Reducing zytiga dose

[CharlieBC]

Hi, my full story is in my profile, but a recap: 10 years ago, prostate removed; then radiation; then Lupron. Recent events: Became ADT resistant, mets in lymph nodes. Stayed on Lupron, added Casodex- bad reaction to Casodex. Switched to 1000mg zytiga and 10 mg prednisone- PSA dropped from 34 to .19. Unfortunately, my liver enzymes shot through the roof (AST: 208, ALT: 563). To prevent permanent damage, I am taking a 2 week break to hopefully give the liver a rest and reset, then will re-test next week. If the liver shows normal, MO wants me to resume zytiga (750mg) and prednisone.

My question to you who have experienced something similar- I would like to drop the dose to 500 or even 250, and have it with the breakfast as mentioned here, and in the U of Chicago study. If it stabilizes low, I will stay on the lower dose with breakfast. I can increase the dose if the PSA rises. Is this what you did? Is there an alternative I should check out? Zytiga worked for me on the cancer. Just full dose on empty stomach seems hazardous to my liver.

Thanks.

Charlie

[Tall_Allen]

You are confusing two very different things:(1) reduced dose Zytiga to prevent side effects

(2) reduced dose Zytiga taken with meals to save money

#2 does NOT reduce side effects (like liver damage). It only saves money. It is a way to get the same absorbed dose of abiraterone using fewer pills. Because the absorbed dose is the same, the effect on the liver is NOT diminished.

You can only do #1 to reduce the effect on the liver.

[CharlieBC in reply to Tall_Allen]

TA thanks for your response. I was thinking food may act as a buffer. What is a good new dose? 750, 500, 250? MO will have me taking blood test every two weeks so we can monitor it for PSA and liver enzymes.

[Tall_Allen in reply to CharlieBC]

With Zytiga, food increases absorption and does not act as a buffer. You want to keep the dose as high as possible because lower doses are less effective. So start with 750 mg. Maybe you will be able to increase the dose later after your liver acclimates to it.

[CharlieBC in reply to Tall_Allen]

Thank you.

[GoBucks]

I had similar AST & ALT numbers after 7 months of Zytiga. I took about a 7 week break(until my ALT & AST were normal). I then restarted my Zytiga at half dose(500mg) with 5mg prednisone. Fortunately my liver numbers remained good and I then bumped up to 750 mg and have stayed there for for 30+months with no liver issues. Hopefully you can have the same results. Your break should be as long as it takes to get your liver numbers back to normal-not just 2 weeks. Then no reason you can't start back up at 500mg. As Tall Allen said, you don't want to eat food with the reduced dose. That's just giving you the same effect as a full dose.

[CharlieBC in reply to GoBucks]

Thank you. The two weeks is the next test period. Like you said, if the numbers are good, I'll resume. Otherwise, I'll wait til they ARE good.

[fmenninger in reply to CharlieBC]

Hi Charlie:

I had similar issue with zytiga as well. Liver enzymes creeped up to beyond acceptable range and had to stop. Then, wait until liver enzymes drop and took lower dose of zytiga. Then numbers looked good for about a month and then liver enzymes creeped up again. MO decided to shut it down and told me Janssen Pharm we’re having issues with a population that had these SE’s with rising ast and alt levels. No much else you can do as If you lower dose to almost nothing it may not be as effective. Hope this dies not occur in your case as the worst thing is you can’t even have a beer as alcohol is completely off limits when your liver is twitching!

[CharlieBC in reply to fmenninger]

Thanks. I get tested next week. I am not interested in giving up beer or wine.

[fmenninger in reply to CharlieBC]

Yeah. It sucked as it seemed like it took forever to get my liver enzymes down to normal (baseline) when I stopped taking zytiga. Now I can hand my 12 NEIPA a week. Stay strong....

