Jevtana (Cabazitaxel) before Xofigo (Radium 223)

[Finlay66]

Hi

I was speaking to an Oncology nurse last week who suggested that after Docetaxel, Oncolgists were inclined to prescribe Jevtana before Xofigo. This apparently is because it is less effective the other way round. I have to say my instinct was to try radiotherapy before going back to chemo. The Docetaxel has not really reduced my PSA and it is climbing. Mets are mainly in the bones.

I'd be grateful for any views and experience of this, either internationally or in UK.

Thanks

[RyderLake1]

Hello,

You might want to try Pluvicto (Lutetium-177). As a result of the VISION trial it is approved for use after chemotherapy (docetaxol). It might prove to be more beneficial to you than Xofigo (radium-223]. There are several trials underway in the UK and elsewhere. If you want to widen your search a little the Germans have been using Pluvicto for many years.

[Tall_Allen]

The nurse is wrong.

Morris et al. reported the results of a small trial comparing Xofigo + docetaxel to docetaxel alone in 53 castration-resistant men who had ≥ 2 bone metastases. They were given either:

• Xofigo (55 KBq/kg) every 6 weeks for 5 injections and lower dose docetaxel (60 mg/m2) every 3 weeks for 10 infusions

• Standard dose docetaxel (75 mg/m2) every 3 weeks for up to 10 infusions

• The normal schedule for Xofigo is 55 KBq/kg once every 4 weeks for 6 injections

• The normal schedule for docetaxel is 75 mg/m2 once every 3 weeks for 6 infusions

• The timing adjustments were made for patient convenience

• Almost all had tried a second-line hormonal therapy

• Most were taking a bone-strengthening agent

With 52 weeks of follow-up:

• Median PSA progression occurred after 6.6 months in the combination arm vs 4.8 months in the docetaxel-only arm

• PSA declined by ≥ 50% in 61% of the combination arm vs 54% of the docetaxel-only arm

• Median radiographic or clinical progression occurred after 12 months for the combination vs 9 months for docetaxel only

• All 10 treatments were given for the combination, whereas there was a median of 9 of 10 treatments in the docetaxel-only arm

• 12% discontinued treatment in the combination arm vs 23% in the docetaxel-only arm

• Serious adverse events were suffered by 48% in the combination arm vs 62% in the docetaxel arm

• Serious blood disorders were noted more often for docetaxel-only

It seems that the more toxic docetaxel dose could be reduced by the combination without any loss of efficacy.

ejcancer.com/article/S0959-...

Xofigo was also found to work well after docetaxel.

thelancet.com/journals/lano...

Docetaxel's effectiveness was not diminished by previous Xofigo.

ncbi.nlm.nih.gov/pmc/articl...

Email those links and discuss with a good oncologist (not a nurse). There are current clinical trials of the combination occurring in the Netherlands, but Idk if they allow Brits.

[Two-oceans]

Hi,I am in Cape Town and here also doctors put you after Docetaxel first on Jevtana and then on Xofigo. I am originally from Belgium and my Belgian oncologist is much more in favor of first Xofigo and only later on Jevtana. He is maybe right because Jevtana didn't work after Docetaxel for me .

[Finlay66]

Thanks all. This forum is so helpful before talking to my Oncologist. Even if I get the brush off at least I've done my research and feel better informed.