Docetaxel re-challenge not going so well

[fmoser]

Hi all,

My father has had 3 rounds going for his 4th round of docetaxel tomorrow. Five years ago at original diagnosis was when he had 6 rounds of docetaxel and it really worked well. This fall Xandi stopped working and his PSA went from Aug 5.3 to Oct 20.9 with a small tumour in his bladder seen on CT.

Before his first round of chemo Dec 20- PSA: 182 ALP:518 LDH:357

After his first round of chemo Jan 9- PSA: 281 ALP: 916 LDH:759

After his second round of chemo Jan 30- PSA: 504 ALP:769 LDH: 561

10 days after his 3rd dose he fainted and was hospitalised and diagnoses with A-fib. Is this common to be provoked by chemo? He was put on a beta-blocker and he has to give himself a blood thinner (injection) each day for 30 days. During this hospital stay his haemoglobin went to 90 to 77 in 48 hours and he was discharged. He's been extremely fatigued as all his blood values have been low. His ALP was 570 during this time.

He will get a blood transfusion tomorrow with his fourth round of chemo. Yesterday his blood values came in

After third round of chemo Feb 21- PSA: 670 ALP: 898 LDH: 848

Is it normal to have ALP and LDH values rise and fall so drastically. His PSA didn't seem to rise as exponentially as previously, could that indicate some response?

He had a bone scan and CT scan today. We will see the MO on Tuesday after his 4th round?

I am having a hard time see my dad so weak so suddenly. I am assuming it's just that the chemo is reeking havoc on his body and because his blood values are so low? (hb: 80 HCT: 0.26, Erythrocytes: 2.8, platelets 112). Last time he did Docetaxel he had hardly any symptoms and was able to work, it's shocking how different the experience is for him this time around. Now he's short of breath and very weak. Is it time to switch to Javanta? Is it normal to need support with transfusions to help continue with the chemo regiment?

I'm worried and looking for some hope.

[CAMPSOUPS]

I hope others more confident in their opinion than I am of mine will comment.

I feel his PSA rise is not the typical PSA bounce/rise seen in the first few chemo infusions sometimes. It seems his PSA is on a trajectory despite the chemo.

I would hope to verify that before doing a 4th infusion and the results of the scans might help shed some light on whether the chemo has been of benefit or not.

[Tall_Allen]

Maybe discuss Jevtana+carboplatin - he seems to be resistant to docetaxel.

[fmoser in reply to Tall_Allen]

Is the combination more effective than Jevtana on it's own?

[Tall_Allen in reply to fmoser]

Yes:

"Carboplatin added to cabazitaxel showed improved clinical efficacy compared with cabazitaxel alone for men with metastatic castration-resistant prostate cancer. Although adverse events were more common with the combination, the treatment was safe and generally well tolerated. Our data suggest that taxane–platinum combinations have a clinically beneficial role in advanced prostate cancer and a randomised phase 3 study is planned."

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

[tango65]

I would request a direct biopsy or a liquid biopsy to do histological, IHC and genetic studies of the cancer to see if the cancer may respond to olaparib, rucaparib, keytruda or chemo with platinum compounds.

Docetaxel may be associated with atrial arrhythmias and also with bone marrow depression.

accessdata.fda.gov/drugsatf...

[fmoser in reply to tango65]

Thank you! So frustrating we asked for genetic testing over a year ago (in canada) and they have yet to provide the results. Looks like we will have to do this privately via foundation one. Is a liquid biopsy sufficient?

[tango65 in reply to fmoser]

A liquid biopsy most probable will yeld enough material given the PSA values.

[EdBacon]

Probably the cancer and not the chemo making him feel bad.

Jevtana (Cabazitaxel) is approved when docetaxel becomes ineffective so worth asking about. It's also an easier chemotherapy for most to tolerate, it was quite a bit easier for me. (I've had both).