PSA is increasing after 11 cycle of Docetaxel, what should we do now ?

[mgaa]

My father has done around 11 cycle of Docetaxel, 5 of them was combined with Cisplatin.

First 3 cycles of Docetaxel alone took his PSA from 7 ng/mL down to 3.680.

between cycle 4 to the end of cycle 7 his PSA increased to reach 8.03.

Adding Cisplatin brought his PSA down to 0.890 after another 4 cycles and then he started developing hypersenstivity and complications so he stopped that Chemo therapy.

Now his PSA is rising again and it reached 2.47 ng/mL, we're now torn in between:

1) his MO recommended Xtandi, which costs ~ 1300$ and that's around 4.5X of his monthly income and the national health service in Egypt is not administering it.

2)instead, the national health service suggested a mix of Mitoxantrone & Vinorelbine chemotherapy.

I have some concerns as I can't find enough clinical trials to support that besides I feel like he has been on chemotherapy for too long (~ 14 months) so that doesn't seem the right choise for me.

I'm leaning forward Xtandi and we can try to sort out the financial bits of it, but I got 2 questions:

1) is there something better we should try or ask his MO about other than Xtandi ?

2) is there any financial aid programs for Xtandi either from Astellas or any other institution ?

I got the full case history with all PSMA reports in my profile summary, thanks a lot in advance for your input.

[Tall_Allen]

Is Xofigo available in Egypt?

[mgaa in reply to Tall_Allen]

unfortunatly not, I've asked for it after your comment on a previous post of mine.

I've found "177Lutetium-PSMA" treatment and then our MO suggested that will come further down the line and not now.

Thanks a lot for your reply.

[tango65]

He is an ideal candidate for LU 177 PSMA since he had previous abiraterone and chemo. The Vision trial showed a survival advantage in similar patients. It does not make sense that the MO does not want to use this treatment.

[Shamrock46]

My husband has been on Xtandi for about 18 mos. during which time we paid nothing. 1) Our supplemental drug ins. (Humana) pays about $6,000/mo. and Astellas covers the rest. Your doctor/hospital should be able to help you apply and the hospital itself may have grants available. 2) In the USA you have to either qualify through Social Security or get a letter from them telling you why you don't qualify (income standard is about $25,000 or lower). You then work with Astellas. 3) Xtandi has many SEs and my husband has suffered most to the point that he is now on only 1/day. His PSA is also rising & I see no point in continuing with Xtandi if it's no longer effective. Lupron is also starting to cause minimal memory issues. We meet with MO this Tuesday. Good luck.

[dudubaya]

I was under the impression that Enzalutamide(Xtandi) does not work if Abiraterone(Zytiga) has already been administered and failed. Nonetheless in case your MO has prescribed it why not consider using generic versions of Enzalutamide in case Xtandi is unaffordable. Here in India the generic version costs us equivalent of 250 USD every month. My Father has been on it for more than a year now

[mgaa in reply to dudubaya]

thanks for your reply. I’ve tried looking into getting the generic version from India a year ago and most pharmacies I’ve tried were very pushy and keep asking me to transfer money so I felt like most probably it’s a scam.

Is there a trusted platform or method I can get the medicine from ? I’m living in UK in case that makes exporting from India any easier.

Thanks a lot

[dudubaya in reply to mgaa]

Mostly for us the medicine is sourced by the hospital from their trusted pharmacies. I have bought it a few times directly from a pharmacy recommended by our oncologist as well as a few times from online platforms like "Tata 1Mg" which are pretty reliable. But AFAIK the reliable online platforms only deliver inside India.

If you are interested in the Indian generic version and are concerned about reliability then you may try getting it from the manufacturer directly. We are using the one manufactured by BDR Pharma its trade name is BDENZA , suggest you to take a shot by calling or emailing them on the address given in their website

[mgaa in reply to dudubaya]

Thanks a lot for this detailed reply.