What does ‘oral chemo’ mean

[Brysonal]

I have read a few times here in the UK people say they are on chemo tablets or ‘oral chemo’. What is this? I had my first chemo last week as an infusion of Docetaxel

Thanks in advance

[Tall_Allen]

Some people call hormone therapy "oral chemo." Technically, I guess it's true that it is a chemical that kills cancer cells. But it is not what most of us mean by the term "chemotherapy."

[Hidden]

Ask them what they mean. Some people call Xtandi, Zytiga, Orgovyx, prednisone, etc. oral chemo.

[treedown]

I was given a handout about chemo drugs when I started Zytiga. It seems the terms are bandied about loosely.

[Hidden in reply to treedown]

You are right about how loosely the term "chemo" is thrown around. And it doesn't help that a website called "Chemocare" has every medication under the sun listed. I think that ends up being detrimental to the treatment of cancer since there are many people that are really opposed to anything "chemo".

[treedown in reply to Hidden]

Right. Additionally the hand out was all about separating clothing and not getting close to pregnant woman, etc. Freaked my wife out a bit until I called my doc and confirmed zytiga doesn't need to handled as delicately.

[Brysonal in reply to treedown]

Ah,, I've also read now that at the start of the pandemic in the UK, Docetaxel infusions were stopped and Abi/ Enza approved instead and were described as 'oral chemo' as a safer alternative to the infusion. So I think UK guys who got these hormonal anti androgens when they were expecting chemo were told they were 'oral chemo' (doing an equivalent job maybe).

[Brysonal]

Thanks all. Yes very confusing also for men reading about the benefit of ‘early chemo’ and thinking they’ve had it when they had been on a second generation HT not Docetaxel.

Appreciate the clarification

[Walkingwell]

'Chemo' can be confusing, but I believe there are oral chemo therapies for prostate cancer. For example, Tegafur/uracil (sometimes sold as UFT), and estramustine. Both are taken as tablets or capsules. They are not as widely used as the intravenous chemo therapies docetaxel and cabazitaxel. 'Early chemo' and 'combination therapy' usually means docetaxel.

[max00 in reply to Walkingwell]

Erleada (Apalutimide) is an oral chem pill. It has safe handling, and disposal instructions, plus disposal bags...

[CAMPSOUPS in reply to max00]

Just trying to keep things on the up and up.Apalutamide is an antiandrogen just as Enzalutamide is an antiandrogen.

They are both drugs in the class of hormonal anti androgens.

There are quite a few websites that list almost every cancer medication/treatment as chemo.

[Walkingwell in reply to CAMPSOUPS]

Yes, I agree about Erleada - hormonal anti-androgen.

[Brysonal in reply to Walkingwell]

Thank you. I have never heard of Tegafur or estramustine! Docetaxel I had last week by infusion and am aware of other infusion options given at later stages but the 'i've been on oral chemo' comments confused me!

[Hidden]

I took part in a six month clinical trial in 2004. Essentially the trial was in three cycles. Each cycle consisting of ketoconazole and doxorubicin for weeks 1, 3, and 5 and estramustine and docetaxel and for weeks 2, 4 and 6. During weeks 7 and 8, no treatment was received. Plus ADT in the form of leuprolide and high daily dosages of Prednisone. As explained to me, each drug administered has cytotoxic properties.

Caution. Be sure and discuss with your Medical Oncologist the use of any supplements and diary products with estramustine as these type of products will bind with and affect the absorption of the drug.

I wish you the best,

GD

[Brysonal in reply to Hidden]

My goodness I just read your profile and posts/ your clinical trial.

So basically in 2004 your MO went very early with an Uber aggressive approach of hormone therapy and a mix of chemos ( most of which I haven’t heard of). He basically sorted a couple of you out completely! And you say you were very newly diagnosed with mets when it began.

Wow! what a story!

My MO wanted me off all supplements before Lu-177 started. Nobody in UK team had ever asked what I took!

[Chugach]

Pills instead of IV infusions

[Hidden]

Yes. Short story. My primary treatment failed within a year. PSA never really came down. With monthly PSA and several nuclear bone and soft tissue CT scans, (PSA went from 6.x to 32.x in four months; new scans showed metastatic lesions in spine. I received the obligatory Lupron and Casodex from one RO. I asked what he would do under my circumstances. Told me that he would find a MO on top of their game. A real specialist. Problem in research. Didn’t know one. I asked my second RO two weeks later. This guy said that he sat on a SPORE Committee with one. This guy was a Researcher and Professor of Radiation Oncology. He called and two hours later I received a phone call and the MI wanted to see me the next day, Spent almost 2 hours with him and he went over my before and after scans, explained his clinically trial, etc. i didn’t want palliative treatment as my dad previously died of colon cancer that was probably metastatic prostate cancer at age 59. So I signed up as a guinea pig.

