Need Help with Next Gen ADT

[swwags]

I haven't updated my bio for awhile but I am still hormone sensitive MPCA. My PSA last month was undetectable. I had a bilateral orchiectomy in February but was also on Erleada which I stayed on until recently.

So what's changed is that I also have Stage I Multiple Myeloma. Erleada and Xandti are both Contraindicated with my MM protocol.

I won't see my One again until November but am working with his PA who spoke to him about ADT.

He wants my to take NUBEQA® (darolutamide) - His first preference.

Otherwise ZYTIGA® (abiraterone acetate) - his less preferred. I looked at side effects of both and see little to no difference other that abiraterone lists Infected nose, sinuses, or throat (cold) as a common side effect. Infections are obviously dangerous when the MM treatment goal is to wipe clean your white cells.

MM, for those that don't know has my white blood cells overtaking my marrow, then eventually bone tissue, and the treatment involve wiping out the cells using Revlimid and Brotezomib. Also, Dexamethazone is used as part of the 4 month long induction therapy, with the goal to put my in remission. That's followed by a stem cell transplant but that's for another time

Question, and I will ask this of the PA on Monday, why would the oncologist prefer daralutamide over abiraterone? Or differently stated, can someone any of you weigh in on the differences?

Greatly appreciated as always.

[Tall_Allen]

There have been no randomized comparative trials. As you surmise, most of the side effects are due to ADT anyway.

In favor of abiraterone is that you will be taking a hefty dose of steroids anyway for your MM, so extra prednisone won't be required. Also, there is excellent evidence that ADT+abiraterone is advantageous for men who are metastatic and hormone sensitive, like yourself, while there is no such data yet for ADT+darolutamide (only for ADT+darolutamide+docetaxel).

Darolutamide does not cross the Blood Brain Barrier, so if you are prone to seizures, or the MM meds make you more prone, it may be a good choice. Also, in lab tests, it doesn't activate GABAA receptors, so it may make one less drowsy. But this has not been proven clinically yet. But if the meds for MM make one drowsy, it is something to consider.

[swwags in reply to Tall_Allen]

TA thanks very much. I did neglect to mention that insurance only covers it in combination with docetaxel, which you note is the typical protocol for hormone sensitive, but learned today my Oncologist put it an auth request with premeditated plan to appeal a denial. Again, I'll ask why Monday. Not seizure prone and only been on MM tx for 4 days but thus far only minor side effects. I appreciate the quick reply. This helps thank you.

Edit. I did review and three of the four medications list seizures as a side effect.

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

My M.O. recently took me off Casodex (but still on Lupron) and put me on Nubeqa. I am very fond of my M.O. but he told me the reason for the Nubeqa is that he now gets a bigger kickback.......🦨.................... (I pray my M.O. doesn't read H.U.).....

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 09/30/2023 2:05 PM DST

[Ahk1 in reply to j-o-h-n]

Are you serious about the kickback?:-). And he admits it? I am very surprised

[j-o-h-n in reply to Ahk1]

Let me put it this way......... When I met my first wife...... I told her I had a foot size there.... she challenged me to prove it.... So I showed her..... and of course she said...."that's not a foot" and I said "Hey, why quibble about a few inches?"

nuff said???

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 09/30/2023 4:03 PM DST

[swwags]

Update on this. I didn't get to talk to the Oncologist Monday but spoke with his Nurse Practitioner. They are appealing the denial of Daroltumide. She said the Doc's thoughts were that Darolutamide was more efficacious but as importantly, fewer side effects when having to deal with the SE of MM drugs. I'll talk efficacy with him in November when I see him. Hopefully the appeal will be resolved and I'll be on one or the other by then.

[swwags]

Another update. I wish I was seeing the oncologist sooner but so be it. I was approved for abiraterone. TA to your point, at least I'm already on the corticosteroid for MM. I may try to push him for the Nubqa as the MM drugs all have risk of seizure and I feel like Abiraterone is just piling on. I'll chase it in a month.