With Xtandi failing and my metastasizes not PSMA avid enough for Lutetium my MO referred me to the Kinghorn Cancer Centre in Sydney to be assessed for a clinical trial involving BAT and Carboplatin (chemo). I am now in the trial and have had my first testosterone injections plus the carboplatin infusion. After 1 week my PSA flared from 50 to just over 90, in other circumstances this would have sent me into a major meltdown but the experts assure me this is a common occurrence and it is possible my PSA will remain elevated while I receive the testosterone boosters. Apart from the PSA response, side effects have been limited to a couple of days of fatigue. I am scheduled to have follow up bone scans in late November - so until then its wait and hope.
BAT trial: With Xtandi failing and my... - Advanced Prostate...
BAT trial
Good luck mate!! I didn’t know there was an Australian BAT trial, I hope it does the truck for you…
Stuart
Thanks Stuart, it's called Hitech trial, NCT03522064 and is sponsored by St Vincent's Hospital Sydney. It feels like I've bet the farm on this, so by December I'll either be a very happy camper or checking out exit strategies.
Hah, but if you do exit, you'll hopefully be built like the Hulk when you get to the other side of you exit!!!!
Good luck, thank you for keeping us in the loop.
Good luck. Let us know how it goes.
My understanding is that you are not passing the inclusion criteria for that trial with carboplatin and BAT as they require you to have a BRCA genetic mutation.
You had a genetic testing some time ago and they didn't find any actionable mutation back then.
Did you have a new somatic testing and qualified or did you just let in into this trial without passing the inclusion criteria?
One more thing. I had a discussion about this trial with TA and he suggested me to ask the lead MO of the trial why they are not administering Jevtana (cabasitaxel) with carboplatin as it is proven to be very effective if you have a BRCA somatic mutation. Could you ask for that information? Maybe it will help you with your cancer. I assume that you are passing the inclusion criteria and that you have a BRCA somatic mutation.
Thanks Seasid, oddly enough I didn't challenge their right to include me in the trial. I have no idea of the trial design or the statistical model they intend to use to slice and dice the trial results. All that is way beyond my pay grade. I think I can assume the team at Kinghorn are aware of cabazitaxel and my understanding is they chose carboplatin to test if it might also be a viable option for treating metastatic prostate cancer. Cancer trials are not risk free - the trial managers are happy to have me in the trial and I am very happy to be included.
Maybe you could ask for guardant 360 cdx liquid biopsy as your PSA is very high now or alternatively (even better) you could go to Peter Mac cancer Centre in Melbourne and they could biopsy you so you can know for sure your genetic mutations.
Once you are in Melbourne you could ask for a second opinion from dr Murphy. I believe you could even have a telephone appointment with him for about 400 dollars and he could then consultant the tumor board of the hospital in Melbourne. They are the best cancer Centre in Australia and the 20th best in the world.
Just ask your GP for a formal referral for second opinion. It is totally fine to have a second opinion if we have a terminal ilnes.
The problem with BAT is that it doesn't extend life.
I was myself thinking about BAT and that was one of the reason that I irradiated my prostate in order to kill the CRPC in my prostate and to be more carefree if I end up doing your trial also.
I didn't do the genetic testing yet but the reason behind is that the genome of the cancer always changing and I concluded that a fresh biopsy would be more useful to determine the treatment.
Currently I am still doing fine but my PSA started to rise rapidly and I would like to get a baseline parametric MRI of my irradiated prostate and the surrounding area in order to see if the irradiation killed the CRPC or if there is any repopulation with cancer.
I believe that the guardant liquid biopsy cost 5000 dollars and it may not be accurate but if you can spend the money than it could show you if you have other treatment options.
The following test is available through DHM pathology and it is po paid by Medicare. You could find out if olaparib parp inhibitor or keytruda immunotherapy could be beneficial for you:
sonicgenetics.com.au/our-te...
