Triplet Therapy Failed. Now what?

[Worriedson9]

I've posted about my father here before - you can check my post history for my older posts.

To keep it brief: 60 years old, diagnosed with metastatic prostate cancer in June of last year (at 59). Doctor started with hormonal treatment while waiting for him to regain some strength, added Abiraterone (Zytiga) and Docetaxel chemotherapy as soon as his body could handle it effectively starting triplet therapy. After 6 cycles that ended around 3 weeks ago, we got the worst possible news today: he did not respond that well to the treatment (the doctor is calling it a "mixed response" and is saying that he's not anticipating a response with more cycles or other types of chemotherapy). He's looking at other clinical trials, or possibly Lu-177 (apparently, there is a global shortage of this and it is not readily available here in Canada).

Anyone else familiar with this situation?

It all went downhill so fast...

[Izzygirl1]

First of all, I’m sorry your dad is going thru this. I understand how hard this is for you too!

My husband is close to your dads timeline. He had triple therapy (Lupron, Nubeqa, and Docetaxel). They did a body scan after his last chemo treatment and it looked like things were worse, but the doctor said that it was “scarring” and not active cancer we were seeing.

What is making your dads doctors think it hasn’t worked? Is your dad in pain or feeling worse? My husband is dealing with fatigue but is not in any pain.

Our doctor said if this triple therapy doesn’t work he’s got a plan b and a plan c. I did hear that Pluvicto (Lu 177) is hard to come by now, and I hope that issue clears up soon!!!

[Worriedson9 in reply to Izzygirl1]

Thank you for the response.

I'd sure want this to be the case as well! The doctor does not seem super optimistic, however. Is scarring common?

My dad isn't feeling worse but he's more fatigued. Also, Lu-177 has a global shortage apparently.

Do you know what those plans are?

[Shams_Vjean in reply to Worriedson9]

My MO advised that treatment will often cause bone mets to appear “darker” than previously seen by CT scan prior to treatment. Spread of mets is perhaps the most important indicator, and that can continue to occur until after Chemo is completed. The spread of mets or lack thereof after treatment, as seen in subsequent ongoing scans post Chemo, can be significant indicators. Likewise for results with PSA, and certain blood work markers/enzymes related to kidney and liver function or bone degeneration (ALP).

[Mw921000000]

Gosh im so sorry to hear this. Has your dad done Xtandi yet? We moved on to this when Zytiga messed with his liver enzymes and it’s been working ok. If he “failed” chemo it should open him to some clinical trials

[Worriedson9 in reply to Mw921000000]

Nope, we've yet to try Xtandi. I think the doctor wants to continue Zytiga for a bit. The liver metastases is what got worse for him, apparently?Thanks for the response.

[Kaliber in reply to Worriedson9]

I’m so sorry to hear of the course of events with your father’s treatment, so far. I’ve been on Xtandi myself , for a while and I’ve been successful with it…. Maybe your father some success with it as well.

Hearze hoping

❤️❤️❤️

[Worriedson9 in reply to Kaliber]

Thank you for the response!Was your journey similar? Did they add Xtandi after chemotherapy?

[maley2711]

So, if I understand you correctly, at diagnosis your Docs unanimously agreed that there was nothing worth trying and you should go with hospice to help you with pain and all the other problems of advanced cancer. Basically, they gave up on you. But you didn't give up, aand here you are 4+ years later...whoa!!!! How has your QOL been the last 4+ years...hopefully better than the day you were advised to enter hospice? If my understanding is correct ??, you experinced a massive failure of our medical system? To me , an unforgiveable failure !!!!

Am I overeacting to your story???

[Cooolone]

A shining light... A beacon for others to admire and try to emulate!

[Cooolone]

Sorry to read about your dad's journey! But hope is powerful and encouraging too! Don't give up as there are many treatments out there.

Has your dad had any genomic testing? This might open the door for a few drugs to try. Unfortunately today, we still aren't at the truly "individual" personalized medicine that would possibly help patients. But the genomics sometimes provide amazing results where none was expected.

Aside from that have you the ability or considered a medical vacation to Germany? Contact them and see if the Lutiem is available... Yes, out of pocket can be steep, so there's that to consider

Wishing you the Best

[Worriedson9 in reply to Cooolone]

Thank you for the response!

Yes, we're considering it. That or India. First, we need to consult with the doctors to see if it's something worth trying. Besides, they're referring us to another hospital for clinical trials.He had some genomic testing but they ruled out the mutation - BRCA, I think it's called?

[Cooolone in reply to Worriedson9]

There's a few genomic markers that are actionable, whether it be with approved drugs or maybe one or two under trials. It's good if tested as they would know then if this may be another treatment path if positive for any of the markers.

Best Regards

[Shams_Vjean]

You didn’t mention his PSA response. Was it at all better? worse? Was there a recent scan showing spread of metastasis beyond the prior one? How long prior to the beginning of Chemo did the prior scan occur?

You don’t need to answer these questions for me, but they’re all very pertinent to assessing his response to treatment. Regardless of how well they were addressed by his MO, in my opinion this is a very appropriate time to be seeking a second opinion, if the financial resources/insurance will allow. I wouldn’t lose faith before another set of well qualified ‘eyes’ have reviewed his response to treatment.

Best of luck to you.

[j-o-h-n]

Don't lose Hope!!! It took 10 miserable years to get rid of my first wife. You're a great son.... I hope you have siblings who can help with your dear Dad. Give your Dad my regards....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 03/07/2023 6:00 PM EDT