Time to move on from xtandi? And Ra-223 before jevtana? Thoughts?

[ellie2211]

Hi everyone,

My father just switched his MO ( due to insurance issues) he is currently on xtandi

His bone scans are stable but his PSA is going up. (From 16 to 20 in a month)

His new MO says we can be proactive and mentioned starting him on Radium 223 and possibly provenge before we move on to jevtana.

Both his old and new oncologist agree that he should wait a bit before starting the jevtana and stay on xtandi for the time being....since his scans look good.

But I don't know if we should just wait .....and then start with the jevtana (before the ra-223)?

What are your thoughts?

I had heard of jevtana coming before ra-223 and am unsure what the order does

Thank you!

[GP24]

Xofigo/Radium 223 will work against the bone metastases but the therapy takes six months and the PSA value will continue to rise during that time. This causes many patients to terminate the Radium 223 therapy because they want to control the PSA value. If you accept a PSA value of maybe 200 at the end of the Radium 223 therapy you should get it now and not later.

[Hidden in reply to GP24]

When I became castrate resistant, my doctor suggested doing Radium 223 before starting a second-line anti-androgen. But my PSA was doubling every 3 weeks so I couldn't imagine going through 6 months of treatment with that kind of doubling time. I think this is why many people don't get it until the end.

[Hidden]

Going to a second anti-androgen after the first becomes ineffective rarely works more than a few months if at all. Sequencing with chemotherapy has proven to be more effective. The CARD trial showed that with patients on either Xtandi or Zytiga, switching to the other anti-androgen was less effective than switching to Jevtana.

nejm.org/doi/full/10.1056/N...

Jevtana is a more effective treatment than Radium 223. Radium 223 only goes to the bone. LU-177 is a better radioisotope treatment, but currently only available in some countries (not the US yet)

[Tall_Allen]

That's a 4-month doubling time, which is pretty rapid, and his PSA is already getting up there. I see the value of a scan confirmation, but with the rapid a PSADT, I think you should push for a change.

Here's an article about combining medicines with Xofigo. Maybe send it to his oncologist and tell him you would like to discuss those options at the next meeting:

prostatecancer.news/2021/02...

[ellie2211 in reply to Tall_Allen]

Is it a good idea to go with radium 223 before jevtana? Is that something you have heard of before?

[Tall_Allen in reply to ellie2211]

Please read about it in the link I provided.

[Patrick-Turner]

Ra223 aka Xofigo is used where Pca is only in bones. That's my situation now and I have my second dose Ra223 on next 23 April. I was offered chemo but refused because I had 5 doses in 2018 and it failed badly, like chemo so often fails with Pca.I had Lu177, which got rid of all visceral mets, but now have bone mets which could not all be killed with Lu177 which is based on PsMa expression. But Pca in bones mutated to not making PsMa so there was no point to having more than the 6 doses I did have.

Psa is about 300 now. But I don't have Pca symptoms. I have no idea what my future is.

Ra223 replaces calcium where mets demolish bone structure, so then the alpha particles radiate the Pca mets, hopefully killing bone mets. I have no idea how well this may work.

My Psa was rising 2.7 times per month before start of Ra223, but I've had one Psa test since first Ra223 dose and Psa increases has slowed down.

But I also stopped taking Xtandi even though my onco said I should continue, because afaik the Xtandi was having ZERO effect on slowing Pca or keeping Psa low, and may have been making Psa faster. I had a friend whose Psa increase accelerated after he began Cosadex.

Taking any drug for TOO LONG is dangerous where there is not the slightest benefit.

I contacted Astellas Pharma who make Xtandi, and they refused to answer any questions I had about.

Patrick Turner.