Should my dad continue docetaxel? He seems weakening so much.

[leechi]

My Dad with mHSPC (GS8 and PSA 50) and we found this in June 2022. ADT was first treated in July and Docetaxel was started in Aug. After the 5th injection of docetaxel, my dad at the age of 75 seems very weak. The PSA drop from initial 50 to 0.28 before the 5th docetaxel.

The first 2 docetaxel seems running good. But on the 3rd docetaxel he seemed start to get infection and got fever going in hospital treated with antibiotic and it prolonged the injection from 3 weeks to 5 weeks. We returned to 4th docetaxel and start to add abiraterone but again after 2 weeks he got infection and we go into hospital treating again with antibiotic. We only able to take abiraterone for 10 days only. Now we are on the 5th docetaxel and since hoping to get less side effect and we swithced to Nubeqa. However, that even worse since Nubeqa made him totally exhausted and he can't even walk normally and we have to reduce it by half. But at the end of the second week he got infection with fever 38.5 again and we have been back to hospital treating with antibiotic.

So, my questions are:

1) Are those chemo infection normal? Should we really need to go all the way to 6th docetaxel? i am so worrying that he can't afford the toxicity anymore. What would make one consider to stop the Chemo?

2) Is the infectoin normal in Chemo? how come it happens every time even we already applied the G-CSF.

3) Do Nubeqa really made one totally exhausted? The situation is that with Chemo he almost sleep or lying on bed all day and totally no energy to sit down. Even walking is very very difficult thing to him.

4) Anything taking with Nubeqa can restore him some energy? or mininize those tireless side effect?

5) Or we need to switch back to abiraterone?

6) If we just stop the Chemo and move to Nubeqa only now, will this make big difference on the result? Since we really have no idea on what's the benchmark goals of having 5 or 6 or 7 Chemo.

Sorry to ask some much questions, but i think we may need to start to seriously consider if he can afford the toxcity of Chemo. Seeing he's so weak under infection now i am worrying we will make a wrong decision to determine to stop it if he can recover from infection but my problem is up to the 6th Chemo we are really concerning if he can afford it.

Many thanks for all of your thought.

[Tall_Allen]

That is a great PSA response to chemo and the Nubeqa. The chemo will be over soon (usually 6 infusions). The judgment about whether he can tolerate more chemo should be made based on his bloodwork, not his temporary fatigue.

In addition to the G-CSF, he should be getting an antihistamine, a corticosteroid, and iv fluids.

[Seasid]

Is he in a process of developing peripheral neuropathy?

If yes than he should stop Docetaxel chemotherapy as as possible.

Here is a link to dr Fred Saad about the use of chemotherapy:

"Chemotherapy in Prostate Cancer- When, Why and How"

urotoday.com/journal/everyd...

I personally believe that after 4 cycles he could switch to Enzalutamide or Darolutamide.

If he is not in a process of developing peripheral neuropathy than he could stay 6 cycles.

[Seasid in reply to Seasid]

Cabasitaxel is recommended for people who are developing peripheral neuropathy.

For example i developed grade I peripheral neuropathy after 6 cycles of Docetaxel chemotherapy.

If I would do again chemotherapy in the future I would try Jevtana (Cabasitaxel chemotherapy).

Otherwise it looks that Docetaxel chemotherapy is more gentle on bone marrow. I really didn't have any problem with my blood work during Docetaxel chemotherapy. And my oncologist didn't recommend me to have G-CSF.

[MateoBeach]

Am curious about infection requiring hospitalization with IV antibiotics. Not typical of docetaxel chemo. Exactly where located? Blood infection suspected? Did they grow bacteria out of blood cultures or other source such as urine? Does he have the minimal adequate Neutrophil WBCs (>1000)?

There is diminishing returns with more doses of chemo. Less additional cancer fighting yet side effects are cumulative. Would suggest discussing stopping for now due to severe side effects and the infections. Nothing magical about six cycles. Nubeqa does not typically cause severe fatigue for most since it does not cross into the brain. Chemo does.

[Seasid in reply to MateoBeach]

I can't recall that during Docetaxel chemotherapy treatment I was fatigued.

Only Jevtana is crossing the blood brain barrier. That is why I am considering having Cabasitaxel chemotherapy treatment later on in order to avoid brain metastasis. Docetaxel is not crossing the blood brain barrier therefore I am not considering it. I know this as I was thinking about me developing brain tumor. I have the met in my neck just under my skull.