Expectations after six cycles of Taxotere

[ronton2]

My husband was diagnosed with advanced prostate cancer nearly three years ago, receiving a regimen of ADT, which included abiraterone, Lupron and prednisone. When that no longer worked, he started first-line chemotherapy. He just completed his sixth cycle. His PSA dropped until the sixth infusion, when it rose slightly from 1.3 (his lowest number). What can he expect going forward? More infusions? How long will the treatment keep his disease from rising. His last PMSA Pet Scan showed no bone or organ involvement, just lymph mets. His oncologist is terrific but I, his husband, would like to hear from others on this site who have undergone similar treatments.

[tango65]

This is the info of a RCT for docetaxel. The median progression free survival was 6.3 months.

nejm.org/doi/pdf/10.1056/NE...

After progression from docetaxel there are other therapies available.

It is possible that docetaxel will re-sensitize the cancer to abiraterone or enzalutamide.

Then there is Lu 177 PSMA treatment, xofigo (Ra 223), Olaparib, rucaparib keytruda, combination of drugs, a large number of clinical trials with new drugs called protacs, and immunological trials etc..

At this time he could request Provenge a vaccine which can prolong life.

[spencoid2 in reply to tango65]

Isn't the linked study a bit old to be considered relevant?

[tango65 in reply to spencoid2]

I don't know of a more recent RCT of docetaxel in mCRPC after failing ADT plus an antiandrogen drug.

[tango65 in reply to spencoid2]

This study could be considered a more recent RCT of docetaxel.

Docetaxel is the control group and there were up to 10 cycles with docetaxel in patients with mCRPC who failed enza.

ascopost.com/news/october-2...

[Woodstock82]

By the time I had my last Taxotere (docetaxel) infusion my scalp hair was already growing back, but then I suddenly lost half my eyebrows, most of my eyelashes, and my nose hairs. I sniffed and sniveled and blew my nose a lot. It took about six more weeks before I felt like I was back to normal.

My PSA reached a nadir about nine weeks after my last infusion, then started to climb slowly but steadily. Seven months later it had doubled, so I was formally declared "castrate-resistant" and started on my next treatments -- Zytiga and Jevtana. That was over two years ago, Since then -- so far, so good. My PSA has stayed down, my mets are not growing or spreading. The side effects of the ongoing Lupron and Zytiga are no fun, but the treatments are doing what I need them to do.

[ronton2 in reply to Woodstock82]

He may be headed for Jevtana or other new treatments. He may re-try Zytiga, according to his oncologist. Thanks for your reply, Woodstock82

[Jimmie1939]

My husband passed about a year and a half ago. He had metastatic bladder cancer. He went through all kinds of surgery, chemo, etc. I wish he had undergone the targeted immunotherapy first. That was quite new at the beginning of his illness. I feel you should ask your oncologist about the DNA/geno testing and discuss the newest targeted immunotherapies with them for your husband.

I answered this because I know the trauma you are both undergoing with your husband. It is hard to cope with so many opinions. Your oncologist is your best resource for proper and innovative targeted therapy treatment.

[ronton2 in reply to Jimmie1939]

Jimmie1939, Really appreciate your reply. I have read about targeted therapy but my husband has not discussed this with his oncologist. Meeting this Tuesday and I will attend and bring up questions taken from your answer. Yes, this is traumatic and frustrating but I refuse to let us wallow. Innovated targeted therapy is a best place to start. Thanks.

[Marshb52]

Lipton worked well for me. After about a year of it and a few months off I’m actually getting testerone boosters and feeelong great. Having practically no T makes for bad changes in the body especially weight gain. Keeping an eye o PSA but hopefully I can keep off it. I didn’t make a good woman!

[ronton2 in reply to Marshb52]

He has exhausted Lupron. But thanks for replying.

[ron_bucher]

If PSMA shows lymph node tumors, aren't they radiating those?

[ronton2]

ron_bucher, That is a good question and one of the reasons I posted. I will be with my husband when we meet with the oncologist and I plan to ask him about your statement. Many thanks. This site is so helpful.

[slpdvmmd]

Sounds on the surface like he may meet criteria for Lu177 which is probably most effective in nodal disease vs bone. You really need to read your individual insurance coverage as the exact criteria will noo doubt have different twists and turns based on the coverage.

Overseas Lu177/pluvicto may also be combined with external beam radiation if the disease is confined to a specific lymph node bed

The insurance document will have a statement similar to this:

Age > 18 y/o and ECOG performance status 0-2, AND

Documentation of a PSMA positive PET/CT scan*, AND

Documentation of serum testosterone of <50 ng/dL (< 1.7 nmol/L), AND

Prior treatment with one or more AR (androgen receptor) pathway inhibitor (e.g. enzalutamide [Xtandi] and/or abiraterone [Zyitga], and/or apalutamide, and/or darolutamide, AND

Prior treatment with one but no more than two taxane agents (e.g., cabazitaxel and/or docetaxel), AND

No combined concurrent use with immunotherapy or cytotoxic chemotherapy, AND

No concurrent use with any investigational agent or another radiotherapy

* Either 68Ga Prostate specific membrane antigen (PSMA) -11 [Locametz] PET/CT OR 18F DCFPyL (piflufolastat or Pylarify) PET/CT would be covered for consideration of the use of lutetium (Lu 177) vipivotide tetraxetan for:

The treatment of documented progressive metastatic castrate resistant prostate cancer (mCRPC) OR

For salvage therapy when ALL the below criteria are met:

a. Original clinical stage T1-T3 and NX or N0 treated with prostatectomy and/or radiation therapy, with biochemically recurrent/persistent disease (1).

b. Results of conventional imaging (2) performed within the past 60 days are negative for metastasis

c. Patient is a candidate for curative intent salvage therapy (3)

d. PSA level is > 1 ng/ml or PSA is rising

e. PET/CT has not been performed within the past 3 months

[ronton2 in reply to slpdvmmd]

Can't thank you enough for responding with such detail. Yes, it does appear that he would be a good candidate for Pluvicto. He is seeing his oncologist in three weeks for another infusion and a game plan for the way forward.