Confusion As To Next Treatments - Carboplatin and Cabazitaxel

[Mount_Rainier]

Thanks in advance! I was diagnosed at age 76 with stage 4 metastatic prostate cancer that has spread extensively to bones, lymph nodes and lungs. My profile contains a complete description of events including lab work, scan results and treatments. That was in June 2020. After treatment with Cosiodex, my PSA dropped from its high of 973 and Alkaline Phosphatase of 702 to Oct 2020 when PSA had dropped to 4.71 and has not gone lower.

July 2020 started Lupron, 3 month injection and Xgeva monthly injection. Both continue as of Feb 2022.

Sept 2020 - Started Abiraterone and Prednisone. PSA at that time was up to 21.77

Oct 2020 - Genetic Counseling and testing: negative

Dec. 2020 - Total Testosterone was <3 ng/dl and Free Testosterone was 0.2 pg/ml

March 2021 - Foundation One CDX testing: no actionable mutation.

April 2021 Stated Enzalutamide. PSA was 22.43 Alkaline Phosphatase 119

July 2021 PSA was 40.25. Total Testosterone was <3 ng/dl and Free Testosterone was .06 pg/ml

Please note that I have had several scans done which are detailed in my profile.

Sept 2021 Started Chemo, Docetaxal Three week infusions

Sept 2021 PSA was 97.20 Alkaline Phosphatase 116

Nov 2021 PSA was 156.73 Alkaline Phosphatase 95

Nov 2021 After 3 infusions of Docetaxel I was switched to Cabazitaxel. 3 week infusions

Dec 2021 PSA was 207.0 PSA, Free was 37.40, Free/total PSA Ratio was 17.1%,

Dec 2021 Free Testosterone was <0.2 pg/ml

Jan 2022 PSA was 497.55 Alkaline Phosphatase was 92 after 4 infusions of Cabazataxcel.

After seeing the results of my last CT scan done on Jan. 2022, my Oncologists told me she had sent a referral to Seattle Cancer Care Alliance for a second opinion. She indicated the lung nodules had increased and that the chemo treatment was not working. She indicated it was going to take longer than normal to get a response from SCCA due to Covid challenges. She offered a drug called Carbozanitib, one pill daily indicating only a 30% efficacy.

I asked about adding carboplatin to the current chemotherapy (cabazitaxel) and she agreed to add it. She didn’t seem positive but more accommodating to my suggestion. She cautioned about continuing Chemo stating that if a Clinical Trial was available through Seatle Cancer Care Alliance, they usually want a 30 day absence from chemo treatment.

My question to my oncologist, regarding adding carboplatin to cabazitaxel was just that, a question to her, not a suggestion, as I had read of it being an option for others on this forum. She didn’t offer it up as a suggestion but indicated if I wanted it, she would agree.

Any input from this group regarding my case and the potential benefits or concerns of adding carboplatin to cabazitaxel and continuing with another round of infusion before waiting to hear from SCCA would be helpful and appreciated. Thanks for this forum from a willing financial supporter.

[Tall_Allen]

Here's what I have about Jevtana+carboplatin:

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

I know one patient who had the combo. He tolerated it well. It seemed to slow progression in his case.

While we're waiting for FDA approval of Lu177PSMA617, there are some clinical trials you may qualify for. I guess the closest ones to you would be at UCSF or Stanford:

prostatecancer.news/2020/08...

There are also some promising trials of BiTE therapies and CAR-T at City of Hope in Los Angeles, UCSF, and OHSU:

clinicaltrials.gov/ct2/show...

clinicaltrials.gov/ct2/show...

clinicaltrials.gov/ct2/show...

clinicaltrials.gov/ct2/show...

clinicaltrials.gov/ct2/show...

clinicaltrials.gov/ct2/show...

clinicaltrials.gov/ct2/show...

[Mount_Rainier in reply to Tall_Allen]

Thank you Tall_Allen!

[Mount_Rainier in reply to Tall_Allen]

Still getting valuable, helpful info from your link TA. Much appreciated!

thelancet.com/journals/lano...

[Javelin18]

It sounds like we've followed different paths, but are facing a similar decision, choose remaining Standard Of Care (SOC) option, or start on a trial. It's not an easy decision to make, or one for a doctor to advise.

There are strong correlations between treatment effectiveness for hormone sensitive or local prostate cancer, but once we get into the realm of progressing metastatic disease, finding the right treatment involves a bit of luck. I think this is reflected in your MO agreeing to carboplatin , rather than proposing it.

From my initial conversations for my decision, your plan sounds similar. Perhaps do another SOC treatment while investigating a trial that might work well for you as an individual. Like my MO, yours is concerned that the disease will progress while waiting for the trial to start.

[Mount_Rainier in reply to Javelin18]

Thank you Javelin18

[Roches]

Hi My husband has had advanced prostate cancer for 10 year’s

We live in the uk so I think treatment is different.

He had bone Met in one area, original psa 101.

He has had different hormone therapies including Lupron.

He has had aribiteron and prednisone.

That no longer works and has started first chemo session today.

If this doesn’t work, it’s just time.

I wish you well but we don’t have anymore options so can’t really help.

So sorry.

[Mount_Rainier in reply to Roches]

Thank you Roches!

[j-o-h-n]

Greetings mountrainier,Good that you've chosen to join us. Great info and camaraderie........

Based on your userID I would guess you're located in the Washington state.

Keep posting here.....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 02/01/2022 6:51 PM EST

[Mount_Rainier in reply to j-o-h-n]

Yes j-o-h-n, Seattle in fact. Great info and camaraderie here for sure!

I plan on being around for a Long time!

Thank you!

[j-o-h-n]

You'll be here for a very very long time....But please do not gaff* out....we need you!!!Spent two wonderful weeks in Seattle long time ago.....

* term used by pole climbers in the Army......

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 02/01/2022 7:11 PM EST -Lunar New Year: The Year of the Tiger

[subliminaldood]

Wow! You've been through the ringer!! We are in similar situations but of course different... I'm in the same place, going back to an SOC because my trial got shut down due to covid. This time Cabazataxel and Carboplatin... The SCCA doc suggested adding the Carboplatin "due to the presence of the BRCA 2 mutation." I see you don't have an mutations so that is interesting. As I understand it the mutation is what is causing the meds to become ineffective. I'm hoping this round of chemo knocks down my PSA (57.1) so that I can then start a (different) trial afterward. Of course adding one more course of Chemo makes me uneligible for the specific PT112 trial I just signed up for. So now hoping there will be another trial of that drug that I qualify for. Best of luck!

[Mount_Rainier in reply to subliminaldood]

Just to be clear about the introduction of Carboplatin to the Cabazatxal (Jevtana), my oncologist at Valley Medical Center had decided that further chemo treatment was not recommended and suggested the referral to SCCA as the next step. It was only in response to my question about adding carboplatin did she say it was an option and she would direct the infusion center accordingly. My question was information gathering more than suggesting it might be an additional treatment option. I was a bit surprised when she ordered the combination for my infusion on Feb. 7.

At this stage, I find Javilin18 's assessment above to reflect the most likely scenario and feel my oncologists 32 years of experience still has value even though it may seem to be a bit out of sync with the common treatment methods.

Expecting the best for all of us! Keep Going!

[Mount_Rainier]

I just received a message from my oncologist at Valley Medical Center and she is very complimentary of Dr. Montgomery at SCCA. She is also now ordering two cabazataxel with carboplatin treatments. This gives me some needed assurance that she's open to the possibilities of this having a positive impact.

We're all in this together! Keep Going!

[Grumpyswife]

She sounds like a good one!