Round 3 Cabazitaxel/Carboplatin combo

[HopingForTheBest1]

I decided on this combo because of being BRACA2+ and finding positive comments. Have had no prior chemo, but multiple other therapies. The most effective one to date was Olaparib/Lynparza which lasted almost 2 years.

Two days prior to this round 3 treatment I had updated blood work (3/28/22). PSA has dropped dropped from 62 initially, to 14 after round 1, to 6 after round 2 three weeks ago!!!

Feeling very positive about this continuing PSA drop until I met with my MO on morning of round 3, and gave me a dose of reality. He cautiously said that while this is a positive development, the best way of knowing how I am really doing will be by having updated CT and whole body bone scans within the next several weeks. He has had patients with very low PSA and extensive cancer, while some with PSA in the thousands and minimal disease.

No matter what, I am still feeling upbeat, and minimal/tolerable side effects so far. I do understand that as I continue on this treatment every 3 weeks for the foreseeable future, side effects will probably get more challenging and cumulative as time goes on. As always, hoping for the best.

PS - While I am being treated with Neulasta to successfully improve my white blood cell count, my red blood cell count continues to be below normal levels at 3.2, hematocrit at 29.6, and hemoglobin at 10.0. Suggestions?

[treedown]

Thats sounds promising. Its never bad news to see PSA drop. I hope your scans look good and symptoms or lack of, are worth noting as relative. I hope your scans show regression.

[Tall_Allen]

There is a unexplained phenomenon that when taxane+carboplatin works a PARP inhibitor usually works too. There doesn't seem to be any cross resistance.

If your RBC doesn't recover, a transfusion may be needed.

[HopingForTheBest1 in reply to Tall_Allen]

How low does it need to go for me to need an infusion?

[Javelin18 in reply to HopingForTheBest1]

I was told by an ER doctor that they give transfusions when hemoglobin reaches 7. My MO ordered a transfusion for me when mine was 7.8. I think she wanted to ensure that I had sufficient reserves before my next chemo treatment.

It's expected that hemoglobin will be lower during chemotherapy.

I think you should be happy with the drop in PSA. Since chemotherapy attacks fast growing cancer more than slower growing forms, I think a PSA drop is always a good sign.

[leebeth]

After 3 doses of same cocktail, my husband’s RBC was 3.19, Hct 30.7, and Hgb 9.8, and his doctor was very pleased with his labs. So much so that this cycle he is not having and mid cycle lab work, and next draw will be right before his 5th infusion. He is feeling great, and PSA has dropped from 41.3 to 10.1. Not as dramatic as yours, but his scans showed improvement as well.

I hope you are tolerating treatment well also! No side effects at all so far.

[ishitasen]

Interestingly patients who are BRCA 2 positive do very well on lu177 PSMA therapy. Possible mechanism being that tumours with mutations in DNA repair pathway genes would have an inability to overcome DNA breaks induced by the lu177 or even better the Ac225 psma treatment