Thanks Seasid, all good suggestions. I haven't asked the Kinghorn center for a treatment program, I simply applied for a clinical trial they are managing. They are linked to the Grattan Institute and St Vincents Hospital, possibly not a flash as Peter Mac but still a pretty good pedigree. I have been impressed by their expertise and energy, until my current course fails this is what I am committed to.
I have to add that it is now too late for a biopsy as you are already doing a chemotherapy and there is a danger from infection because of your compromised immune system during chemotherapy.
You could ask for a biopsy later if they believe that you need it. I wanted to have a CRPC biopsy of my prostate before my prostate irradiation but professor Joshua said that it would be interesting but not necessary.
I think the point of BAT here is to accelerate the growth of the prostate cancer so it will be more responsive to chemo which might extend life.
Will follow your BAT trial with interest.
What is the protocol for testosterone? How many months on and how many months off.
What meds do you take while on the no testosterone phase?
clinicaltrials.gov/study/NC...
You can find here all the information about the BAT trial.
Thanks
Do I have it right ?
Continuous Lupron
A shot of testosterone + carboplatin once a month?
Hello Scout, in my case it is continuous Zoladex. I had to cease enzalutamide 3 weeks before starting the trial treatments. The treatment cycle is every 6 weeks with 2 shots of testosterone, one in my right and left buttocks. I then have the chemo infusion that takes a bit over an hour. I have blood tests before and at 1 and 3 weeks after treatment with a teleconference the day after the blood tests.
Please keep us updated on your progress.
Hope it works for you mate.. good luck! Never give up
All the best! After a couple of cycles you will have information telling you if you are indeed a responder. I am doing a self administered form of BAT. So far so good. You may be interested in this video. urotoday.com/video-lectures...
Hi there! I am not sure if they are recruiting in Australia, but check for arx517, I forgot the name of the trial but that’s the molecule. Maybe it could help you if you can get into that trial.
The PSA increase is completely normal. I would be concerned if your non-zero starting PSA did not go up during high androgen treatment. Hopefully they are also measuring testosterone. I would want to measure either SHBG or free testosterone.
PSA is overexpressed by androgens. Trial data indicates 5-7x. This is why some guys claim that finasteride and dutasteride "treat" PSA. I have heard talk about this like it is some type of black magic (some men even talk about supplements like curcumin which has a fraction of the PSA repression). The truth is not so sinister. We simply need to understand how the KLK3 gene is expressed and realize that PSA is not cancer. It is a test marker.
ARSIs (e.g., Xtandi) repress PSA 80-90%. We can use PSA for a crude indicator by comparing values during similar environments.
I typically let my PSA fall to around 0.2. But when androgens go high, KLK3 is stimulated, and my PSA goes over 2.0. It is straightforward to take PSA to undetectable values and back to high values in a brief period.
The chemo/BAT trial could prove to be a huge win for us. The theory is that DNA double strand breaks will be induced by both therapies. This has been shown preclinically.
After chemo/BAT there is a good chance that you will be resensitized to ARSIs. Clinicals show 60%-90% resensitization and the duration and efficacy are improved. Duration by a factor of two.
Do not buy into simplistic statements that BAT monotherapy does not improve OS. New trials are packaging BAT into sequential therapies. We have already shown the sequential survival advantage, but the pre-determined trial objectives didn't include the appropriate goals. This is being corrected.
Interesting, I am doing the same theraphy. BAT + ARSi, even my PSA numers are the same. I let the PSA rise for two months, then Daro to bring it back. I add Ola this time, will see if it ha additional effect.
Hi Bjry Just curious, did you have a FDG PET scan as well as a PSMA PET scan ? If so, were your tumours rated as discordant and therefore you weren't a candidate for Lutetium? Good luck with the trial. I'm in OZ as well so will be following the results. Cheers.
I think that the SUV max was low.
It is only my guess.
Lutetium only kills the psma positive cancer. In short you can't really kill the cancer with psma treatment. The cancer will repopulate.
