Opinions on Xtandi (sic) mono-therapy?

[TEBozo]

Friend has maintained a low .050 and below with only this drug for over 6 months. . Got initial Lupron shot and didn't go back.

[EdBacon]

This was tested in a phase 2 clinical trial. Seemed to work well.

pubmed.ncbi.nlm.nih.gov/247...

[EdBacon]

Here's some longer term results. They look good too. There's also the EMBARK phase 3 trial.

sciencedirect.com/science/a...

[MateoBeach]

We know that many men who are intolerant of standard ADT do very well for some time on the androgen blocker, bicalutamide or some years before it fails and must be stopped. For me it worked for almost 5 years before switching to feeding the cancer. Enzalutamide may well work even better. Good results from the trial EdBacon linked! Worth a try if you cannot tolerate ADT IMO.I had low dose radiation to my breast tissue in two easy treatments to prevent the gynecomastia and nipple tenderness before starting bicalutamide. Worked well.

[Hidden]

TE, the other plus is, does not have to be taken with steroids, lowering your immune system. My husband will prob start xtandi next week on top of the lupron. 🙏

[TEBozo in reply to Hidden]

My friend am member of the PC club has/had advanced PC and besides going to Mexico for Dendritic Cell Therapy, he is only taking Xtandi and his PSA is negligible.

[Hidden in reply to TEBozo]

Te, Thank you for letting me know this about your friend.

[TEBozo in reply to Hidden]

I am going to Tijuana for my 3rd Dendritic Cell Therapy session Monday. June PSA 0.55 July 0.51. Prior to 1st Dendritic Cell Therapy session.

[TEBozo]

my oncologist made a comment that it would sometimes make Lupron less effective if administered later on. Thanks to all.

[Hidden in reply to TEBozo]

On a wing and a prayer, I hope not!

[Tall_Allen]

Maybe.But it will require a comparative trial against ADT+enza with long-term result on survival. We know that ADT+enza improves survival vs ADT alone. So it remains to be shown that enza monotherapy is as good as the combination.

Just as there is a Casodex withdrawal syndrome (the cancer adapts to feed on Casodex, so that stopping Casodex lowers PSA), an enza withdrawal syndrome has been found, but it seems to be minor:

erc.bioscientifica.com/view...

[Benkaymel in reply to Tall_Allen]

Do we know if ADT+Enza improves survival over ADT followed by Enza? I'm not sure that the trials compare against sequential therapy. I saw a post yesterday of someone who got 4 1/2 years out of ADT alone then added Enza and got 4 more.

[Tall_Allen in reply to Benkaymel]

Yes, they looked at post treatments of the control group. Overall survival of those who used ADT+enza exceeded the survival of those who took ADT followed by anything. Be careful about interpreting anecdotes as evidence.

[Benkaymel in reply to Tall_Allen]

Thanks Allen, yes I understand that everyone is different. The difficulty is knowing what is best for me. I guess I'll only find out after trying treatments.

[spw1]

My husband was advised not to do Enzalutamide as a mono therapy as it only blocks the uptake of androgens; if the cancer cells find a way around ARs his MO did not want there to be too much androgen in the system. With Zytiga mono therapy might work better as it stops the making on androgens.

[podsart]

Glad to see there is more attention and thereby more info in this approach. I was a Dr Myers patient and he put me on Xtandi monotherapy feb 2016, psa immediately went undetectable and stayed there.. He then titrated down, eventually to 3 pills per week until, until 5/31/22 when became detectable. Dr Myers had retired and my new Dr had continued with this approach. So, I went back to full dose after the 5/31/22 bad result and the June, July and last 8/15/22 psa are undetectable again. Next months test will determine if a titration down can begin,

I had an extensive discussion re treatment selection pressure, dosage and dosage duration. I assumed the bad result was from mutation adaptation, etc. He disagreed. He believes I had so little Xtandi in my system and the days off per week, especially, the 2 day weekend off coupled with the half life of xtandi, was too thin against hi stress events, and other factors to maintain an effective barrier. For a long time I have asking all around about dose and dose duration function impacts. Perhaps it’s the area under the curve, an integral, where u hunt for min dose, given time, who knows, he said no one wants to do such a study.

Apparently a number of his previous Dr Myers patients also were put on this regimen and my Dr got a handful of them and they are doing well, but none went below 1 pill per day.

[CharlieBC]

Not sure if this is what you are seeking (From JAMA): Enzalutamide Monotherapy vs Active Surveillance in Patients With Low-risk or Intermediate-risk Localized Prostate Cancer

The ENACT Randomized Clinical Trial

jamanetwork.com/journals/ja...

[TEBozo in reply to CharlieBC]

I think that's Zytiga. But interesting.