My husband is scheduled for his first cabazitaxel infusion this Friday. He’s had some neuropathy in his feet, now it’s going up to both legs with one swelling. He’s into very advanced stage 4 PC and has bone Mets throughout with high bone pain, high PSA (70, doubled in last month) limited physical abilities and 3 fractures in his back (palliative radiation has helped). The chemo is the last ditch effort as he has failed all other SOC (Xtandi, Abiraterone, Docetaxal, ADT- resistant now).
Question- could this chemo make neuropathy worse, and is it something we should be concerned with.
He did do 6 rounds of docetaxal 8 months ago that helped for a couple months or less.
and any suggestions to deal with the increasing neuropathy issues?
52 years old dx 2/20/2021 with bone Mets throughout skeleton
Thank you in advance for any advice.
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The likelyhood of neuropathy with Cabazitaxel is low, certainly lower than Docetaxel. The PROSELICA trial showed 0% grade 3-4 neuropathy at a dose of 20mg/ Square meter body surface area and 7% for all grades of neuropathy. It's a low risk.
If it works, he should get some pain relief. I was in serious pain, on meds 24/7 when I got my first infusion. Pain went down to nothing in less than a week.
Also, the side effects have been quite a bit milder than Docetaxel.
Thank you, that is good to know. His pain is very extreme, 20mg oxy every 4 hours, 125 mcg fentanyl patch every 48 hours. If this helps pain it would be a miracle. I’m glad to hear you did well 🙏
I was maxed out on my pain meds (Norco plus over-the counter meds) and still in a lot pain, in tears at one point, just couldn't take it. Got the infusion on Friday 8/12 and pain was still getting worse the day after. But after that it started to slowly improve. I woke up Tuesday with no pain. I couldn't even believe it. Don't know how common that it is, but I didn't expect relief that quickly.
Yes, I've done Docetaxel for 6 cycles. I have bone mets that are very painful to the point I could barely walk or get out of a chair.
I agree with his doctor 100% about going on chemo now and not waiting. I'm in the same situation and that's what my doctor recommended. There is no way I was going to wait for Pluvicto when there is good, effective treatment available now.
The plan for me is to do the chemo as long as it works and I can take the side effects. My doctor will give me up to 10 cycles.
One thing to keep in mind is if he does Radium 223 (Xofigo), he won't be able to do Pluvicto after. That may change down the road, but that's how it is now.
He could be treated with Xofigo or with Lu 177 PSMA instead of chemotherapy. Both treatment has shown to prolong life in RCT, He could request the vaccine Provenge which could help to prolong life.
Consider doing a direct biopsy and if it is not possible a liquid biopsy to study the genome of the cancer, and do histological and IHC studies, The cancer may have mutations which make it susceptible to treatment with olaparib, rucaparib, keytruda or similar drugs
He is scheduled for first Pluvicto September 28- because of shortage. MO wanted chemo started asap because of seeing his numbers and PSMA scan. She is not hopeful he could wait another month for treatment. But it is the next step if he is able 🙏
Perhaps the Lu 177 PSMA treatment will give him a break from the chemo. The other possibility after the Lu 177 PSMA is to consider clinical trials.
A biopsy may be important to select a clinical trial. There are many clinical trials available. He may need to consult with doctors a different institutions to see what they recommend.
Yes. We had been trying to get into a clinical trial (our doctor recommended) but our insurance keeps denying- we appeal, peer to peer, hours and days of me on the phone with them. They take too long and a different patient was put on the trial. Our options are limited with our insurance. Still waiting for approval for the Pluvicto.
Correct. This trial needed doctor follow ups and lab work weekly- which the MO we are seeing is out of network- they would not cover any of that. We are near Seattle Wa. The trial would pay for travel, stay, and the meds, just not the follow up care.
My husband did many treatments with Carbazitaxel over 5 years. It was very effective in keeping the cancer at bay in his case. He did have some neuropathy but he did 2 courses of docetaxel prior to this and that was when the neuropathy started.
I wish your husband all the best from this treatment. Do not give up hope. My husband has had 4 infusions of chemo and his PSA has risen from 99 (pre chemo) to 414 just before the previous one. The MO may change to Cabazitaxel next time, we hope. I understand exactly how you feel as my husband is resistant to ADT, Enzalutamide and now looks like Docetaxel. I try very hard to focus on possible solutions but hope that your husband's pain can be managed. It is difficult to feel hopeful when pain persists.🙏
I’m so sorry for what you two have had to endure and am praying for relief. I have had some peripheral neuropathy in one heel with cabazitaxel plus carboplatin (started Jan 2022). It is not serious and have had some improvement. I also had a blood clot in that same leg so I’m not sure if the neuropathy could be related to that.I don’t see any mention of testing for BRCA gene mutation. Has that been ruled out?
I am sorry to hear about your husband. Please see my last post on neuopathic pain. It may help. I would think carefully about the treatment likely benefits and quality of life issues and discuss with his oncologist. Remember, it's his decisions, not the doctor's.
Thank you, that post is an interesting read. I will definitely refer back to it if he gets to that point. And we are definitely weighing out the quality vs quantity. He is at the end of the road and will do anything to stay on his feet as long as possible. Unfortunately I think his body is going to reject treatment options before his mind. He is just not strong enough.
Prayers to you that you continue to find ways to ease the symptoms of this horrible disease.
Yes, it can be very hard to make those choices with such high stakes. I try to research the treatment and quiz the doctor on percentage success for the treatment. Even if it is the very last treatment option, that I have available to me, I would only consider chemotherapy if there is overwhelming evidence of its value to extend my life in a meaningful way without placing me in more pain and discomfort.
It's a personal choice. I hope you and your husband make the right choices for you.
Thank you. Chemo (docetaxal) worked for a month or two after stopping it beginning of this year. And it wasn’t so hard on his body but alot has changed in 8 months…
Really sorry to hear the terrible time you and your husband are experiencing. My prayers go out to the both of you and hope relief will come soon🙏🏻🙏🏻🙏🏻
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