Why not use Chemo early?

[alephnull]

I am a G9, PCa in my lymph nodes and probably elsewhere. PCa is definitely recurrent. I have had RP, RT, and almost 8 years of ADT.

Met's at this point don't show up on scans but my PSA is slowly rising.

Anyone know why the medical community doesn't try to treat with Chemo.

After all, isn't chemo the one thing that will kill cancer cells(along with other healthy cells).

I mean, with what appears to be low load cancer, but known cancer, why not use chemo to kill it while it's down?

Why do they wait until the cancer has taken off?

Just wondering....

[Hidden]

Why do they wait until the cancer has taken off?

This is exactly the thinking behind the CHAARTED clinical trial, a trial to test the results of doing chemotherapy early long with ADT.

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

Since then, there have been other trials, most notably the STAMPEDE trial.

Here's a video about the STAMPEDE trial, Docetaxel arm:

vimeo.com/149626704

I was told about these trials when I was diagnosed and I went ahead and did 6 cycles of Docetaxel chemotherapy in accordance with the trials.

So far I'm doing well at 4+ years from diagnosis with stage 4.

[bud_manning in reply to Hidden]

I was told after diagnosis and RP that Lupron was SOC and not a candidate for chemo or RAD. After all their high dollar stuff quit, then my MO starts me on docetaxel. Question if I may, did you do anything with the docetaxel? It would seem you have had a better response than most I have read about, or what the drug claimed to do.

[Hidden in reply to bud_manning]

I did Docetaxel chemotherapy plus 10mg Prednisone along with ADT at diagnosis. I didn't do anything additional.

After a year, my PSA started rising quickly, doubling every 3 weeks so I was wondering if doing chemotherapy had any effect. My doctor said he often sees this with patients who do early chemotherapy. Now I'm wondering if the benefit is longer-term since I started Zytiga 3 years ago and have had an undetectable PSA for almost that entire time.

There's been an update to the CHAARTED trial and they are still seeing a long- term benefit in overall survival for high-volume patients that did early chemotherapy, but not for low-volume.

ascopost.com/News/58544

At median follow-up of 53.7 months, median overall survival was 57.6 months in the docetaxel group vs 47.2 months in the ADT alone group (HR = 0.72, P = .0018). Among 513 patients with high-volume disease, median overall survival was 51.2 months vs 34.4 months (HR = 0.63, P < .001). Among 277 with low-volume disease, median overall survival was 63.5 months vs not reached (HR = 1.04, P = .86).

[alephnull]

Gregg and Nalakrats thank you for your responses.

I've had two Oncologists and neither thought it was time.

For me, it's a matter of it's the best time, as the PCa is in a more vulnerable state.

[JWPMP in reply to alephnull]

My husband has low burden mets or however you say it...single suspicious bone spot and several lymphnodes. He is G9.

His MO is at UCSF. I asked her if adding chemo to Jim's case is relevant (he's on Lupron, Abiraterone, and prednisone)She said the data didn't support chemo for my husband at this time. She gave no further explanation.

[Hidden in reply to JWPMP]

There hasn't been a proven benefit for patients with a low disease burden. It's also harder to prove a benefit with patients that will probably live for quite a long time anyway. Those of us with a high disease burden are often the ones that benefit from adding additional treatments.

[Tall_Allen]

The evidence so far is that Taxotere does nothing for you if you take it before metastases become apparent:

prostatecancer.news/2019/02...

Advanced hormone therapy has been effective in some clinical trials.

[alephnull in reply to Tall_Allen]

So, Taxotere only finds mets.

Does this mean, it doesn't attack cancer in the lymph nodes?

If it's recurrent but isn't found via scans, do they have any way to find where the heck it is.

My thoughts are that it's either in the lymbic system or are microsopic mets.

Does active cancer live freely in the blood supply?

[Tall_Allen in reply to alephnull]

Taxotere destroys cancer cells in any kind of metastases.

Cancer cells travel in blood, lymph and nerves and harbor in tissue reservoirs anywhere. It doesn't matter where it is.

[noahware]

I wonder if part of the reason could be that SOC is in part driven by third-party-payer dynamics... do insurers pay for early chemo more reluctantly than for later chemo? Docs need to fight insurers on things as cheap, simple and logical as DEXA scans, after all, so that wouldn't surprise me.

Some docs, like Bob Liebowitz (of Compassionate Oncology), have promoted the early use of chemo along with ADT for several decades now for nearly all PC patients. Although still a minority approach, the science increasingly seems to back this approach, so far as I can tell.

[MateoBeach]

Appears to me that you do certainly have remaining cancer ( micro-metastasis) and are now becoming castrate resistant. So you need to change up treatment. That could be either adding abiraterone to ADT, or going to chemotherapy (docetaxel is first line) followed by going on to ADT with abiraterone plus prednisone. Either seems reasonable to me and I see no fault in your reasoning. Good luck amigo.