Failure of zytiga after 2 months

[Rafithussain]

Hello everyone my psa level on 27 oct 2021 was 1.93 ...I was on adt vacations...from 18 nov I started taking zytiga 1000mg with prednisolone 5mg...during last week I started feeling severe pain in RT hip...on 22 jan psa has raised to 4.32 and t < 10 ,alp 173 a bit increased..plz help me to decide what should b NXT step

[Tall_Allen]

docetaxel plus Xofigo. Consider Provenge as well.

[tango65]

The cancer has become castration resistant.

When an anti androgen such as zytiga , enzalutamide etc, fails, the best course of action seems to be chemo instead of trying other anti androgen since there is cross resistant.

Other possibility is to apply for a trial with Lu 177 PSMA, which is a systemic therapy which will treat the cancer anywhere (bone, organs, lymph nodes), it has less side effects than chemo unless there is diffuse infiltration of the bone marrow by the cancer and it has been shown to be more effective than chemo.

List of clinical trials with Lu 177 PSMA:

clinicaltrials.gov/ct2/resu...

You could also request Provenge, the only cancer vaccine approved by the FDA which has been shown to prolong survival.

Request a direct biopsy of the mets (if it is possible to do it) to see if there are mutations or histological findings which could make the cancer to respond to Olaparib, rucaparib, Keytruda or similar drugs, or to chemo with platinum compounds.

[cesces in reply to tango65]

Lu 177 PSMA is readily available in Germany and Australia.

And very reasonably priced in Australia.

[Rafithussain in reply to cesces]

I live in India.. I need to search wether it is available here

[cesces in reply to Rafithussain]

I'm certain it is available in India as well.

[tango65 in reply to Rafithussain]

There are several places in India for Lu 177 PSMA therapy:

nuclearmedicinetherapy.in/v...

rgcirc.org/diagnostics/depa...

fmri.in/doctors-profile/ish...

You could also check, Tata Memorial, Ambani hospital, Bombay hospital, and Jaslok Hospital since they do Ga 68 PSMA ans they may be doing Lu 177 PSMA.

[Magnus1964]

You need to get back on zytiga ASAP. I am not a fan of ADT vacations. It only gives new cell lines a chance to do find a work around.

[Rafithussain in reply to Magnus1964]

With the use of zytiga my psa continued to rise.. On 27 oct it was 1.93 and i started zytiga from 18 nov .. On 22 january psa had raised to 4.32

[Magnus1964 in reply to Rafithussain]

Then maybe you need to move on to xtandi.

[j-o-h-n]

Review this for India: (Lu 177 PSMA),

nuclearmedicinetherapy.in/t...

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 01/30/2022 3:26 PM EST

[diamondrn]

Zytiga only worked for about 6 months for me.

The MO has decided to go with Xofigo (RADIUM-223).

There is some talk about also going with either Xgeva or Zometa to prevent bone fractures.

[Rafithussain in reply to diamondrn]

I have received 12 doses of zoldrenic acid in 2018 nd 2019...can it b repeated

[diamondrn]

I can't answer your question specifically, Rafithussain

The info on this link might be helpful >>> mayoclinic.org/drugs-supple...