Next steps after cabazitaxel

[Arcticfox44]

Hello again - I've completed six chemo treatments with cabazitaxel alone. PSA has fallen from 83 in early July at the start to 5.1 a couple of weeks ago (after five treatments). I live in Nicosia, Cyprus, and am being treated here but I'm also a Mayo patient of Drs. Kwon and Orme. They have identified me as a candidate for Olaparib, based on genetic tests. I'd welcome thoughts on that, and generally on where we might go when the chemo ends, or before it ends. I should add that I'm also on Zoladex injections every three months and have been for several years. Thanks again.

[Tall_Allen]

If you are BRCA+ and mCRPC, a PARP inhibitor combined with advanced hormonal therapy may be effective. However, you first have to wait for your cancer to come out of senescence. Chemo causes cancer cells to enter an invulnerable cell phase, and PARP inhibitors can only kill cancer cells that are trying to divide. PARP inhibitors often cause anemia, so your blood work has to fully recover from cabazitaxel too.

[Arcticfox44 in reply to Tall_Allen]

Thanks very much. No doubt the Mayo doctors will explain this when I see them next week. Do you have any thoughts on how low I can expect PSA to go with just cabazitaxel alone? I've had six of the projected max of 10 treatments, and as I mentioned PSA was 5.1 after five treatments, down from 83 at the outset in early July. Presumably we'll keep going with cabazitaxel as long as PSA responds. If we did get down to zero or near zero, how durable might that be without resorting to Olaparib or anything else?

[Tall_Allen in reply to Arcticfox44]

All good questions. only time will tell.

[Arcticfox44 in reply to Tall_Allen]

Thanks again.

[Arcticfox44 in reply to Tall_Allen]

Hello - I'd be grateful if you could take a look at my latest update, with PSA having jumped to 344 from the low of 3.6 last November. It seems we have somehow lost the plot on this. I'm back in Cyprus and the current plan is to go on chemo with taxotere and carboplatin, starting on June 17. Kwon has listed lutetium as another option but I tried this in Istanbul (Anadolu Clinic) last year and it wasn't very effective after three rounds.

[Tall_Allen in reply to Arcticfox44]

You might also add enzalutamide to your regimen. Normally, we wouldn't expect it to work very long, but the PRESIDE trial showed that chemo might keep it working longer.

prostatecancer.news/2022/10...

If you can travel and stay in the US for a clinical trial, I would look into the following because of your history of high PSA. They allow patients who have already tried Pluvicto:

clinicaltrials.gov/study/NC...

[j-o-h-n]

Yiasou............... watch those Turks............

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 10/31/2023 11:05 PM DST

[Arcticfox44]

Thanks again. Dr Kwon recommended taxotere plus carboplatin plus enzalutamide but there is a problem here in Cyprus because the "protocols" don't permit enzalutamide. I may try to get it and take it anyway if taxotere plus carboplatin doesn't work. It would be hard for me to stay in the US for a trial.