In the CHAARTED trial, metastatic burden was divided into low burden (4 lesions). CHAARTED’s criteria seems to have become the standard for evaluating how metastatic burden affects choices of treatment and outcome.
I bring up the metastatic burden, because I could not find a clinical trial where ADT+AAP (Abiraterone +Prednisone) did not offer a superior outcome to ADT+D (Docetaxel) in 70+ year old patients with a low metastatic burden. When QOL is factored into the equation, the choice seems overwhelming.
I began this journey in December following the Peace1 “triple therapy” approach ADT+AAP+D. After completing my 1st cycle of Docetaxel, my MO took me off AAP and reduced my dosage of Docetaxel because my liver enzymes elevated. Effectively, I am on a treatment plan that matches the CHAARTED trial of ADT+D.
The CHAARTER, GETUG15, and STAMPEDE clinical trials confirm that I will derive a benefit from ADT+D, but there doesn’t appear to be any benefit that is greater than ADT+AAP.
I have completed 3 cycles of Docetaxel (3/4 dose). Is there any reason that I should continue beyond the 4th cycle? My preference is triple therapy. But, if I can’t continue on triple therapy ( Darolutamide has same enzyme issues), what do I lose by stopping Docetaxel and returning to ADT+AAP?
Thank you warriors! This experience is truly drinking from a fire hose.
Why not resume your triple therapy when the chemo is finished by restarting the ADT and AAP (or Daro)? So still triple therapy but one part gets postponed. I don't think it is that uncommon for the treatment to be adjusted depending on your response, particularly for the chemo part. But not sure what the impact of that is on treatment effectiveness or if it has been tested. I just finished 6 cycles of chemo last week and am on a similar regime.
OzzieJ. Hope you are doing well. I have interpreted “triple therapy” to be de novo concurrent treatments
If my plan was ADT+AAP until castration resistance; and then, I began Docetaxel, I never considered that to be “triple therapy”. Interesting point!
I think that you are stictly speaking correct but not every case fits exactly in a neat box and I guess that's where the oncos earns their money. My own case is BCR after RP and the treatment regime is essentially "triple therapy" with Doc + ADT + Daro. My onco, who is a teaching professor, explained that not everything is exactly covered by a trial and it is sometimes necessary to draw inferences as to what is the best treatment in each case even if not exactly by the book. Keep drinking from the firehouse followed by a stiff glass of whiskey.
Forget about all this stuff, your Bio ends with you off to ski in France. I want to read about the trip! 😁
Your teaching professor is spot on. I’m over seventy. But, I don’t have hypertension, obesity, diabetes or any of the co-mobilities that skew the statistics. It is evident to me that the drug maker wants trials with young healthy metastatic participants, despite the fact that most of the patients are old and already sick.
What is next for you?
I would have been depressed of I didn't get out skiing this season so it had to be done. Next up is 8 weeks of RT starting in three weeks time. I am also on ADT for 3 years and they will add second level hormone therapy which I think is Darolutamide (to be confirmed). My onco wanted to give me a few weeks to recover from the chemo before starting on more hormone treatment. Fun and games.