Zytiga after Xtandi?

[Lynsi13]

Hello, I have been searching posts but haven't found the answer I'm looking for. I know men often try Xtandi after Zytiga, but is it ever reversed? My dad seems to be failing Xtandi and I'm wondering if Zytiga would be a viable option? His doctor has mentioned Pluvicto, but their website says it only provides a 4 month survival benefit? It seems silly to go through infusions every six weeks if you're only going to gain four months? (I hope that doesn't sound harsh.)

[tango65]

When one of the new anti androgen fails the best sequence seems to be to do chemo instead of other anti androgen since there is cross resistance among the different new anti androgens.

Discuss doing docetaxel and eventually he could try zytiga and see if there is a response. If there is not then he could qualify for cabazitaxel.

nejm.org/doi/full/10.1056/n...

If possible try to get a biopsy of the mets.

[RyderLake1]

Hello Lynsi,

After five and a half years on Xtandi (enzalutamide), I am now on Zytiga (abiraterone) . It is still early days as I have only been on Zytiga for less than a month but so far so good. No serious side effects and the drug seems to be working. After going steadily up for the previous six months on Xtandi my PSA has fallen quite dramatically. It is currently .018. I have gotten used to taking Prednisone with food but taking Zytiga on an empty stomach was a problem. Particularly when at my age the period of time between supper time and bed time seems to be diminishing rapidly! 😊I got around this problem by taking the Zytiga pills when I first get up to pee around midnight.

As for Pluvicto (Lutetium-177) I am a big fan. It has been used extensively in Germany, Great Britain, India, Australia and most of the world quite successfully. The United Dtates

[RyderLake1]

My reply accidentally got sent. My last few sentences were the United States and Canada are definitely late in approving this drug. Think of it as working extraordinarily well for a third of the men who take it. Another third see some help but the cancer does not disappear. With the final third Lutetium -177 doesn’t seem to help at all. Remember you have to be PSMA positive on a PET scan for this drug to work. Hope that helps!

[Tall_Allen]

You get even less from the second hormonal. The survival improvement depends on a lot of factors (especially his PSMA avidity and PSMA concordance). 4 months is the average among those who get a lot of improvement and those that don't get any. I assume he's had docetaxel.

[Schwah in reply to Tall_Allen]

I think you mean medium as opposed to average TA. Could be a big difference to someone considering a treatment. As I understand it the medium could be only 4 months even tho some men may survive extra years? I know you know this but for Lynsi13, this info coukd matter. Medium simply means half the people survive more than 4 months and half less than 4 months. I wonder why they never fo give average or at least give info on long term Survivors of any?

Schwah

[Tall_Allen in reply to Schwah]

Median (with an n)

[Schwah in reply to Tall_Allen]

yes correct.

Why do you think these studies do not readily provide info on outliers that may survive long term. I think many patients who are reluctant to try a treatment with only a four month median survival, might feel Quite differently if they knew for example that say 20% of the people survived an extra year or more. It seems relevant yet requires much digging to find that info. Or is it relatively easy to find ?

Schwah

[Tall_Allen in reply to Schwah]

They provide that info. If one looks at the Kaplan-Meier curve, a quarter of the men survive about 8 months longer with Pluvicto vs SOC.

[Schwah in reply to Tall_Allen]

Thx Ta….that’s a pretty good fact. I’d think many men who may think it’s not worth it if it’s only going to add 4 months to their life, might think Differently if they knew 25% of men lived 8 months or more longer on the treatment .

Schwah

[Tall_Allen in reply to Schwah]

The real benefit is probably with early use and better patient selection. All approved therapies increase survival 3-6 months (median) for mCRPC.

[MyDad76 in reply to Tall_Allen]

Do you perhaps have a link to Kaplan-Meier curve for Pluvicto?

[Tall_Allen in reply to MyDad76]

Figure 2 of the VISION trial:

nejm.org/doi/full/10.1056/n...

[Hidden in reply to Tall_Allen]

Hi Tall Allen

If xtandi given after Docetaxal and javenta did not work from the first dose, is it worth changing to Zytiga or will they both not work at all?

[Tall_Allen in reply to Hidden]

I would ask for a biopsy of a metastasis to find a medicine it might be vulnerable to, perhaps on a clinical trial.

[Hidden in reply to Tall_Allen]

Thanks TallAllen

Do you know of any trials. Currently in hospital with a bladder infection, radiotherapy on spine starts next week for painful mets

[Tall_Allen in reply to Hidden]

There are hundreds of trials. Discuss with your oncologist.

[EdBacon]

Better off doing chemotherapy between anti-androgen switching. Docetaxel or Cabazitaxel if Docetaxel has already been used recently or wasn't effective.

I did a direct switch from Zytiga to Xtandi and basically got nothing out of it. I'm doing Cabazitaxel now until my Pluvicto is available in late January just to slow down the progression. Judging by my improvement in pain, that seems to be working.

[MateoBeach]

Yet another consideration, and one based on current published clinical trials of BAT, would be to do a few monthly cycles of a single injection of testosterone cypionate 400mg when enzalutamide fails to restore sensitivity to it or to abiraterone. This has not been integrated into the SOC protocols yet, but should be given the results already published from RCTs.

See discussion of the TRANSFORMER and RESTORE trials:

prostatecancerfree.org/pca-...