Chemo (Docetaxel) not working 76 YO

[Vishwa1890]

Father’s profile:

At age 70, Diagnosed with Pca in 2015 after seeing initial PSA as ~ 270.

Got the surgery done in December 2015 - Bilateral sub-capsular Orchidectomy. PSA reduced to 1 and eventually gone down to 0.05 etc…

He was on BICALUTAMIDE medicine for about 4 years and PSA was well under 4 for quite sometime.

PSA started rising in 2019. His doctor didn’t change any medication but straight away went to Radiation. Later we realized that’s mistake and change doctor in 2020 June. He was then given Zytiga (Aberiterone)… it worke well for about 8 months and got the PSA under 1.

In 2021 June PSA started to rise again ~20. He started docetaxel on October 2021, His PSA was ~ 20 in October 2021, now today’s (3-Dec-2021) PSA test shows it is 98. This is after 4 infusions. Does this mean Docetaxel is ineffective? Or do we have to give it more time before we see good results?

Please help.

Thanks.

[Tall_Allen]

Try switching to cabazitaxel+carboplatin

[Vishwa1890 in reply to Tall_Allen]

Thank you. Will convey this to MO. Greatly appreciate your recommendations as always.

[Vishwa1890 in reply to Tall_Allen]

Hi Tall_Allen , spoke with MO. He is saying to wait for some more time to use cabazitaxel+carboplatin, as that’s a last resort. Btw, PSA still increased further with Docetaxel usage, and it is 105 currently. MO is saying to increase the dose and continue on Docetaxel for some more time. Do you think waiting is a bad option.

Anyone, kindly help on this situation, please?

[Tall_Allen in reply to Vishwa1890]

I don't see what you gain by waiting.

[Vishwa1890 in reply to Tall_Allen]

MO’s thought process is, if we give cabazitaxel+carboplatin now itself, and if Ca still grows, then we will not have any last option. So, he wants to increase docetaxel dose and see if that does any benefit, before switching to cab+car.

Also, could you please advise on this?

Is Erleada (apalutamide) an alternative to Abiraterone? Also, your thoughts about combined usage of Abiraterone and docetaxel (I read one of your posts that they are more effective when used together).

Thank you!

[Tall_Allen in reply to Vishwa1890]

The problem with his "logic" is that earlier use increases survival more than later use, and the combo is more effective than either taxane alone in setting back the cancer. If you let the cancer progress, it will have much less benefit.

Let's say there are 2 patients, A&B. A is given docetaxel for 6 infusions (about 4 months). After 3 months recovery, he is given cabazitaxel+carboplatin for 6 infusions and he survives for 3 months after that. Total survival=4+3+4+3=14 months.

Patient B is given cabazitaxel+carboplatin for 6 infusions.He needs no further treatment for 12 months. Then he will repeat it. Total survival=4+12+4+2=22 months.

Also, your father's ability to tolerate the side effects of chemo is better now than it will be later.

It is ALWAYS a bad idea to save a good therapy as a last resort.

ncbi.nlm.nih.gov/labs/pmc/a...

[Vishwa1890 in reply to Tall_Allen]

Thank you so much for the great rationale. I will talk with MO again.

One thing that worries me is that, based on the examples you gave, is the maximum survival anything between 1-2 years? Or would there be any remote chance to prolong it?

[Tall_Allen in reply to Vishwa1890]

I just picked numbers to illustrate the point. I have no idea what his actual numbers will be.

[Vishwa1890 in reply to Tall_Allen]

Thank you. 🙏

[Vishwa1890 in reply to Tall_Allen]

Allen,Sorry to bother you again. We are going to meet MO tomorrow. I looked at MO’s detailed plan of action.

Here in the order,

1. Increased dose of Docetaxel for 3 more infusions in a span of 2 more months.

2. If 1 fails, try Enzalutamide (xtandi)

3. If 2 fails, PRRT / LU177 theraphy

4. If 3 fails, cabazitaxel+carboplatin

5. If 4 fails, biopsy—> PARP inhibitor

How does this look to you? Please advise.

…,

For step 1 above, is it a good idea to have docetaxel combined with Abiraterone (as per PEACE trial)

clinicaltrials.gov/ct2/show...

Can I ask him that as an alternative modification to step-1, if he still pushes back on cab+car for further (step-4)?

Thank you 🙏

[Tall_Allen in reply to Vishwa1890]

My opinion doesn't change. Cabazitaxel was designed for cases where docetaxel doesn't work. PEACE1 is only for starting triplet therapy at the same time - too late now.

[NotAlwaysSunshine]

Hi Vishwa, my husband is age 60. He is trying taxotere for the 2nd time and it's not working. It did not work the first time. His MO is doing the same as your MO. Cabazitaxel (Jevtana is next in line) We will find out if he starts in January. We are close to the end of treatments and hope LU177 is available soon. Tall Allen has great advise! Don't wait and go to Cabazitaxel now.