Zytiga to Xtandi

[Chris52981]

Has anyone failed Zytiga and tried Xtandi and if so how did it work and are side effects tolerable?

[CAMPSOUPS]

Well darn it. Does this mean the switch to dexamethasone didnt work?That was only a month ago I think.

Others will give experiences I'm sure but overall as you know it is variable in terms of effectiveness and degree of side effects.

I'm not a expert and his Dr. with all knowledge of your dad's condition, age, etc. needs to be given a lot of weight.

Sometimes a course of chemo is given when Zytiga or Xtandi fails as it can make the switch or in some cases re-starting the same drug effective again.

[Chris52981 in reply to CAMPSOUPS]

I am not sure if dexamethzone worked in just looking at the negative always

[CAMPSOUPS in reply to Chris52981]

I guess what I meant was when zytiga plus prednisone starts to fail then sometimes switching from the prednisone to dexamethasone will cause the Zytiga to continue to be effective awhile longer.

[Tall_Allen]

Better to alternate with chemo:

prostatecancer.news/2019/12...

[tango65]

It may work for a short time, some months.

It seems that doing chemo with docetaxel or cabazitaxel may re sensitize the cancer to the anti androgens. Lu 177 PSMA PET/CT may be other option if there is previous treatment with chemo.

urotoday.com/conference-hig...

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

[Chris52981 in reply to tango65]

Can someone in decent shape but 70 with managed heart disease handle chemo

[dico]

My husband tried it. Zytiga/prednisone failed after two years so we decided to give Xtandi a try, knowing that it would probably work 6 months at most. He took the full Xtandi dose for five weeks. He was very sick the entire five weeks and his PSA went up. His last Xtandi does was 2/27/22 and he is still trying to regain enough strength to start Keytruda.

[Chris52981]

I mean there are still many options right

[Magnus1964]

I was on zytiga for 3 1/2 years then went to xtandi and it lasted 4 years.

[PHnerd in reply to Magnus1964]

What did you switch to after the Xtandi?

[Magnus1964 in reply to PHnerd]

Nothing. I haven't been on any treatment for a year and a half..

[Hidden]

My husband was on Zytiga for about a year then switched to Xtandi for almost two years. (While on Xtandi he also did Provenge which didn't do much if anything.) When Xtandi failed he did 10 courses of BAT until psa rose back up to 17. At that point (Oct 2021) he started a second round of Xtandi which lowered his psa back to 4. PSA is currently slowly rising so he is staying on Xtandi until his psa spikes again then he will go back on BAT.Side effects on Xtandi are awful but my husband is highly treated and still out playing golf. Give it a try--Xtandi after Zytiga definitely works in a subset of men and they don't really know who will benefit until you try it. (Which is why they don't do AR-V7 tests, they just prescribe the ridiculously expensive drug for a few months and see who responds.)

[bwochf in reply to Hidden]

May I ask you how your husband performed the BAT procedure?

[Hidden in reply to bwochf]

He was injected every 28 days (+/- a few days; it doesn't have to be exact) with 400 mg testosterone cypionate. Chemo was the only SOC option left for him in Jan 2020 (he says he will not do chemo), so he suggested trying BAT and his doctor was willing. His psa rose from 30 to 34 after the first injection then started dropping until it reached a nadir of 6. He had two more cycles while his psa was rising, and when his psa reached 17, he restarted Xtandi for the second time and his psa reached a nadir of 4. Recent scans showed bone and lymph and possibly one unbiopsied lung spot are mostly stable.He is excited to start the next cycle of BAT now that his psa is rising because he feels great on it, but his doctor says not to rush it. Xtandi is still working to some degree so he will wait for failure before starting BAT again.

[Hidden]

That's what I plan on doing. BAT, then Xtandi, then BAT then Xtandi.

[Hidden]

One RCT has been completed but only for one round. Another is being done for repeats. And then there is the BATMAN trial for HS guys like me. So, I plan to give it a try. If it works, it works, if not, RT?