[fmenninger in reply to fmenninger]

2. Ha ha

[ctflatlander]

I had the same issues, reduced to 750, took a break, then to 500. Been on 500mg for 36 months and liver doing great.

[CharlieBC]

Thanks. I'll know next week where it stands.

[Dlanghorne]

I had prostatectomy Jan 2019.Started Lupron +Zytiga 1000mg in July 2019

AST and ALT went out of range in November 2019

Doc lowered Zytiga to 500m plus Lupron

PSA has remained undetectable with monthly bloodwork

[CharlieBC in reply to Dlanghorne]

Thanks, Hopefully that will be my experience.

[Cmdrdata]

I have had my PCa since 2006. Had radiation (SBRT study) for my first primary treatment. years later PSA never got to undetectable after 4 years. Then Lupron and casodex for two years. Undetected for a while then started to rise agarose to 15. Then detected met in L3 spine in 200. Chemo cocktail for 8 months. Followed by lupron and casodex. PSA was undetectable after the first 8 weeks. In 2018 PSA started to rise again. Switch to Zytiga 1000mg + 5mg prednisone. Have stayed undetectable with T < 50 and PSA undetectable up to now. No lupron or other T suppressor other than Zytiga.

PS: I am tempted to change to the 250mg dose, but since my blood work is normal except for a few that just below the limits, my Onc says stay the course.

[CharlieBC in reply to Cmdrdata]

I was thrilled with the results of the Zytiga- PSA down to .19. It was my liver doing the complaining. Hopefully, I will find the right dose to accomplish the PSA control, without the liver enzyme concern.

[Jaguarxj]

How long were you on the Casodex for. My PSA shot up to 8 from 1.25 in 2 months they put me on Casodex for 21/2 months but I had no reaction from it whatsoever. My PSA has dropped to .02 undetectable so now my oncologist has taken me off Casodex decided to put me on Zolidex combined with Xtandi for life. Stay tuned for my next PSA in 3 months.

[CharlieBC in reply to Jaguarxj]

I was on Casodex for a whole 17 days. Knocked me for a loop. Couldn't eat or drink, no energy, headaches. If it would have worked, I would have stayed with it. I am surprised that your oncologist took you off something that was working. Did he/she say why? Good luck with your journey.

[Jaguarxj in reply to CharlieBC]

Apparantly if you stay on Casodex for a certain length of time it does serious damage to your liver as well it doesn't work forever, eventually the PSA will start creeping up again. Iguess to save it for a rainy day.

[Hidden]

Cancer.gov: cancer.gov/news-events/canc....

An RCT.

My personal story: I started taking 1000 mg of Zytiga on an empty stomach and my BP went up so high that I had to see a cardiologist. Drugs got me back down but it was still pretty high. I researched and experimented and determined that it was the Zytiga (severe BP increases are a not-so-common side effect but if it happens to you it's 100%). Reducing the Zytiga to 250 mg with food dropped my BP much more than the drugs. I stopped the drugs and my BP has stayed low. Every once in a while I take 1000 mg of Zytiga for a few days just to check that my BP still skyrockets. Anyway, I talked to my MO and she agrees that I need to watch my cardiac condition and I should continue taking 250 mg with food. She doesn't want me experimenting with the Zytiga anymore. She thinks it's effective the way I am taking it and by messing with the 1000 mg I am stressing my heart. I think I should listen...

[CharlieBC in reply to Hidden]

Thanks for your story. I thought that a lower dose with breakfast would be less stress on my liver. But, as mentioned above, if it is equal to 1000mg on an empty stomach, I would have the same stress on the liver. I get tested Tuesday for PSA and liver enzymes. We'll see where that takes me.

[Hidden]

I wish you luck.

I would guess it might be the same stress. But the only way to know for certain is to try it and see how your liver enzymes react.

My BP went way down so the cardiac stress isn't 1 to 1 with the blood levels of AA.

Perhaps food would reduce some of the liver stress? Maybe not, but maybe.