just an update from my last post. Martins prostate cancer which has now spread to his liver showed 4 small mets on the latest scan. 1 was large enough to do a biopsy. It is now showing small cell prostate cancer which we understand is quite aggressive. We are still waiting to see if the biopsy shows BRCA 1, BRCA or any other mutations. He is starting Carboplatin-Etoposide chemotherapy tomorrow. Has anyone had this type of prostate cancer and been given this mix of chemo? We have basically been told that if this doesn’t respond there is little else they can do.
Martin still has no symptoms. Feels fine and is working away. Any knowledge of this would be much appreciated.
The MO doesn’t think the cancer will he PSMA avid anymore so that rules out Pluvicto.
Thank you,
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I am sorry to hear about this new development. I am sure that T.A. or one of the other more knowledgeable members will chip in soon but in the meantime .....
I understand that small cell prostate cancer usually responds well to this type of chemo combination. Will there also be radiotherapy and immunotherapy? I notice that this is what they seem to do in the U.S.
This trial: clinicaltrials.gov/ct2/show... recently reported some success and I think it will be moving onto another phase shortly. It might be worth contacting them directly to see when the next one will open. There were three sites in the UK and I think Ireland has some sort of reciprocal agreement with NHS UK.
I haven't seen any results yet from this trial: clinicaltrials.gov/ct2/show... but someone else may know about this. Again it isn't recruiting at the moment but I guess if they have had positive results they may do so soon. It had a site run out of the Royal Marsden in London.
One member here was in contact with a group in Germany who may be working on a theragnostic for small cell prostate but no update as yet. I will keep you posted if I see anything.
Dr. Jason Lewis in U.S. is also developing a theragnostic to target DLL3 but his work will not get to trial for around a year from now. I think they will accept overseas patients on trials in U.S. but of course all of the testing etc has to be self paid. Again I will post if I see anything on this.
It also might be worth contacting Dr Sen's group in India to see if they think Fapi or PRRT will be of any help. I think you would have to travel there for scans to check this but you could contact them and ask. They seem very helpful.
hi Nicola. Thanks for replying and sending on the links. It looks like it is an uphill battle and is quite scary. They scan after 3 cycles of chemo to see if it is working. Hopefully it will be. It is only 4 years since Martin was first diagnosed with prostate cancer so things have progressed rapidly. Please God he will go into remission and buy some time. We will travel anywhere for treatment.
Thanks very much TA. Really appreciate it. Martin going to discuss Trials with his MO tomorrow. Would be good to have a backup plan after chemo if needed.
Hi Chris. Martins latest lesions are in his liver. The largest was 12mm. They were able to carry out a biopsy on that. They were found on a Ct scan and an MRI
I have had multiple lesions on the liver since last year, went through chemo with jvantana from last September to March of this year. The biopsy showed it was not small cell but ordinary prostate cancer, a plus for me. Have been on ADT since 2018 and xgeva since 2019. I am back on chemo with doxetaxel that I had back in 2018. The PSA was 502 before the chemo and is 133 after two treatments, will know if it dropped more next week after blood tests. Feel good other than the typical side effects of fatigue, hair loss and taste loss for a week after. If this does not keep the PSA down then there is Y90 SIRS radiation treatments so we forge ahead and keep on fighting, the radiologist said I am very healthy other than the cancer. He also said with all this chemo i a have a tough liver and kidneys, both are operating normal.
Hi! My dad is in the same boat. He started the same chemo drugs, just finishing a second round. He has tolerated it really well but his first scan is next Friday so we’re hopeful. My parents met with Dr. Andy Armstrong at Duke and he made us aware of some clinical trials but we are also still waiting to hear back about mutations. We were also made aware of a trial that is going to be live and recruiting soon but isn’t online yet apparently. I’m happy to provide any info if needed.
Hi- I have been in the Duke Champ trial since January 2023. It consists of 2 chemos, carboplatin and Cabazataxil and 2 immunos nivolumab and ipilumab? Sp? I believe they are the same as opdivo and yervoy? I have responded well and have been able to tolerate both forms of treatments with little to no side effects. We stopped the double chemo after 6 sessions as my scans were clear compared to beginning scans. I have continued with only the alternating immunotherapy. I just finished round 10.
My cancer is considered the aggressive variant type which qualified me for this trial. No mutations. My psa was 2.47 in the beginning and it went as low as .01 in the trial. Unfortunately, my last psa reading increased from .03 to .08 in 3 weeks and my recent scans show some new activity so it may no longer be working for me. These type cancers are not usually psma avid and psa readings may be misleading. I have progressed in the past at a psa of .01. I pray and hope for the best and send the same to you and all the warriors on this site.
The metastasis to the liver in prostate cancer is a bad prognostic sign. Most of the time the liver metastasis does not express PSMA receptors so you are quite right that if this is the case, then Pluvicto therapy is ruled out. In the present scenario, the Carboplatin-Etoposide chemotherapy combination is the best option.
Thank you for your reply. Do you think Provenge would work or keytruda/Pembro? My husband is still asymptomatic. If we hadn’t seen the scans he would not know he is so ill. He has completed 3 cycles of chemo now and is tolerating it very well. Any advice is greatly appreciated.
Please ask your oncologist to test for PD-L1 as well. The KEYNOTE - 028 trial has shown preliminary evidence of antitumour activity of Pembrolizumab in patients with advanced PCa with favorable adverse effect profile. Another option though experimental at present is Lu177 FAPI based theranostics
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