Looking for thoughts on next treatment after Docetaxel

[davebliz]

Here's my background.

- Living in Canada, diagnosed in 2018 with 4+4 and PSA 40.

- On Zoladex since 2018 and still on

- 35 sessions of radiation in 2018 and PSA dropped to <1.

- PSA started rising (got to 40) in Summer 2020 and started on Zytiga

-Scans showed 30+ mets to spine, ribs, pelvis but no soft tissue or lymph nodes mets.

- Had genetic testing and have BRCA2 and HOX13B mutations.

- Zytiga worked for 7 months and PSA dropped to 10.

- Started on Docetaxel in Fall 2021 for 10 cycles.

- PSA dropped to 10 but the mets had a very slight increase.

So what's next: more chemo, Radium 223 (I have no pain), PARP inhibitor, or something else.

Thanks for your thoughts.

[Tall_Allen]

PARP inhibitor + Xofigo, as in this study:ejcancer.com/article/S0959-...

I don't know what is approved in Canada.

[davebliz in reply to Tall_Allen]

TA, thanks for the link. In reading the article, it seems that the study showed that Xofigo worked better for patients that were DDR+ but I didn't see anything that showed results from combining Xofigo and PARP at the same time, am I missing something? Do you know of a study that did that? Thanks.

[Tall_Allen in reply to davebliz]

Sorry - that showed that patients who have DNA repair-defects (DDR+) do better with Xofigo. They also respond well to PARP inhibitors, especially if they are BRCA+. DDR+ patients received significantly more subsequent therapies, including PARP inhibitors.

These trials are examining combing them:

clinicaltrials.gov/ct2/show...

clinicaltrials.gov/ct2/show...

clinicaltrials.gov/ct2/show...

[tango65]

I would discuss Olaparib, niraparib or rucaparib.

urotoday.com/conference-hig...