What next? Abiraterone->Docetaxel->Cabazitaxel-> ?

[pka21]

We r from India, New joinee to this group, looking for suggestions from great worriers or experts as per their exp/knowledge.

1.what could be the other options for us or what should I discuss with my doctor to add or think?

2.what would be the best sequence for next treatments?

3.How long cabazitaxel, Enzalutamide (Xtandi) generally work in mCRPC setting post-Abiraterone & Docetaxel?

4.Rechallenging Zytiga ? will it work (if used with DEXA as earlier used with prednisolone and also not aware about steroid switch)

Dad treatment history:

Dx at Jan 2018 at age of 49yr, Baseline PSA 2500,GS-10,St-4, adenocarcinoma ca prostate with extensive LN mets and bone mets (bone marrow involved),

started with Abiretrone/prednisolone + leuprolide -> Oct 2018 BSO(orchidectomy), PSA decreased to 0.7 then slowly gets increased in months ( had pet scan in btw which shows stable disease).

So after 2.2 yr of Abiraterone, i.e March 2020 psa 15, after scan get to know now its mCRPC, started Docetaxel chemo 9 cycle psa decreases from 15 to 10 to 7.15 to 4.7 last,finishedc9 cycle Docetaxel at Early sept 2020.From Oct 2020 he started getting pain in right hip (however we had continued monthly zoledronic acid injection since Aug 2019 later which become quaterly after docetaxel).

Pet scan in Dec 2020 shows improvement in multiple sites, tumor shrank (however PSA increased to 6.9), so started to take pain killer and later one palliative radiation. Pain decreased.

On Feb 2021, PSA increased from 6.9 to 15, so as per Dr its a clinically Progressive disease, so prefer early chemo before enzalutamide as the Patient is fit.

They wanted to reserve enzalutamide for the future, currently, we finished 2nd Cabazitaxel cycle (3rd scheduled for tomorrow) and probably will go for psa check after 3 cycles to check whether it benefited or not (still continued with few pain medicines, pain controlled completely when on medicine and able to do all the things without any side effect from chemo).

For future treatment, Dr told us that we have option of Enzalutamide, Lu177 PSMA therapy.

MSI is not High ( so looks will not good for immunotherapy )

Germline BRCA : Negative

Somatic BRCA with HRR : waiting, probably will get the reports after 15 days.

[Tall_Allen]

In India, you can get Lu-177-PSMA. I would consider that for his next treatment. Either that of Xofigo. If he can get Xofigo, consider a combination with another therapy:

prostatecancer.news/2021/02...

If he still has adequate white blood cell production, also consider APCEDEN, which is available in India.

[pka21 in reply to Tall_Allen]

Thanks a lot Allen for your valuable suggestions. I will discuss with my Dr. and I agree lu177 seems the best for his next treatment.

However, I am wondering Xofigo availability in India, I will get that clear in my next appointment.

Whats ur thought on Zytiga rechallenge in somewhere future treatment?

Sorry I heard first time about APCEDEN , any study/ trial link will be highly appreciated.

[Tall_Allen in reply to pka21]

I'd try Xtandi next time rather than Zytiga; Erleada, if you can get it.

Here are links about APCEDEN in India:

isct-cytotherapy.org/articl...

futuremedicine.com/doi/10.2...

journals.lww.com/md-journal....

[pka21 in reply to Tall_Allen]

Thanks!

[LearnAll]

Lu177 is available in several hospitals in New Delhi and Mumbai. You can check with Fortis Hospital, Gurugram (Delhi) Dr Ishita Sen is admired highly by her patients. Other hospitals are Max Super Speciality or possibly Apollo Hospital. In Mumbai, Tata Memorial, KokilaBen Ambani hospital are also great. Make phone calls and check.

[pka21 in reply to LearnAll]

Thanks LearnAll,Yes we are in touch with TMH Mumbai from starting, will discuss more after cabaxitaxel. currently doing chemo in Kolkata (near hometown).

Sure seems good to check with Dr. Ishita as well.