Abiraterone - alternatives

[NLondon43]

Only 3 months after completing 6 rounds of Docetaxel my husband was put on Abi as his onco felt the chemo had been unsuccessful. However the onco is now saying he will pull him off the Abi as his PSA has doubled for the each of the 2 months he’s been on it. In the UK once you’ve been on Abi for 3 months you can’t get Enzalutamide - should we therefore be asking for Enza before the 3 months are up ? Note- when we asked the onco this question he said if the Abi fails the Enza will fail.

[Magnus1964]

Just because zytiga fails it does not mean xtandi will fail.

[NLondon43 in reply to Magnus1964]

Yes, that’s what we feel, we may have a battle with the oncologist though!

[NLondon43 in reply to Magnus1964]

Thank you for your response by the way!

[Hidden]

Xtandi is the next step after Zytiga failure.

[Hidden in reply to Hidden]

Not always.

[Hidden in reply to Hidden]

And you would know, how? Your posts dont even reflect you belong here.

(Fixed autocorrect)

[Hidden in reply to Hidden]

It's your, not you're.

[NLondon43 in reply to Hidden]

Thank you for your reply, that’s helpful, although NICE (our equivalent to the FDA) would argue that it isn’t. But surely if it’s considered to be the next step in the US it should be worth a try! The oncologist literally shrugged his shoulders when my husband asked what next if Abi fails.

[Tall_Allen]

He is right that Xtandi will not last long if Zytiga fails. I know Pluvicto has not yet been approved by NHS. Can he get Xofigo.

[NLondon43 in reply to Tall_Allen]

Thank you TA. Yes, he can get it in certain hospitals but I suspect we’ll have to make a fuss as the oncologist didn’t suggest it.

[j-o-h-n in reply to NLondon43]

Make a Hizzy Fit....? Did Your doctors take a course in Hizzy Fitting? Tell them you took a course in checking for hernias and would they liked to be checked?

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 08/04/2023 1:56 PM DST

[Hidden in reply to Tall_Allen]

I just discussed with my MO, she mentioned Xtandi after Zytiga failure will give you median 19 months.

Zytiga after Xtandi will fail.

[Tall_Allen in reply to Hidden]

Xtandi after Zytiga lasts longer than Zytiga after Xtandi. They both last longer if given together with Chemo.

[Medline]

Dexamethasone is a CYP17A1 inhibitor, like Abiraterone. On paper, Simvastatin reduces steroidogenesis by inhibiting CYP17A1. Curcumin is also a weak CYP17A1 inhibitor [pubmed.ncbi.nlm.nih.gov/315...].

Inhibition of AKR1C3 activation by Indometacin overcomes resistance to Abiraterone. Melatonin, which has a similar chemical structure to Indomethacin, is also an AKR1C3 inhibitor [melatonin-research.net/inde...].

[Proflac]

Ask about Pluvicto. Not yet approved for NHS due to cost but if you have the means you can get it privately. It may not be suitable - depends on PSMA scan which unfortunately you will probably also have to pay for. Also ask your consultant about clinical trials he might be eligible for. Good luck.

[lcfcpolo]

My understanding is that in the first 3 months in the UK they will switch you to Enzalutamide from Abiraterone if the side effects are bad with the first taken or vice versa. Even if switching to Enzalutamide does not last long, at least it is buying time and who knows he may have a great response, although trials indicate this is unlikely.

I wonder if reaching out to a German or Australian or even Azerbaijan or Turkey or Indian hospital is now a good thing. They are much more experienced than the UK and I understand cheaper as well regarding Pluvicto (LU177) and the alpha drugs such as AC225, J591 etc.

Good luck.

[NLondon43 in reply to lcfcpolo]

Thank you, we feel the same. In the appointment it was like the onco was saying ‘oh it won’t buy you much time so just go away and die’, the whole consultation was so mishandled.

[lcfcpolo in reply to NLondon43]

If you look online you can pay for a second opinion at The Royal Marsden. I believe appx. £500. In theory these are the best of the best in the UK.

I think the suggestion of Nubeqa is also a good one, it might be worth approaching the manufacturer directly to see if they will supply for compassionate use.

Sorry that I cannot help more. Only other thought was have they checked biopsy or can they do a blood draw to check for any DNA mutations.

[BigTom123]

Nubequa?

[NLondon43]

Thanks for your reply. You have to be non-metastatic for Nubequa and he has extensive bone mets, although the Docetaxel seemed to clear the lymph nodes, seminal vesicles and the prostate capsule.

[Bret5 in reply to NLondon43]

That’s not correct. Nubeqa has 2 approved uses and one of them is for metastatic. This is explained on their website. Also, I know because I’m on it and I have numerous bone lesions. Triple therapy which Consists of Eligard injections plus Nubeqa pills to take testosterone to undetectable, Docetaxel chemo, and Zometa for bones. At City of Hope in Newnan, Georgia.

[rsgdmd]

I am in somewhat similar similar circumstances. Finished chemo last Nov. and in Jan. my PSA started to rise. Tried switching to dexamethasone from Prednisone with the abiraterone, as studies show that can help, but didn't in my case. When I had quadrupled from my PSA low and was above 2.0, my MO felt I was castrate resistant and stopped abiraterone. She felt Xtandi would not be worth trying as only 20% chance of success and even those don't last long.I qualify for Keytruda due to genomics of my cancer so recently started that. Still on Lupron.

[RoseDoc]

Ask about Nubeqa. It seems to be the new favorite in the US.