Dexamethasone transition - process?

[marchinda]

Hi all! As a follow up to my last post, our MO has prescribed 0.5mg of dexamethasone to be taken with Zytiga. That's miracle #1! Miracle #2 is that we got an appointment with Dr. Deanmeade at Johns Hopkins to discuss BAT. (My previous post detailed that my husband's PSA is rising rapidly - doubling time is about 3 weeks - but there is nothing on the scans yet.)

Problem is that apparently no one at MSK has ever done the switch to dexamethasone from prednisone thing, and so they don't know the process. I feel like someone here told me there is a way to go about this - can someone let me know? MO said we could just stop prednisone immediately and switch to dex, but I wanted to see what others did to make the switch.

Thanks, all! Here's hoping my husband is in that 62% that respond to the switch!

[Hidden]

The doses are equivalent so it's just a straight switch over, you don't do anything but switch.

I've done it and my doctor just had me start taking it instead of Prednisone. There were no problems and I've been on it for over a year now. And it worked for me.

[marchinda in reply to Hidden]

Thank you so much for your reply, gregg57! My husband has responded well to everything else, so hoping that this will work, even for a few months (we just want to try and stop the progression before we start BAT).

[Hidden in reply to marchinda]

My doctor was skeptical and told me he had not had much success with it.

After he saw my response, his attitude seemed to change. I remember on a recent visit we were walking down the hall togther. He excitedly told me "Hey, I started a guy on Dexamethasone today!"

So glad I tried it.

[marchinda]

Thanks for that. My husband's doubling time is pretty scary, so I think that's helping our MO be more open. I'm hoping the doubling time doesn't have much to do with whether switching the steroid will be successful or not.

[TeleGuy in reply to marchinda]

I don't understand why docs are so resistant to trying the steroid switch. The drugs are cheap, and you can check your PSA in a month to see if it has worked. You don't have to lose a lot of time trying it. If it doesn't work, you need to have had a Plan B anyway.

[skateguy]

I switched one to the other just last week.. No issues/side effects from the switch. My issue is tapering off properly. I have done it to quickly in the past and have experienced all the common side effects possible.

[SupportP]

Hello! I have a question pertinent to this posting, but first want to say how important this forum is to me. My very dear friend has stage 9 metastatic pc. We started docetaxel 9 weeks ago, after becoming hormone resistant. He receives Lupron shots every 3 months. He is holding steady with the cancer having spread, and continuing to spread, into bones but not into lymph nodes or organs. We are hoping the chemo at least maintains that position, although of course we're also hoping for more than that. He was taking Zytiga and then Xtandi, but the hormone resistance put a stop to that. He is still taking prednisone daily, but also takes dexamethasone the day before chemo, the day of chemo, and the day after chemo. My question is: Is anyone able to explain the possible advantage of substituting dexamethasone for prednisone every day? I'll read articles about that question, of course, but these HU conversations are so very helpful in giving high levels of information paired with equally high levels of support. Even from this distance it's quite a blessing to feel as if one is talking over the situation with friends.

[GoBucks in reply to SupportP]

SP you have asked a question inside a someone else's post. To get a response you should ask this question in a seperate post. And of course I will respond with: what did your Dr. say?

[SupportP in reply to GoBucks]

Thank you for the reply and the guidance about procedure! The Dr. has not yet said anything ... my question was one that popped up from reading the beginning of this conversation regarding steroids. I'm sorry for being so clueless about the proper procedure for asking the question!

[Hidden in reply to SupportP]

In general, doctors use medications that have been tested and proven in clinical trials. When Docetaxel (Taxotere) was first used in a clinical trial for prostate cancer back in 2000, it was taken with 10mg of Prednisone daily.

nejm.org/doi/full/10.1056/n...

Since then, 10mg of Prednisone daily has also been used in other clinical trials using Docetaxel (STAMPEDE) and second-line Cabazitaxel (TROPIC).

I can say from my own personal experience, daily Prednisone while on Docetaxel makes a HUGE difference with side effects. I tried without it to see and it was night and day. I think this is the main reason why it's used.

Dexamethasone is more commonly used as a "pre-med", administered during the chemotherapy infusion. As far as I know, it's a bigger dose upfront and again, helps a lot with side effects. People often say they feel good for a couple days until it wears off.

That's the extent of what I know, best to talk to his doctor about it.

[SupportP in reply to Hidden]

Thank you for this information! What you've written dovetails with the experience my friend is having -- taking prednisone (10mg) every day, but substituting Dexamethasone the day before, of, and after chemo. The reason for the substitution is what I'd like to know -- not as a complaint at all, just because it's important to stay on top of the thinking behind the treatment choices. Again, thank you for your clear and helpful explanation!