Triple Therapy

[TMcgee]

I started with Lupron+Abiraterone + Docetaxel. As I mentioned before elevated liver enzymes caused MO to place me on an Abiraterone vacation after cycle 1 of Docetaxel. Docetaxel was reduced to 3/4 dosage.

Yesterday, I received my 3rd cycle of 3/4 dosage of Docetaxel, my 3 month injection of Lupron and monthly xGeva injection. But, I was told not to resume Abiraterone.

I started out following the Peace-1 trial; but my MO is prioritizing the Docetaxel treatment over the hormonal treatment. Although it hasn’t been communicated to me, I suspect that I resume Abiraterone until after the 6th Docetaxel cycle. What are the implications of this decision?

I understand that the Abiraterone inhibits the cancer’s ability to create its own testosterone. Does the Docetaxel accomplish the same thing? I’m guessing the answer is no, or the Peace1 trial would have given all participants a Abiraterone vacation otherwise.

My thought is to have my MO run labs and if my liver enzymes are within limits, I would like to resume Abiraterone. Then, a week before my next cycle, check my labs again, to make sure that resuming Abiraterone didn’t push the enzyme levels high enough to cause a delay in Docetaxel. Thoughts?

Again, my thoughts are based on the theory that all three treatments are essential to achieving the survivor objectives. Quite frankly, if I’m risking my life expectancy and giving up QOL, then, I want to re-think the entire treatment plan.

[TMcgee]

Not to put you on the spot, but I’m still unclear as the Docetaxel and Abiraterone’s relationship? If chemo kills the cancer, why do I need the Abiraterone during the chemo treatment cycles?

BTW: thank you for the suggestion. I suspect that my MO will like.

[tango65]

What happened to your liver enzymes when you stopped abiraterone? Docetaxel could also increase the liver enzymes.

If the liver enzymes came down after stopping abiraterone, they could do a triple plan using darolutamide like in the Arasens trial.

ascopubs.org/doi/abs/10.120...

It has been approved by the FDA.

[TMcgee in reply to tango65]

after my 1st cycle, AST=351, ALT=663 and ALP=479. I stopped all supplements (Tylenol was an issue) and Abiraterone. Enzymes returned to normal range.

In reviewing the ARASENS study, I noticed some of the same challenges with enzymes. During my treatment session, I asked the PA about switching to darolutamide. I haven’t received a response yet.

Thanks for the response.

[Hopeful129]

could you ask to add Daralutomide? My husband was on that as part of the triple therapy. A year later now with some radiation thrown in after chemo, there are no side effects to Daralutomide other than the ADT effects

[TMcgee in reply to Hopeful129]

Hopeful: did your husband take SOC+Docetaxel + Daralutomide together; or the Darolutamide after SOC+Docetaxel? Thnaks

[Hopeful129 in reply to TMcgee]

he started Daralutomide then started chemo 2 weeks later, along side SOC.

[TMcgee]

thank you for responding. Glad to read that your husband is responding to the treatment. I responded to Tango above about darolutamide.

As best I can tell, there has never been a study comparing darolutamide and Abiraterone head to head. One study ncbi.nlm.nih.gov/pmc/articl... evaluated previous studies and concluded that Darolutamide was best overall performer with Abiraterone second. The study narrows the field, but doesn’t offer the specifics that I’m seeking.

[TMcgee]

I completely Agee with you!

[Hidden]

To answer one of your original questions about Docetaxel. How it affects pca cells is different than abiraterone.

Docetaxel interferes with how the pca cells divide. en.m.wikipedia.org/wiki/Doc...

[TMcgee]

thank you so much!

[GoBucks]

My liver enzymes went crazy too after 7 months of abiraterone. Stopped completely until everything normal. Restarted at 500 mg and went up to 750 when liver tests were still normal. Stayed there until recent vacation. Still <0.01.

[TMcgee]

thank you! Very helpful information. I have asked MO to perform labs to make sure that Docetaxel isn’t causing elevation; and then, put me back on Abi at a reduced dose and check it a week before 4th cycle. Waiting for response

[TMcgee]

I found this follow-up study to the Peace1 trial. The study analyzes “ym” (under 70 years old) versus “om” over 70 yrs old. Median time before the Abi stopped working was 30 months for om versus 42 for ym. Those om that tolerated the triple therapy received similar benefits to the ym. It seems obvious to me that MO should be doing everything possible to keep me on the triple therapy (no idea what the help would be).

ascopubs.org/doi/abs/10.120...