My dad was diagnosed with Advanced PC in summer 2020. Gleason score of 9/10. PSA of 71. Since then, it's been one dose of bad news after another: Prostatectomy didn't bring his PSA numbers down. Bone mets on spine, pelvis, possibly liver. Castration-resistant. BRCA gene present.
He did radiology on his spine and pelvis mets in April, but it was clear that it was only for pain relief, not treatment.
After only 6-months on Abiriterone (Zytiga), his PSA is now back up to 700.
We've been offered two options:
1. a trial of atezolizumab + cabozantinib - an immunotherapy treatment that seems to be promising in Breast Cancer. But, if he is put into the control group, he'd receive enzalutamide (another ADT drug).
2. Olaparib (Lynparza) - I'm not super convinced of the efficacy of this treatment course. It looks promising in those with the BRCA mutation, but only against a second ADT drug (the UK hasn't approved it as a treatment because of this).
I'm leaning toward the trial, since Lynparza only showed a median of 5 months more progression-free survival vs moving to a second ADT drug.
Any thoughts on trial vs Lynparza. Or is there something else we should try? I've read some studies that showed antiandrogen withdrawal syndrome is positive in men with higher PSA numbers.
I'd appreciate any feedback as I'm researching as best I can, but there's so many ways PCa can present differently and I'm a bit lost.
Thank you.
Chemo/Pluvicto or Clinical Trial?
Clinical Trial vs. Zytega
Getting ready for clinical trial
Exclusive Fasttrak - Apply to clinical trial testing a new immunotherapy for prostate cancer!
Estradiol Clinical Trial in UK?
Lynparza, of course. Why would you not go with the sure thing?
prostatecancer.news/2019/10...
The side effects can be rough, though.
Cabozantanib + atezolizumab had decent results in the Phase 2 trial, but the side effects were onerous as well:
meetinglibrary.asco.org/rec...
In that trial, they only looked at tumor response, not at overall survival. I confess I'm jaded by cabozantanib. It has failed as a monotherapy to extend survival in all previous trials. It changes the tumor microenvironment, making metastases harder to detect. This may have simply masked the tumors and not provided a real survival benefit.
I am concerned about the side effects, but like you said, both look to have fairly onerous side effects. He just feels so miserable on the Zytiga that I hate knowing that he's unlikely to get the relief he's hoping for on another treatment.
Thank you for the links and the info. I just want him to be able to make an informed decision about his next steps and these will help.
It sucks that the treatments that work the best also have high risk of side effects. Of course, the BRCA2 mutation is what made his prostate cancer so aggressive. But, so far, it's one of very few genomic mutations that have a treatment.