missed the boat on triplet therapy?

[Idyllwild]

my dad just finished his 6th round of taxotere this last September (along w eligard q 3 months). His psa thus far has had a favorable response. Sadly I had mentioned adding zytiga (after reviewing peace trial) at his initial consult and was told this would be next line for when he had a psa progression.

My question is would there be any benefit of adding one of agents (zytiga, xtandi, nubeqa) at this point or would we not really obtain the summative effects/should we just at this point wait for a progression since he isnt treatment naive anymore?

tia

[Tall_Allen]

Consider getting a new oncologist.

If his PSA is 0.64, maybe he can still wreak some benefit if he starts Zytiga or Nubeqa now. If he can't start it immediately, he'll have to wait for progression.

[john205]

When I began treatment, the standard did not include either abiraterone (Zytiga) or Xtandi (enzalutamide) at the beginning. so I began with Lupron and docetaxel. After 2 1/2 years, my PSA rose from nearly zero to over 2.0, the typical threshold for treatment resistance. At that point, both abiraterone and Xtandi had been approved for treatment of metastatic resistant prostate cancer, so my onconlogist and I opted for Xtandi (I preferred a drug that did not also require prednisone). PSA dropped again to near zero and now, after another 2 years it is rising slowly. I anticipate that I will be into something new in the next 6 months or so. So in my case, adding enzalutamide later in the sequence has been very successful for 2 additional years, not a bad result.

Your father appears to be somewhere in between treatment naive and treatment resistance, so I cannot advise you regarding the timing of your father's treatment, except to say that before PEACE, adding one of those drugs later, at the time of resistance, was the standard (the STAMPEDE and ARCHES trials) and was shown to be effective.

Since then, with the results of PEACE and related studies, triple therapy at the outset (Lupron, docetaxel, and abiraterone or enzalutamide) have become the standard for treatment naive metastatic prostate cancer.