Reduce Cabazitaxel dose or add a week to the period?

[mikell]

Which is better, 4 week Cabazitaxel schedule or reduced dose with 3 week schedule? It triggers AFIB for 4 or 5 days in the middle and I'm hoping to spend a bit more time out of AFIB.

[Tall_Allen]

What does your oncologist say?

[mikell in reply to Tall_Allen]

Oncologist (changed about 6 months ago when previous Onc had a baby and moved out of state) favors moving the dose downward and keeping the period at 3 weeks. Not so happy with the current Onc as she always gives the impression I'm taking too much of her valuable time. That being said, after 5 years treatment for MPCA, I also have many doubts about my previous treatment plans, and my spine is pretty much a mess after ADT, radiation to cervical and thoracic vertebrae and Xofigo, with 3 collapsed vertebrae, severely limiting current movement. I pretty much went along with everything my Oncs suggested and don't believe that has served me well. I also had been after SBRT treatment of my spine and prostate when I had only one noted metastasis (early 2107) but was effectively steered to IMRT. Newer SOC might have helped considerably.

[Hidden]

My understanding is the 3 week interval is chosen to give your body the minimum recovery time. Since the cancer takes longer to recover, each time you hit it you drive it down more. So I would think you don't want to go to 4 weeks, but rather adjust the dose or possibly a fraction of the dose more often such as 1/3 every week.

It's best to ask your doctor though since this is just based on my understanding and I'm not a medical professional.

[MateoBeach]

Prostate cancer is fundamentally (in general) a slow growing cancer. That being so I am speculating (guessing) that a longer cycle between treatments of chemo than what may apply to other cancer may just be fine for treating PC. Whereas the dosing might be more important for maximal impact on vulnerable cancer cells. But I am not a medical oncologist so this should be discussed with his MO. Perhaps there is no wrong answer. Is it certain the chemo is triggering the A Fib?

[mikell in reply to MateoBeach]

So little is certain in cancer treatment but I have been very athletically active before cancer and had a heart stress test about a half year before my first bout with AFIB, which occurred about a week after my final IMRT session. It seems worth noting that there were 3 angles used to the thoracic vertebrae. The two seemingly major ones (30s) were 45 degrees off vertical, one appearing to be directly aligned with my heart after is passed through the vertebrae and the other seemingly hitting my right lung. The other one, seemingly less at about 10s, was straight up, which burned the hell out of my lower esophagus (for about a month or longer) and either caused or worsened a hiatal hernia. At any rate, from that time forward, anything could trigger AFIB. And any kind of stress to the system, especially chemo (I generally get 3 or 4 days straight AFIB) about 6 days after infusion, and the AFIB periods get shorter and the normal periods between get longer the further away the infusion was. BTW, if I had had the option for SBRT instead of the single plane IMRT, I highly doubt I would have AFIB today. Oh, and recent CT scans and chest xrays now keep mentioning some abnormality in my lower right lung. And yes, I am now on Eliquis. Strangely, I had no warnings of such possibilities. Amazing how promising treatments seem beforehand and how they often appear afterward.

[MateoBeach]

That makes sense but is so unfortunate. Incidental but significant damage to your heart and lungs wile treating vertebrae. “Organs at risk” they call it and are supposed to calculate the dose received at every point in their treatment plan. Agree about the SBRT.