Cabazitaxel not working anymore seems, PSMA Scan & PSA shows progression

[pka21]

We have completed 9 cycles of Cabazitaxel chemo, LD 05/08/21 (post-Abireterone ->Docetaxel(10 cycle)).

PSA->15 (1 Feb 21)->13.64 (#post 3 cycle, 5 April)->15.3 (#6 cycle, 14 June)->22.7 (#8 cycle, 2 Aug).

HB: 9.9, Also Found No feasible site for Biospy to check BRACA. My father tolerated the chemo well and stable now.

went for PSMA PET CT on 17th Aug:

In comparison to previous 68Ga PSMA PET-CT scan dated 15.12.2020:

Many of these lesions (in bilateral proximal humeri, right 3rd & 5th ribs, sacrum, bilateral pelvic bones and bilateral proximal femora) show increased tracer uptake (SUV max. of the reference lesions in right iliac bone & right femur are 22.8 & 11.4 respectively) – represent active metastatic disease. Rest of the skeletal lesions show no significant tracer uptake, suggesting healed metastases. [Increase in tracer uptake is seen in many of the skeletal lesions since previous study, previous SUV max. was 6.8]

 Many of the skeletal metastases show significant interval increase in tracer uptake.

 No interval new lesion noted.

Overall imaging features are suggestive of disease progression.

Our Dr. suggested below options:

Cabazitaxel+Enzalutamide (Phase II data)/ Enzalutamide/PSMA therapy with Enzalutamide.

We have to wait around 1 month for Lu177 psma therapy appointment if required, till the time being Dr. suggested to start Enzalutamide and meet with Nuclear Med doctors to check the eligibility (psma uptake ?) & time for Lu177

Kindly advice or share your thoughts on this?

[Tall_Allen]

Sounds like a good plan!

[pka21 in reply to Tall_Allen]

Thanks, Allen for your response!

So we should stop cabazitaxel now and avoid starting (Cabazitaxel+ Enzalutamide)? and probably we should choose taking Enzalutamide now and add Lu177 psma therapy after a month and continue.

[Tall_Allen in reply to pka21]

I was saying this plan sounds good: "Cabazitaxel+Enzalutamide (Phase II data)/ Enzalutamide/PSMA therapy with Enzalutamide." I understood that to mean you will continue with Cabazitaxel and enzalutamide (there are no new metastases). And continue with enzalutamide and add LuPSMA.

[pka21 in reply to Tall_Allen]

I agree, this is also looks a good plan.

But our both Dr.'s conflicting on using Cabazitaxel+ Enzalutamide together. Basically Dr. Amit Joshi at Tata Memorial, Mumbai is not in favour of using them together rather starting new treatment as Enzalutamide and add Lu PSMA.

So I am litte confused now and also wondering will Enzalutamide work as long as it used to, if used with Cabazitaxel together.

[Tall_Allen]

The CHEIRON trial (below) showed on advantage of combining cabazitaxel and enzalutamide in progression-free survival (PFS) but no advantage in overall survival.

urotoday.com/conference-hig...

My opinion FWIW is that because you will be following up with LuPSMA anyway, it may be enough that you are forestalling progression. But I defer completely to Dr. Joshi. Enzalutamide will increase expression of PSMA for a couple of months, so by the time the chemo is finished, your PSMA therapy should be optimal.

[pka21 in reply to Tall_Allen]

Sorry but the above link which u shared is for "Docetaxel + Enzalutamide" not "Cabazitaxel & Enzalutamide"

I just read few links regarding Cabazitaxel + Enza (not sure how appropriate it would be), looks like it really decreases the PSA well for time being but especially for Abiraterone naive patients (However we have already taken Abiraterone as 1st line of treatment )..........So wondering to use

urotoday.com/conference-hig...

"Enzalutamide will increase expression of PSMA for a couple of months" Noted thanks ....this might help lu177 to work better. Also wondering if we start now Enzalutamide as monotherapy at least for a month till we get an appointment for lu177 and later continue Enza with lu177............Are we taking full benefit from Enzalutamide?

[Tall_Allen in reply to pka21]

Generally, if it is true for one taxane, it is true for the other. Sometimes, enzalutamide will work better after chemo.

[luis85715]

MY DOCTOR SUGGEST TO GET PSMA PET SCAN BUT ONLY UCSF OFFER THE SPECIFIC SCAN BUT IT IS TOO EXPENSIVE, MY INSURANCE IS FROM AZ AND DID NOT COVER OUT OF STATE, AND TEST ONLY AVAILABLE IN SAN FRANCISCO CA, COST AROUND $18,000 TOO EXPENSIVE, MY DOCTOR SAID IF I GET THE TEST DONE MAYBE WE CAN GET THERAPEUDIC MEDICINE FROM MANUFACTURER? ANY PERSON GET THE PSMA PET SCAN OUTSIDE THE COUNTRY FOR COST, PHONE NUMBERS WHERE TO CALL...THANKS. I TRIED DIFFERENT ADT BUT MY CANCER METASTASIS TO A FEW SPOT ON BONE.

[Leader4077 in reply to luis85715]

UCLA does Gallium 68 scans for about $3300. Dr. Jeremy Calais runs this scanning program there.

[luis85715 in reply to Leader4077]

I NEED GALLIUM 68 PET SCAN FOR PSMA, YOU SAID UCLA COST AROUND $3,300 WHERE DO I CALL? TO FIND OUT..THANKS

[Leader4077 in reply to luis85715]

Call UCLA radiology after you get on UCLA health website. Use, “PSMA Gallium 68 scan” in your search bar. I have done the scan twice.

Mike