the purpose is to increase PSMA expression within about a month. Also, good idea to get an FDG PET scan to check for patterns of heterogeneity:

prostatecancer.news/2019/12...

[Nirman in reply to Tall_Allen]

Yeah we already done Psma pet scan aswell fdg and we’ve got high uptake of Psma and almost very very low FDG uptake so scans are very positive for Lu177psma therapy

[Nirman in reply to Nirman]

Actually the treatment will start only after twelve days from now and psa is increasing really fast less than 2 months of doubling time so we thought to do something to halt psa within these 12 days

[Nirman in reply to Nirman]

It’s been already 3 weeks with dexamethesone with abiraterone but I don’t know how long it takes to notice psa change on dexamethesone steroid switch or should I add xtandi immediately or wait one more week to give steroid switch some time to work sometime we get a lot confuse to make a decision but we feel so blessed by these support group and very knowledgeable men like Allen, Nal , Patric, JOHN spreading humour, Jackpine there are so many forgive me if I don’t mention them thank you for inspiring and guiding

[Tall_Allen in reply to Nirman]

I don't understand. Is he taking abiraterone with dexamethasone AND enzalutamide at the same time.

[Nirman in reply to Tall_Allen]

He was diagnosed 4 years back with stage 4 metastatic Gleason 8 with several bone mets he was on abiraterone with 5 mg prednisone last 3.5 year’s nadir reached 0.011 stayed there for long but last few months he’s psa started increased ng slowly but staeadily

[Nirman in reply to Nirman]

So when he’s psa reached 3 we had a Psma per scan it shows progression with few more bone mets and slight bladder and by junction involvement so that same day we made steroid switch from prednisone to dexamethesone 0.5 and now it’s been 3 week after steroid switch and we are looking for different options

[Nirman in reply to Tall_Allen]

1- steroid switch if it works so we can buy some time and take more juice out of abiraterone which already started failing

2 lu177 Psma - we have to wait 12 days for it doc suggested you may use xtandi if you want to

3 chemo- docetaxal medical oncologist suggest this as it’s gold standard but we are more inclined towards lu177psma cause clinical trial suggests better quality of life and good survival benefits if it’s done prior chemo

[Tall_Allen in reply to Nirman]

If you are talking about the Thera-P clinical trial, you are misinterpreting it. ALL patients on that trial had docetaxel. The question it explored was what to do next - Jevtana or Lu-177-PSMA-617.

[Nirman in reply to Tall_Allen]

Well there is another trial in which they found chemo naive patients had better outcome and survival benefits with lu177psma than those who had any type of chemo therapy give me some time I’ll put the link to that research

[Nirman in reply to Tall_Allen]

researchgate.net/publicatio... These guys doing this treatment last many years and if I am not wrong few of our groups members already had treatment there

[Tall_Allen in reply to Nirman]

You are misinterpreting that retrospective study. "Chemo naive" means their cancer was less progressed when they had the Lu-177-PSMA-617 treatment. They even tell you that in the study:

"At baseline, T-pretreated patients had overall poorer performance status, a higher prevalence of bone metastases, higher PSA levels, lower hemoglobin levels, higher alkaline phosphatase (ALP) levels and had received more additional therapies compared with T-naïve patients"

There is no doubt that patients generally do better with earlier treatment than with later treatment, which is the only thing that study showed.

There have been no clinical trials that randomized newly diagnosed patients to either chemo or Lu-177-PSMA-617. My guess is that the outcomes would not be any different - that's what has been found in comparative studies of chemo or abiraterone in newly diagnosed patients.

[Nirman in reply to Tall_Allen]

Okay thank you Allen

[Nirman in reply to Tall_Allen]

And as per my knowledge lu177psma keeps your health bit intact so chemo is always remain as option after lu177psma fails and you can also have Ac225 as well it doesn’t require Psma uptake

[Tall_Allen in reply to Nirman]

Chemo later always has worse side effects than chemo earlier. By putting it off, you are insuring that his side effects will be worse when he finally uses it. On the other hand, the side effects of Lu-177-PSMA-617 do not seem to be any different if used earlier or later, so you are better off with chemo earlier. Alternating may be optimal: docetaxel ->Lu-177-PSMA-617 -> cabazitaxel

There is a clinical trial now in Australia combining chemo and Lu-177-PSMA-617:

clinicaltrials.gov/ct2/show...

[Nirman in reply to Tall_Allen]

Okay thank you

[GP24 in reply to Nirman]

Ac225 also requires PSMA uptake. It will not work without that.

[Nirman in reply to GP24]

Well my doc said it would work I don’t have much knowledge about that

[GP24 in reply to Nirman]

You misunderstood your doc. Ac225 will attach to the tumor cell just like Lu177. Ac255 is alpha radiation, Lu177 is beta radiation. Without PSMA expression both won't work.

[Nirman in reply to Tall_Allen]

By the way he is still asymptotic he never felt pain and till today he walks 18000 steps

[Magnus1964]

I was a few months between stopping zytiga and starting xtandi. But xtandi started working immediately.

[Nirman in reply to Magnus1964]

Okay thank you

[Chugach]

For me it was about 3 months

[Nirman]

Okay thank you

[Fiddler2004]

Heres is an article on NIH PubMed that may or may not answer your question pubmed.ncbi.nlm.nih.gov/302...

Will be different based on our genes and those of the cancer itself. Xtandi may work best when given alongside another treatment i.e. ADT... ask your Oncologist.

[Nirman in reply to Fiddler2004]

Okay so does that mean in my dad’s case abiraterone worked for 3.5 years so chances are higher for enzaleutamide working for longer period

[Fiddler2004 in reply to Nirman]

Sorry, I have no idea ...

[Spyder54]

I am the opposite. 2 mos on Firmagon (within week of tissue diagnosis from TURP-B), PSA dropped quickly from 47, to 8.1 to 4.5 & Testosterone at 0.0%, then added Xtandi at beginning of 3rd month. Really slowed drop of PSA from 4.5 to 4.2 at end of 3rd month, and only 4.1 at end of 4th month (Feb 20, 2021-last month). Also T went up from 0.0% to 14.1 at end of 1st month of Firmagon + Xtandi, then 15.2 on Feb 20th, 2021 (last mont). I also lost a national assistance program causing co-pay to jump up to $700/month ($8,400 p/yr). For Xtandi which had slowed my progress on Firmagon alone.

My MO/URO switched me to generic Zytiga (abiriterone) + 5mg mornings + 5 mg night of Prednisone. There was a 6 day delay in switch due to CVS Specialty pharm screwup, so I am 5 days now on Firmagon + Abi + 10mg Prednisone. Will know numbers in approx 3 weeks. Any thoughts Tall Allen on why Xtandi slowed progress vs Firmagon alone, and the reverse switch from Xtandi to Abi? No one else seems to know why. Thanks