Things don’t look good!!!

[Fight11]

My husband has been on Zytiga, Lynparza, Keytruda Doxetaxel, Cabazitaxel as well as Carboplatin. Nothing really worked long term. He is Castrate resistant. He most recently had one treatment of Lu 177. His platelets never really bounced back since his first treatment. He will no longer be eligible for Lu. He still has fight and does not want to give up. Are there any options for him with his platelets being low(54)? Hope for one last try with something . Any suggestions would be so so appreciated. Thank you!!!

[Tall_Allen]

I can't think of anything other than Provenge or hormone therapy that won't make the bone marrow problems worse.

[Fight11 in reply to Tall_Allen]

When you say hormone therapy as in Lupron

[Tall_Allen in reply to Fight11]

Lupron and Zytiga or Xtandi. I think that LUPRON+ Erleada + Zytiga is a good combination, as in the ACIS trial:

thelancet.com/article/S1470...

[Fight11 in reply to Tall_Allen]

Even though he has already been on it? Will that affect his platelets?

[Tall_Allen in reply to Fight11]

He's been on that combination? It won't affect platelets

[CharlieBC in reply to Tall_Allen]

TA, I went to the Lancet study- it didn't list dosage of zytiga or erleada. Are they full dose (i.e. 1000mg zytiga)? I had such good results with zytiga, but had to stop due to liver enzymes. Possibly lower dose zytiga, plus Erleada could work.

[Tall_Allen in reply to CharlieBC]

Yes, they used full dose. All you can do is try the reduces dose if your liver can't take the full dose. Some men are able to start off with a reduced dose and slowly increase it. Sometimes the liver will accommodate a slow increase.

[Teacherdude72 in reply to Tall_Allen]

Nubeqa?

[Tall_Allen in reply to Teacherdude72]

What about it?

[Teacherdude72 in reply to Tall_Allen]

Woul it b possibility for this case?

[Tall_Allen in reply to Teacherdude72]

If liver enzymes can't be controlled otherwise, there is no choice but to try a different medicine. There are no guarantees that another medicine will be any better. I know a man who had a poor liver reaction to Erleada, which resolved when he switched to Zytiga.

[Fight11]

he has never taken the Erleada. So should he take that just with the Lupron

[Fight11]

Tall Allen should he take all three drugs together? Or just the Lupron with one of the drugs? If I have my choice I go with the Erleada he has never taken that

[meowlicious99 in reply to Fight11]

My response, Just in case TA doesn't get to your question. Ignore this comment if TA responds.

Study that TA linked is here: clinicaltrials.gov/ct2/show...

in the results tab, improvements were noted in all three drugs together ( Erleada+ lupron + zytiga) .

Not quite sure when you got your chemo but exclusions in that study are : "Prior chemotherapy for prostate cancer, except if administered in the adjuvant/neoadjuvant setting "

[Fight11 in reply to meowlicious99]

So are you saying you would have to combine all three

[meowlicious99 in reply to Fight11]

Yes.

Thrombocytopenia was not an adverse event ( 0%) .

[anony2020]

Is Chemo an option? Just wondering as a layman. Or Chemo plus RT?

[Fight11 in reply to anony2020]

No it would lower the platelets to much. His platelets are 54 as of now

[andrew61 in reply to Fight11]

My platelets are 34 and Hgb 7.8 so getting transfusion and ESA shot today in hope it will allow me to continue chemo. Also applied for compassionate use Yervoy. All long shots but it’s very difficult to give up.

Good luck!

[Fight11 in reply to andrew61]

May I ask what is ESA shot? Also what is Yervoy?

[andrew61]

ESA shot stimulates red blood cell growth but it takes 4 to 6 weeks to be effective.

Yervoy is monoclonal antibody that activates the immune system - it’s a long shot for PCa but my oncologist thinks worth trying if I can get it.

[Fight11]

Best of luck to you. I think it’s worth asking about.

[HopingForTheBest1]

Has a blood transfusion been offered as possibly improving his platelet count? There is also a drug called Tavalisse, which I am not familiar with, that may be an option?

[Fight11]

Blood transfusion doesn’t help platelets I was told. They could give a platelet transfusion however it only lasts 24 hrs. He has had 2 blood transfusions last month. Helped the other blood counts come up. Did nothing for his platelet count.

[noahware]

If I had gone through all these treatments and was looking for a Hail Mary option, I would try to find a doc who would give high-testosterone a chance (either inside or outside a BAT clinical trial protocol). Not recommended for those with bone pain.

Because there is a fear of this WORSENING the disease and it is outside SOC, most docs will not even consider it. So this is not advice, just what I might try, and something to research and consider. But there is a long-shot chance it could slow the PC. If not, it can be discontinued.

One thing I never see discussed here is that high-T therapy can be beneficial for those with anemia. Testosterone administration has been associated with a increase in platelet count, hematocrit and hemoglobin... but also with increased clotting risk and other possible risks, I believe. Worth investigating?

[Beckybark]

Hi there, I'm sorry to hear you are in this position. My husband was in a very similar position with extremely low platelets (around the same as you are describing) and the only option for him was radionuclide therapy with Actinium (he had bone marrow diffusion) rather than Lutetium (well actually he had a combination of both at the clinic). He was PSMA avid. He had treatment in Heidelberg (where they pioneered the therapy) and he responded exceptionally well, his PSA went from 1700 to 0.03. All these type of treatments have some impact on platelets, but his platelets did remarkably recover in the end. He sadly died in 2021, but it certainly gave him another 18 months to 2 years of life (more treatments are coming along all the time with prostate cancer, so our philosophy was always 'the longer the stay alive, the greater the chances of me staying alive' if you see what I mean) when at that time all the other options had run out. Eventually Covid stopped us travelling overseas to explore other treatments in the end. Hope this helps. please message me if you need any more information.

[Fight11 in reply to Beckybark]

sent you a dm