Advice Please

[Univs]

Hi - I am in Canada and would appreciate your thoughts. I have a meeting with my MO next week and am preparing accordingly for a discussion on next steps. Oncologic history is referenced above. Enzalutamide failed after about 6 months. Started docetaxel on Aug 10/22. After 4 cycles, bone scan results, received today, indicate a mixed pattern of response i.e., while many lesions have improved there is also progression in certain lesions as well as new lesions. Any thoughts and or suggestions would be appreciated. Should docetaxel be continued? Really appreciate this forum and the expertise of its members. Thank you

[Tall_Allen]

Can you get Pluvicto or Xofigo?

If not, maybe cabazitaxel with rechallenge of Xtandi.

[Univs in reply to Tall_Allen]

Thank you Tall Allen. I will look into/follow-up with your suggestions. At this point would you see any benefit in continuing with Docetaxel i.e., in hopes of a more fuller response? Thank you..

[Tall_Allen in reply to Univs]

Cabazitaxel seems more appropriate.

[Univs in reply to Tall_Allen]

Thank you Tall Allen. Will let you know the results of my MO meeting scheduled for next Thursday Nov 3rd.

[Univs in reply to Tall_Allen]

Hi Tall Allen - Further to last week's discussion. Met with my MO. Moving forward with Cabazitaxel next week.......possibly Pluvicto down the road........I was not successful with having an Xtandi re-challenge included at this point. Hope your doing well!

[Tall_Allen in reply to Univs]

Did you email him this link?

thelancet.com/journals/lano...

What did he say about it?

[Univs in reply to Tall_Allen]

Thanks TA. Will do and will let you know! Also, would continuing enzalutamide with docetaxel (plus androgen deprivation therapy) i.e., as referenced in the link, be analogous to me, in my current situation, starting Cabazitaxel with a rechallenge of Xtandi? Thank you!

[Tall_Allen in reply to Univs]

Yes.

[Univs in reply to Tall_Allen]

Thank you TA. Will be back in touch....

[EdBacon in reply to Univs]

Xtandi did nothing for me after Zytiga, but seems to be working now with Cabazitaxel chemotherapy.

I'm currently taking Cabazitaxel, almost done with cycle 4. My cancer bone pain was starting to come back mid-cycle with the chemo bad enough to need opioids around the clock. I still had the Xtandi left from my prescription in the cabinet so I looked at that and thought "why not, it's already been proven safe to take with chemotherapy in a phase 2 clinical trial and if it works I might get pain relief." (And now we have more evidence that it works See PRESIDE trial)

My pain went down to zero in around 4 days after restarting Xtandi and has stayed there ever since. I realize that this is just my anecdotal and single data point, but this has been proven in the PRESIDE trial and before that in the CARD trial.

It's something you could discuss with your doctor.

[Univs in reply to EdBacon]

Great input EdBacon. Thank you! Will definitely position as part of my ongoing MO discussions! Best to you on your Journey!

[EdBacon in reply to Univs]

Thanks.

As a side note: Cabazitaxel has had significantly less side effects than Docetaxel for me but still effective. Others have reported this too.

[Univs in reply to EdBacon]

Nice to hear. My first infusion with Cabazitaxel will be on the 9th. Thank you!

[Univs in reply to EdBacon]

Hi EdBacon......just wondering, will you be asking your doctor to prescribe the combo or will you continue to take Xtandi from your last prescription? Is your doctor supportive of the combo? For whatever reason, my MO seemed to down play it but as mentioned, I am planning to approach him again with the further details I have obtained from the group. Take Care!

[EdBacon in reply to Univs]

I'm using up the last of my prescription but my doctor doesn't know I'm taking Xtandi. Guess I'll have to let him know if I want to continue. The science is behind me so not too worried about discussing it.

[Univs in reply to EdBacon]

Thanks Ed. Be interested to know what he says. Just today I tried to reach out/forward documentation to my MO on this issue but was told I would have to further discuss it at my next scheduled appt. Not having an email id for him makes it very difficult to bring up things that may come up inbetween scheduled appointments. Cheers!