STEP-UP RCT. BAT, Enzalutamide, BAT, Enzalutamide, repeat... Sequential Testosterone and Enzalutamide Prevents Unfavorable Progression - Full Text View - ClinicalTrials.gov

clinicaltrials.gov/ct2/show...

RE-sensitizing With Supraphysiologic Testosterone to Overcome REsistance (The RESTORE Study) - Full Text View - ClinicalTrials.gov

clinicaltrials.gov/ct2/show...

Bipolar Androgen Therapy for Men with Androgen Ablation Naïve Prostate Cancer: Results from the Phase II BATMAN Study – PubMed

pubmed.ncbi.nlm.nih.gov/273...

[Magnus1964]

Great pickup. I'll have to ask my research doctor about that. Too bad there's no third drug I could take.

[Hidden]

I like what Morgantaler did. If I had to use limited funds with limited time for dozens of men, I'd likely use cyp and I might make the length of each cycle static. Cyp is cheap and easy to use. The cost for my Androgel is about 8x the cyp cost. And requires 2 applications a day vs. a handful of shots.

I don't have those constraints though. So I let PSA guide my cycle length. I haven't thought about the details of the Xtandi stints but I'll likely do something with scans and PSA.

I'm using propionate during the first day or so, followed by Androgel for the subsequent weeks. And I'm using Casodex to get a really sharp effective T pulse (Androgel leaves your system in a few days anyway).

And I use Zytiga and Lupron for the ADT phases. I could probably get rid of the Lupron but it's simple and has almost no sides for me so I decided to keep it just in case.

I haven't seen SARMs and NPP additions in any of the trials. Maybe they'll make it there someday?

[Hidden]

Exactly what I was thinking. A lutamide is a lutamide is a lutamide. My MO will switch me from Zytiga to Xtandi any time I want. She'll authorize both if I want but she doesn't think my insurance will pay for two at a time.

Awesome that your MO is looking into SARMs. I took a shot on my own and then gave my labs to my MO. Now she is a proponent. The more knowledge the better - my cancer is low level at this point so I don't mind going out on a limb and experimenting on myself. But when it starts rearing its ugly head, I want the MOs to help.

[Hidden]

That's awesome! My PSA goes up on the high T phase and went up to 0.65 on the last one, I hope it drops to undetectable during this low phase but I just started a couple of days ago.

[Chris52981 in reply to Hidden]

What do the phases mean?

[Hidden in reply to Chris52981]

Hi T phase. Low T phase. Repeat.

I've modified this a bit. No oral steroids. I added Zyyiga and more Casodex. Testosterone propionate shots in addition to Androgel. A few other slight mods. And in reality, the cycle length isn't static, it is driven by expected vs. actual PSA.

An example:

BAT example

[Survivor1965]

Hello Chris,

Failed Zytiga after 8 months, went to Xtandi. That was 64 months ago and still rolling (with Lupron also). Side effects suck, fatigue, and long term ADT is wearing me down. My ONC tells me it is basically causing a rapid aging in my body. Im 56 and he tells me I have the body of a 70 yr old, sorry to all you 70 yr olds. I still work hard, very active and spend a lot of time on my feet, and go to the gym.

Its not the life I had planned but Im making lemonade out of lemons.

J

[Hidden in reply to Survivor1965]

If the fatigue, etc. get so bad you feel like throwing in the towel, try a low dose estrogen replacement (0.05-0.1 mg/day patch). And also a SARM (selective androgen receptor modulator).

I did 5 months of estrogen ADT. I'm glad I had the estrogen going for me. Recently I did 2 weeks of low T and low E and my mind went to a dark place - it was so bad that I almost got divorced.

After 5 months I was ready to cash in my chips. A frail little old woman would look back at me from the mirror. Enter high testosterone, then BAT with estrogen replacement and SARMs on the ADT portion. I'm not a frail little old woman anymore! No fatigue other than that caused by staying up late (a terrible habit that I can't seem to kick). No hot flashes. No muscle loss (the opposite is occurring). Libido sucks but is non-zero.

[Chris52981]

Awe thank you God bless you with many more❤️