Thanks to the many on this board that offered suggestions I will soon complete a slightly modified triple therapy of ADT+ABI+Docetaxel. My challenges with side effects included eliminating Tylenol and reducing ABI for one cycle; and then, switching from 1000mg ABI on empty stomach to 250mg ABI+ 10mg Prednisone with low fat breakfast. The end result was PSA dropped to .55 and liver enzymes returned to normal range. The only snafu is a CT scan for breathing issues showed more bone Lesions (2 lesions found during bone scan). Thus, there is a possibility that my diagnosis changed fro low to high volume during the period between initial scan and treatment.
Now, my questions: First, I have read extensively about Nubeqa and it seems to be the better alternative for maintenance after Docetaxel. Outside of the cost issue, is there any reason not to switch from ABI to Nubeqa?
Second, what should be my next steps after triple therapy? Outside of the liver enzymes issue and a breathing issue that went undiagnosed, I was able to continue daily workouts, lost 12 pounds, and seem to tolerate the treatment well. Suggestions?
BTW - thanks to everyone with their help and suggestions to date. Everyone here is awesome!
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TMcgee
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Can't really help with your specific problem but just wanted to say that Travis Mcgee was one of my favorite characters in all fiction of which I have read a lot (Current fav is Joe Pike by Caris) I have followed McDonald's advice and enjoyed an early retirement.
I am living the life of a seventeen year old as well. went to a Sam Cooke/ Ray Charles concert last night and danced in the aisle next to our seats. Not giving up sex that easily, although it is much different than when I was 17.
I did get high enzymes from Abi and reduced dose, now back at full strength and liver is normal. So maybe you can still get some mileage out of Abi.
Yes, we seem to have very similar literary interests. Recently, I have become a big fan of CJ Box’s Joe Pickett and Johnson’s Longmire. Both have a Joe Pike character. Candy for the mind during those days when life isn’t normal.
thanks I will check them out… literally as I get the books on cd at my library. I listen to them at bedtime and they put me to sleep by the 2nd or third chapter..
No greater luxury than somebody reading a story to you.
I am very lucky, my local library offers online audio and Kindle editions for 21 days at a time. It’s a life saver. BTW. In reading your profile, you are (or were) taking 250mg ABI with yogurt. Any issues?
I am on Xtandi right now which is Nubeqa's older brother. I was on Abi my first go round. I prefer it because I don't want added steroids and it is easier to take since you don't have to worry about time of day or with food or splitting up the 2 drugs. I would have preferred Nubeqa as I understand it doesn't cross the brain blood barrier and that seems relevant to me whether any has been proven yet or not.
So far side effects have been about the same on both. I am also on Lupron 3 month shots.
TA. What is the difference between taking Lupron+ABI+ Docetaxel concurrently and triple therapy.? Also, why is 250mg of ABI with food less effective than 1000mg on an empty stomach? Isn’t the absorption 5x?
"What is the difference between taking Lupron+ABI+ Docetaxel concurrently and triple therapy.?" I may have misunderstood. Triplet therapy is concurrent. I thought you were saying that you wanted to start Nubeqa for maintenance after docetaxel, which sounds like you are using it sequentially. But it is better to take an adequate dose of Nubeqa than the inadequate dose of abiraterone that you have been taking. If both doses are adequate, there is no known reason to prefer one to the other.
"Also, why is 250mg of ABI with food less effective than 1000mg on an empty stomach? Isn’t the absorption 5x?" The average absorption is 5X, but results vary widely among individuals. That's why, now that cost is no longer an issue, it is better to be certain of the biologically available dose you are getting. In your case, you obviously were not absorbing enough. Your first clue should have been the reduced side effects - side effects would not be reduced if you were absorbing the same amount of the drug.
“In your case, you obviously were not absorbing enough. Your first clue should have been the reduced side effects - side effects would not be reduced if you were absorbing the same amount of the drug.”
I spoke at length with my MO about your statement. In a prior post, I alluded to overdosing on Tylenol daily and it being the cause of my elevated liver enzyme issue. Originally, MO dismissed my theory, but after tracing my enzyme numbers versus my changes in therapy, he agrees that Tylenol was the contributing factor.
Now, I have the issue of trying to figure out how much Abi is necessary. My MO wants me to stay on Abi and I want to take the drug in the morning with food for QOL reasons. According to the FDA label, I can add fat to my Yogurt to increase absorbency. So, how much absorbency is too much?
Currently, my PSA has dropped from .57, .55, .44 which is the only indicator that I have. I end my Docetaxel in 2 weeks; and then, I plan to decide if I should return to 4x250mg or stay with 250mg and add fat to improve absorption. How far over 1000mg is safe? I couldn’t find any trials where higher dosages were evaluated.
"for QOL reasons" - What QOL reasons? If equal amounts are bioavailable, there are equal side effects. Only the dose that is actually absorbed contributes to side effects or efficacy.
Higher doses of 2000 mg were tried in the Phase 1 trials - it had no greater efficacy but more side effects.
Well, we really never get to KNOW the bioavailability of any drug we are taking because they never test for that! Even when there is metabolic issues, absorbtion issues, etc., with oral medication. So we can regurgitate what studies have shown, but we will never truly know how much drug our body is getting. I've traveled this path with my MO at one of the leading PCa Cancer Hospitals in the country.
Very deep rabbit hole to venture down, the Maximum Tolerable Dosage as established by study, yes, by the drug companies that will sell you the drug vs the possible Minimum Effective Dosage that would achieve the same results... Biochemically as in regard to the individual!
And the Darolutamide is a 2nd generation inhibitor for a reason. If you can get your insurance to approve it, I believe it is worth it. Here's an indirect look between them:
After 15 years of Lupron and casodex my M.O. took me off casodex and replaced it with nubeq/a (/=no u). Been on it for a month and so far no side effects except I'm losing my sense of humor.
j-o-h-n <===<<< Senior management is about to spike my spikes....
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What next? Abiraterone->Docetaxel->Cabazitaxel-> ?
Update
Post-Docetaxel: Holding Steady