[Univs in reply to EdBacon]

Hi EdBacon. I will be starting Cabazitaxel tomorrow. I noticed that my MO has asked me not to take Dexamethasone with Cabazitaxel althought I was taking Dexamethasone with Docetaxel i.e., the day before the day of and the day after. Any idea why Dexamethasone is used with Docetaxel but not with Cabazitaxel? Hope your doing well!

[EdBacon in reply to Univs]

The prescribing label for Cabazitxel specifies a pre-med of 8mg of Dexamethasone to be given by IV so they don't want you taking any additional. After that, 10mg of Prednisone per day is prescribed. So when they hook up your IV, they will go over each of the drugs they will be giving you with Cabazitaxel. There's the steroid, something for anti-nausea and also Benadryl or similar in case you have an allergic reaction.

[Univs in reply to EdBacon]

Thanks very much Ed. Your more helpful than my Dr. Hope your doing well. Will let you know how the infusion goes. Take care.......

[EdBacon in reply to Univs]

Thanks. Here's the full prescribing sheet for Cabazitaxel. Reading it also helps you to sleep.

accessdata.fda.gov/drugsatf...

[Univs in reply to EdBacon]

Wow......Perfect.....thanks so much Ed! I feel empowered going into my session tomorrow!

[EdBacon in reply to Univs]

If you want to feel even more empowered you can calculate your dose so when they show the bag with the dose on it should match your calculation. It's very easy to do with this on-line calculator. You just enter your body weight and height and it gives the number in Square Meters. Multiply that by the prescribed dose of 20mg per square meter. Example: height 175cm weight 86 Kilos = 2.02 square meters, so 2.02 x 20mg = 40.4mg

The numbers may vary slightly depending on which calculation method they use but should be very close. I always look at the bag and check it against my calculated dose before my infusion.

gigacalculator.com/calculat...

[Univs in reply to EdBacon]

This is great Ed. Thanks again. I often wondered about the dose calculation! Heading out this morning for the infusion. Take Care!

[rsgdmd]

Some of what is showing on scans could be from bone flare. ncbi.nlm.nih.gov/pmc/articl...

[Univs in reply to rsgdmd]

Thank you for the reference rsgdmd. An interesting reference. Will use as input for my mtg next week with with my MO.

[Yank66]

Your posts sounds like you and my husband are in the same boat. He’s been on chemo since July. His PSA rose, then dropped , but has risen by 7 points recently to 94.2. Seems to me the taxotere isn’t working. He has a PSMA scan next week, then MO appointment. We’ll be interested in what your MO says. Best wishes to you.

[Univs in reply to Yank66]

Thank you very much. Hope your husband is doing well. I will keep you posted on the outcome of the meeting with my MO which is currently scheduled for Wed, Nov 3rd. Take Care. We can trade notes!

[Univs in reply to Yank66]

Hi Yank66 - Further to our messages last week. Met with my MO this morning. Moving forward with Cabazitaxel starting next week. Pluvicto possibly down the road. Any developments from your side? Take Care!

[Yank66 in reply to Univs]

Met with the MO this afternoon. Dr will pursue scheduling Pluvicto,but may take a bit. We will have to travel 1-1 1/2 hours each way for treatment. It’s not available locally, but that’s not a bad trip. Taxotere is to continue until Pluvicto can be scheduled so that Denny isn’t going without treatment. His PSA is now 108 and additional Mets showed up in right femur. We are hopeful this evening. Our best wishes to you.

[Univs in reply to Yank66]

Thank you for your note. Was Cabazitaxel included as part of your discussions? My MO seemed intrigued by Pluvicto given my situation but because of some local supply issues positioned it as a possible next step. Best to you and your Husband.

[Yank66 in reply to Univs]

Dr said additional types of chemo were available, but he found Pluvicto available at UVA and at facility in Fairfax, VA. Denny has significant neuropathy in hands and feet, so dr. is hesitant to amp up the chemo.

[Univs in reply to Yank66]

Thank you for your note......makes sense! Good Luck!