Doxorubicin is Adrimyacin. Often called the Red Devil. Docetaxol is Taxotere. This combination is often used in metastatic breast cancer. Breast cancer and prostate are related; both are hormonal type cancers. Essentially the results of the trial did not fit the masses. Only nine had a complete response. I was one of the nine. As near as I can tell, I have been most fortunate. If you read his hypothesis closely, it is better to undergo chemotherapy and hormone therapy when the body is strong and the tumor burden minimal before cancer has the opportunity to overtake the body. He started another trial that used adjective chemotherapy immediately after primary treatment, it went nowhere for lack of enrollees. Most fear adding poison to one’s body. And use chemo as a last result. The problem as I see it, is that the body is already weak to with stand the effects of chemotherapy.

This is controversial. Why? Dr A told me that the cure for cancer was found in 1978. There was only one problem, the cure killed the patient before the cancer did. His researched centered on the fine line of poison to kill the cancer and not kill the patient.

Dr A spent a career in academia - research and teaching at major medical schools as opposed to community treatment. Unfortunately, he died of brain cancer before his research was completed.

As a post script, I, as one of his patients, was asked to speak as his memorial service at the medical school. During the talk, I asked why with my success, did not the academia community pick up on his research. I mean..... I was talking to his colleagues, a group of doctors at the school..... the Oresudent if the school responded...... you have to understand that you received what can be best described as an ultra stand of care only because Dr A was a world class expert and was able to conduct trials not considered the norm. And, the lack of availability of funds in genitourologic cancer research for men.

Witness the amount of money raised for breast cancer vs prostate cancer.... two closely related cancers. I ask myself today...... why is another major medical school using the same research protocols for my 62 year old cousin for her metastatic breast cancer. The same school where Dr A was teaching and researching, and not prostate cancer with success...... it is that answer, I do not know, but I do know that research dollars far outnumber for female cancers vs male cancers.

Enough of my rant. Yes,I am a proponent of early diagnostic testing and early use of chemotherapy. I am biased. It’s nit the norm, but considering that when I got into this game, the numbers said that with palliative treatment that I had 2 to 4 years to live; maybe five years to live, what did I have to lose? Since then and while treatment new drugs were developed, they were always the in Arsenal.... I just never needed,,,,, in 2005, being tested were also vaccines and immunology agents. I never needed. But I was kept informed.... some showed promise, some did not. I cast my lot in research and development in an academia setting.

There at least one person in this group, comdrdata, who underwent the same clinical trial. His outcome is different than mine. But we agree that I started much sooner than he did. We both agree that the world suffered when Dr A died.

Finally I tell my story to give hope. One day hopefully others will pick up the research. I am just glad that I asked the right question at the right time.....

and I met a remarkable young researcher and teacher along the way.

Keep killing the bastards....

Gourd Dancer

[Brysonal in reply to Hidden]

Very very interesting . I am guessing the 1978 cure ( the kills the patient before the cancer) was chemo?

When my dad was diagnosed in 2010 already metastatic he got the SOC hormone therapy and only when resistant got chemo which really just held off the inevitable a short while and for a 77 year old it was tough treatment.

He got the classic 5 years post diagnosis. No treatment was given to the prostate itself either and results showing early chemo/ radiation to the prostate do help for some diagnosed with APC do make me ( with zero medical training) ‘ no shit Sherlock’

My London MO just advised Degarelix and Abi saying no one really ever recovers from chemo so didn’t think it would add value.

This of course put me off something that no one is going to rush to embrace! However early Lu-177 is a newish way of killing certain PCa cells with a lot less toxicity so my Finland MO feels 3 x Docetaxel is something worth me trying whilst I am fit. I was not happy to hear the recommendation of ‘chemo’ but following a consult completely bought in. My London MO was also happy to organise it but sticking with Finland except for HT and blood tests happening in London.

I feel if your MO was alive and still researching he would be looking closely at early Lu-177.

If I was to win the lottery I’d put the lot into prostate cancer research to fund a Dr A!

Thank you for taking time to tell your story. It really helps

[Hidden]

I am sure that he would to his arsenal of silver bullets just like the newer class of hormonal anti androgens. I just didn’t need..... they were in develop 13-17 years ago and work great for palliative care. It is the SOC of today.

There a vast difference in treatment across the world by community medical oncologists. It is what they have today to deal with this disease. I applaud. I just wish that there was more funding in research for cure rather than longevity of life.

One last thing. Side effects. This is something that I never fretted about. They are easily managed. I knew I had a terrible disease and took heart that each infusion and oral were killing the little bastards. I knew that I had a strong body and when Dr A said that he felt sure that he had the dosages down, I believed him...... medical professionals are called upon to make decisions like.... can this patient withstand the rigors of chemotherapy? One just has to put their trust in their guy. Hopefully, they are true specialist in advanced prostate cancer only. Recommended to me was not all Medical Oncologist are equal.... some treat all cancers; some treat specific cancers.... and some teach new medical oncologists.... rare is the teacher who teaches specialized cancers.....

Enjoyed,

GD