Cabazitaxel Versus Docetaxel

[fmoser]

Hi,

I joined my father this week for his most recent appointment. He is 5 years post diagnosis and his PSA has started to rise after 2.5 years of stability on enzalutamide and before that 6 rounds of doxetaxel + ADT.

His recent scans have showed some enlargement of pelvic lymph nodes which is most likely the reason PSA has been rising since Jan 2022. It was determined that a change of treatment is needed. The MO's fellow discussed that the MO would likely make a decision between Cabazitaxel vs Docetaxel. When the MO came in she decided since my dad tolerated Docetaxel quite well that she recommends starting with that for 10 rounds starting in Dec. We asked if we could go on a trip beforehand which she encouraged saying "you should do some living before chemo, it's important to go into that with a strong and healthy mind." I thought that was pretty great that she encouraged that. I asked why 10 rounds versus 6. She said the 6 rounds was a modified protocol that was taken from research done in 2007 (ish) on 10 rounds. I am curious how MD's select between these options. She mentioned he'd start with Docetaxel and then that leaves other options for later.

Does anyone know more on what the difference is between these two chemo's? Has anyone else done 10 rounds of Docetaxel after having done the same chemo before a few years prior?

[CAMPSOUPS]

I will be interested in the input you get here with your post.

I will start 10 rounds of Dox next week. I had 6 rounds 3 years ago. Zytiga no longer working has led to chemo next week.

Cabazitaxel seems to be easier on us as far as side effects but surprisingly I learned that it is actually harder on the bone marrow (blood production) than Dox.

I have a lot of bone mets. But my lymph mets can't be discounted either. I was told too that I tolerated the Dox 3 years ago well and it worked well on my bone and lymph mets and would be a good choice again. That I likely still have the cancer cell sensitivity to Dox as I had 3 years ago.

I am getting my Dox in a unblinded trial. If I had been in a different arm of the trial I would be getting Ra-223 (Xofigo) with my Dox but I was not put in that arm of the trial. Dox was looking like my next treatment regardless so no harm no foul in my mind. Cab or Dox was always on my mind as my potential treatment when Zytiga stopped working as chemo will hopefully knock down my volume of cancer again and re-sensitize it so other treatments will be beneficial afterward(Provenge,Xtandi?, Xofigo?,Pluvitco?, etc.). If fingers crossed Dox brings my volume down it will be interesting to see if no added treatment until progression or add something right away. One step at a time though.

[dhccpa in reply to CAMPSOUPS]

did you use ice packs, chips, etc. during chemo? I haven't done it yet but may next year. If so, I may ask about the details if doing that. Thanks

[CAMPSOUPS in reply to dhccpa]

Actually no I didnt use any ice. For my head I had/have skull mets so no way was I about to not let the chemo get to my skull.

As far as hands and feet I think my panic mentality being just diagnosed with a high volume of cancer was "let that chemo flow everywhere".

The very tips of my fingers may or may not be a little more sensitive to cold and heat not sure.

My toes and distal ends of bottom of my feet are pretty much numb but not a big deal.

Being poisoned was an interesting phenomenon. Most of my toenails looked ugly and finally fell off about 7 or 8 months after my last chemo infusion.

Only food that didnt taste right during chemo was black olives otherwise everything tasted good. Lupron and chemo brought my appetite back (which I had lost) into full food cravings and pleasure in eating which was a major relief.

[dhccpa in reply to CAMPSOUPS]

ok thanks. I know some posters have mentioned ice gloves/booties and ice chips. I'd like to avoid nerve damage if I can, but I'll read up on it some more.

[Tall_Allen]

The usual thinking is to let the patient recover after 6 infusions,. But if the first set of infusions worked well and your father tolerated it well, I've heard from several patients who did 10 infusions with good effect. As long as docetaxel worked well, why switch to cabazitaxel? They will monitor PSA and if it no longer works, they can switch to cabazitaxel midstream.

[GP24]

He could get the lymph nodes radiated. This will decrease the PSA value again.

[MateoBeach]

HI fmoser, you state your father is metastatic, so I assume there are cancer sites beyond the pelvic lymph nodes you mentioned. If that is not the case then he should have a PSMA PET scan to see if pelvic LN radiation could possibly be curative.

Assuming that is not the case, then most choose docetaxel chemo first. The most serious risk from that drug is irreversible peripheral neurapathy, which can be terrible. If he starts to develop it in hands/feet while going through docetaxel cycles, then it shoulf immediately be stopped and switch to cabazitaxel.

I presume his is now castrate-resistant (PSA rising despite ADT). In which case he should also (strongly) request referral for the immune treatment Provenge, which increases survival with very low side effects.

[Woodstock82]

I had six infusions of docetaxel, and it worked very well for me. I was very happy not to have a seventh, as the side effects were building up. Would my PSA have dropped further, and stayed down longer, if I'd had more infusions? Perhaps. Perhaps not. No way to know.

When my PSA had risen enough to prompt a new course of therapy, I enrolled in the CHAARTED2 clinical trial and was selected for the chemo leg, so I got both abiraterone and cabazitaxel.

The side effects from cabazitaxel hit me earlier, compared to docetaxel, but most of them were milder. The exception was changes in taste perception, that got bad -- to the point that there was one 10-day period just after the last infusion where even plain water tasted bad. I was sucking on ice during all the infusions, but I don't know if it helped. Perhaps if I hadn't, the problem would have been worse? I don't know.