Cabazitaxel plus carboplatin

[Arcticfox44]

Hello again - I had three treatments with Lutetium-177 at the Anadolu clinic in Istanbul after being referred there by Dr. Kwon at the Mayo. The last treatment was in February 2023 and my most recent PSA was 40. I had chemo with docetaxel at the Bank of Cyprus Oncology Center in Nicosia from Dec 2021 until April 2022. PSA fell from a high of about 60 to a low of about 8 and then began rising again. The Mayo specialists, Dr. Kwon and Dr. Orme, have suggested chemo with cabazitaxel combined with carboplatin as a possible next step. This would probably be done in Cyprus, where I live. I'd welcome thoughts on side effects and how durable the treatment is likely to be. I have had no spread to bones and at the Mayo we discussed trying to grab some tissue to get a better idea of what is going on and where. There is some lymph node recurrence in the abdomen but it seems that in scans, including PSMA PET CT, some locations of PC may be obscured by intestines so location is somewhat unclear. I had another Guardant test recently at the Mayo which was negative. I was on Zytiga between April 2020 and March 2021. This produced a lot of swelling in legs and feet and while PSA stayed quite low, around 8, it fluctuated and never got below 8. I also began in the spring of 2021 to have loss of appetite and weight loss. I take dexamethasone, which was prescribed in the summer of 2021 to try to improve appetite. I've also had chronic lower back pain, which apparently is unrelated to PC. I have had scoliosis for some years. I am on Zoladex injections every three months.

[Fightinghard]

My untrained opinions.

Did Kwon continue to monitor and consult with you progress at the Istanbul clinic? Curious, why did you/he stop the LU at 3 rounds? If it was working for you, most do a minimum of 4 rounds and some do 6 rounds. Again, if still effective, going back to take a few additional cycles might help a lot. The LU has proven to be very good on hitting the soft tissue mets.

If the LU failed, then chemo with cabazitaxel would be the next step after docetaxel in SOC. I have no opinion about the benifits/risks of combining the cabazitaxel with carboplatin, except to point out that carboplatin is very hard on bone marrow, which might not recover.

If your cancer load is still fairly small and staying mostly in soft tissues, I would think about holding the carboplatin in reserve for now, and think about stretching each incremental drug to its limit of effectiveness, before moving on to another.

Remember that none of the drugs (so far) have proven to offer us a cure, so we are basically trading harmful side effects for more time.

Hope you are able to keep a focus on QOL. Some of our members like Kaliber and others have many posts to help brighten your day. Do a search on QOL and you should find lots of posts from the last year. Check them out.

Good luck in the journey we all share.

[Arcticfox44 in reply to Fightinghard]

Thanks for responding. Yes, Kwon was in contact. My PSA did drop some, for example from about 30 to about 20 during the Lutetium, It seems that Kwon did not believe it was worth continuing. Lutetium.

I notice that others have discussed docetaxel plus carboplatin. As mentioned, I had chemo with docetaxel only in 2022, which knocked PSA down to about 8 from about 60 at the start. I just wonder what would happen if I now had docetaxel plus carboplatin. Is that an option? One advantage might be that we know side effects with docetaxel were not too bad, whereas we don't know what they would be in my case with cabazitaxel.

Thanks again.

[Hidden]

Maybe you could try BAT if you d’ ont have bone pain. My hemoglobin value rose from 12 to 15 in month after testesteron injection.

[j-o-h-n]

Yiasou Levente..... mea yi-a Opa!

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 04/27/2023 10:50 PM DST

[Fightinghard]

at this point in the parade of bad drug options we have left, imho the cabazitaxel alone seems to be the best option. No need to blend in the old docetaxel and its side effects if it has lost its benefits. The cabazitaxel side effects are very similar but could be slightly milder. I am at about exactly the same point. Just did round 1 of the cabazitaxel this week. The dr added another companion drug Neulasta (given at least 24 hrs later) to help stimulate bone marrow. Btw the neulasta has a very neat autoinjector device available that the nurse prefills with your drug, sticks it on your arm, then it injects the drug at 27 hrs later no need to return to clinic no idea if the gadget is available in Cyprus

Just keep your chin up and continue to battle as best you can.

Keep us posted please

[Arcticfox44 in reply to Fightinghard]

Thanks again and good luck. I have calls with Kwon and Orme next week so we can go over this stuff.