I was always interested in BAT. Unfortunately you have to be lucky with either BAT and the psma treatment. They extended life for couple of months.
In Australia even if Xtandi regain efficacy after BAT or chemotherapy Medicare would not pay for it again.
Hi Seasid thanks for your reply. I’m always interested to read your comments. Interesting that even though BAT might resensitise PC to Xtandi, I wasn’t aware that you wouldn’t be able to have it again on the PBS. Not sure why not. In any case I’m on Zytiga and possibly BAT doesn’t have the same effect with Zytiga. Nevertheless I will consider BAT as a treatment in the future either according to trial protocols or some form of modified BAT according to those on this forum and others that are using it. All the best.
It looks like that BAT may not extend life, but if you want to try it could at least give you an opportunity to get some testosterone and feel better.
I read somewhere that it is better if you radiate your prostate or that you removed your prostate and cancer from that area so you don't get surprises during BAT that you end up with the catheter or a blocked kidney etc.
PBS rules could be a real problem for us hanging around with this cancer for a long time. That is why I am saving money as Xtandi cost is 3400 A$ per month.
I did find an old post about how to get Xtandi from India, but that was if you are in USA, but it could work even if you are in Australia.
My sister from Serbia said that some people there getting Olaparib from Istanbul. I want to say with this that it may be possible to get Xtandi from India even in Australia much cheaper.
Olaparib from Istanbul Turkey is not cheap. It cost 6500 Euro but at least you can get it and extend your life.
I would not recommend olaparib until you run out of all other treatment options as Olaparib is very toxic, it works very well if you have a BRCA somatic mutation but usually stops working after two years. That card (Olaparib) is better to save for the very end as with the proper mutations it is very effective to extend your life for two more years but it stops working after that. Maybe keytruda after that if you develop a proper somatic mutations?
I recommend Peter Mac for biopsy if you will end up needing a biopsy.
Here is the information from an old post about how to get Xtandi from India.
immunity1Magnus1964
3 years ago
Greetings Magnus1964. I have managed to find your thread of yesteryear. I am likely to be requesting Xtandi over the next few weeks for my currrent situation following recent chemotherapy and Lu177 during 2020. This will follow my current (and 3rd over 5 years) treatment with Abiraterone (Zytiga). You mentioned that you had an opportunity of accessing Xtandi from India. Do you still knowa Dr there able to prescribe and supply it? Is that still possible? The cost of Xtandi here in NZ is over the top (>$20K for 2-3 mo). Difficult to assess but do you have any idea of the potency/purity etc of the Indian-source drug. Cheers, Rob.
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Magnus1964 profile imageMagnus1964immunity1
3 years ago
Yes, download the Whatsapp application to your smart phone. Here is the contact information:
: EMEDKIT, Mr. Singh, phone number +919811604429
He sells several different brands. Astellas is the US original brand.
You can also go online to Indiamart. There is a link to chat with a representative.
Here is a link to the old post about Xtandi from India:
One might consider an excellent read by Russ Hollyer r.e. - personal experience
*Adaptive Bipolar Androgen Therapy for Prostate Cancer*
Best of luck to you.
Good luck with BAT! I hope it goes well.
I interviewed for a BAT trial in Denver a few months ago. As I am still responding to Zolodex, I was deferred for now. Interestingly, in early times 75% of participants regained response to Xtandi, presumably due to testosterone reset. Perhaps you could have another crack at Xtandi after some T.
Stick it out mate it takes time......... after all, it takes many years for the average Aussie to figure out what word Billabong is (However, they learn the meaning of the the word bong at twelve years old).
youtube.com/watch?v=-yILM3L...
Good Luck, Good Health and Good Humor.
j-o-h-n Tuesday 10/10/2023 12:11 PM DST
The PSA spike is normal and should be trending down after a month or so. BAT resensitizes PCa to enza and the other lutamides so make sure you rechallenge with enza after the trial. It is the most significant effect of BAT, extending their use.
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