Post chemo resensitivity to hormonal treatment

[spw1]

I have read here that Zytiga or Xtandi may be tried after chemo despite resistance having developed pre-chemo to one of them. Does anyone have a reference to anything in the literature about this? Thank you

[Tall_Allen]

Here ya go:

prostatecancer.news/2022/10...

[spw1 in reply to Tall_Allen]

Thank you for the prompt response. 🙏 My husband is trying Zytiga (having developed resistance to Enzalutamide in the spring of 2021) after chemo intervention. The oedema he had for several weeks has reduced completely and although his aches and pains have not gone away, we have not seen a huge increase in PSA in the first 3 weeks.

[Seasid]

I asked my MO here in Sydney about this situation and he said that when enzalutamide stopes working that it will not start working again after chemotherapy.

I really hope that abiraterone will work for you. Keep us informed.

I also plan to start with Xtandi paid by our PBS like you and after chemo I would also try generic Abiraterone paid by myself as the PBS in Australia similar to the NHS wouldn't pay again after the first failure.

[Seasid in reply to Seasid]

After reading the provided information I don't believe that I could use abiraterone plus Prednisone after failure of Enzalutamide even after the chemotherapy, at least I don't see any proof of that. It wasn't investigated that way.

[Seasid in reply to Seasid]

Our PBS here in Australia also would not pay for enzalutamide parallel to doxycycline chemotherapy even before the failure of enzalutamide, for example you start with enza and want to continue with enza plus doxycycline. They would not pay.

I believe that in UK and Australia we still don't have approved a triplet therapy. (It may change hopefully).

[spw1 in reply to Seasid]

Thank you for your comments. Given that there is no other treatment being offered, it is worth a try. We are advised to try it for 2-3 months at least before taking a view.

[gsun in reply to Seasid]

Xtandi is enzalutamide.

[Seasid in reply to gsun]

Thanks

[GP24]

In some cases the chemo destroys many castration-resistant cells so Abiraterone or other hormonal agents start to work again. As you said, just give it a try.

[spw1 in reply to GP24]

Indeed. I am terrified of what the future holds for my husband. Pain and disability this disease can bring is frightening.

[EdBacon]

Here's more information from a clinical trial done to test this.

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

From my experience (anecdotal) I got some more time out of Xtandi after Cabazitaxel although I ended up doing them both together for a while. I didn't get much, maybe 2 months and I think it only slowed things down.

[spw1 in reply to EdBacon]

Thank you. I hope that Abiraterone will give us some relief. It is difficult on some days for my husband to get in and out of bed with stiffness. Slow release morphine, paracetamol and celecoxib are the pain relief medicines we are using. On occasion I have used gabapentin but so far UK has not prescribed it. Very worrying and scary times for us.

[EdBacon in reply to spw1]

I hear you there. I am struggling with no energy and pain. I took a shower today which I considered an accomplishment, then spent another 3 hours lying on the couch. Finally got up to do a few small chores. It's been really tough. I'm not on any treatments right now so the cancer is progressing. I have to go another 2 weeks before Pluvicto.

[spw1 in reply to EdBacon]

Hope that the treatment will help you. 🙏

[Seasid in reply to spw1]

Sorry for my confusion.

[Seasid]

You had the biopsy. Did you have any luck with finding some cure with the genetic analysis?

[spw1 in reply to Seasid]

Awaiting that. Takes a bit of time.

[Seasid in reply to spw1]

How long? 4 weeks or longer?

[spw1]

Not sure. We did not order them until after the first results of the liver came out to indicate that it was not neuroendocrine. Will post here when I get anything back.

[MateoBeach]

I heartily agree with Smurtaw. BAT has been shown to provide recovered responsiveness to enzalutamide, and to a lesser degree, to abiraterone after failure (resistance). It is very inexpensive and safe if properly monitored for those who may progress on it. It is very inexpensive: Just one shot of 400mg of testosterone cypionate a month for three months while continuing on ADT. And it is actually enjoyable, good for mind, muscles and bones. Here is a summary for discussion:

prostatecancerfree.org/pca-...

[spw1 in reply to MateoBeach]

Thank you. BAT is v unlikely to be discussed by the NHS UK. So far they are basically showing us the path to the hospice unless it is for palliative radiotherapy.

[noahware in reply to spw1]

It is strange to me that the UK system seems uninterested in exploring BAT in trials. I figured one of the reasons for the PATCH trial (estrogen as a form of ADT) in the UK was the incredible cost savings it would provide to that system. BAT is along the same lines: cheap as dirt!

The for-profit system in the US has little interest in getting either high-T or high-E2 approved by the FDA as mainstream treatments. A socialized system has every incentive to do so, no?

[spw1 in reply to noahware]

I am not sure why but we cannot find anyone interested in actually finding a treatment for my husband at this stage. They are very good at palliative care in community.

[NickJoy in reply to noahware]

I have been wondering about the same thing. It really makes sense that a NHS style system would try to utilise this approach. Why isn't it happening in the rest of Europe? Or Australia? In the UK, I just think they are overwhelmed and can only focus on a few things. Maybe again it comes down to money. If a new treatment can be developed, and it makes money, then that can be put into the system? Or maybe there is more stuff going on behind the scenes than we know. The UK research teams don't seem to put out much information unlike the high profile MO's in US. I find the UK system very frustrating and I think it must be really tough to be an MO working within it.

[spw1 in reply to NickJoy]

Indeed our MO is sad but says his hands are tied. The RO is better and tries to find ways to help. The RO is also hopeful when he speaks to us and kind when suggesting to make sure pain is not suffered unnecessarily (rather than suggesting that pain relief is all that my husband is entitled to).

[MateoBeach]

Understood spw1. However, you can always take things on hand if you determine it is a better path. Do they not have Naturopaths who can prescribe testosterone there? You can learn the protocols and criteria and guide them. Testosterone is very inexpensive, NHS need not be involved. Your life and your choice if proactive.

[spw1 in reply to MateoBeach]

hmm given where we are, trying Abiraterone at the moment, it will clash with trying to do BAT at the same time. We have to see whether this strategy works having started on that path already.