I'm here for my brother. He is 55 now. He has diagnosed when he was 54 with advanced prostate cancer that had metastasized to his pelvic bone. He started hormone therapy on October 2022 and then started chemotherapy for 6 sessions from November 2022 till March 2023 and started Nubeqa at the same time with chemotherapy. His initial PSA was 43 and after finishing chemotherapy it decreased to 1.2.
From April 2023 (right after finishing chemotherapy), his PSA started to increase month by month.
After some genetic tests and so many scans, his M.O. decided to start Abiraterone and Prednisone for him 2 month ago. After 1 month his PSA increased but M.O. told him we should wait at least 3 months to make sure. Now 2 months passed and his PSA increased again from 39 to 46. During this past month he had radiotherapy on his pelvic area for the second time. Now his M.O. ordered CT scan and Bone scan again and told him to continue with Abiraterone and Prednisone for 1 month again and if PSA increase again we may start another chemotherapy.
My question is what other options does he have? His M.O. seems very hopeless and says there is not much options.
Please let me know about any other option or any clinical trial. We are all so worry .
Wish all of you all the best.
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rasher1
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Should get a PSMA scan and look for a pluvicto treatment or trial. What were the results of the genetic tests? Were the test germline (hereditary) or somatic (tumor)?
They just told him his genetic test was negative. Right now there is not any Pluvicto clinical trial runs in BC cancer agency(He lives in Vancouver) and if he wants to do it he has to pay 25000$ for each session.
That's probably correct for a germline but odd for a somatic. Cancer always has genetic mutations...or it could be a general response that nothing was found that was treatable...would be nice to know exactly which genetic test(s) were performed.
I have found these on BC cancer research website, but maybe they are outdated:
EPI-7386-CS-001 / GUTEPI7386
A Phase 1, Open-label Study to Evaluate the Safety, Pharmacokinetics, and Anti-Tumor Activity of Oral EPI-7386 in Patients with Metastatic Castration-Resistant Prostate Cancer
Principal Investigator: Dr. Kim Chi
177Lu-HTK03170
A Phase I/II Study of 177Lu-HTK03170 in Metastatic, Castration-Resistant Prostate Cancer Subjects with Prostate-specific Membrane Antigen-positive Disease.
Principal Investigator: Dr. Don Wilson
GUPR21 / PR.21
A Randomized Phase II Study of 177 LuPSMA-617 vs Docetaxel in Patients With Metastatic Castration-Resistant Prostate Cancer and PSMA-Positive Disease
Thanks so much. I will share these information with him. Right now his M.O. told him that they don't have ant clinical trial for him. We are looking for second opinion from USA.
Check out Fred Hutch and Dr. Heather Chang. She has been great and very in touch with current research and studies. It is in Seattle so not too far from BC.
Hi, I am treated at BC Cancer - Vancouver Prostate Center Clinic and can offer my insights based on my treatment so far.
Based on your description it sounds like 1) they tried triplet therapy in the mHSPC setting but unfortunately that didn't perform well in your brothers case (his PSA rapidly increased from a nadir (low point) of 1.2). So now he is considered mCRPC.
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He received genetic testing for germline (inherited) mutations. He should have received a report indicating what Genes were tested and what was found. In your brother's case no pathogenic (disease causing) mutations were found on the tested genes as per MO statement, I would still look to get the report. The genes analyzed (as per my report) were:
In your brothers case this means that there are no biomarkers from germline genetic testing to indicate a preferred course of treatment.
BC cancer is capable of performing testing for somatic (acquired) mutations (via tumor biopsy). BC Cancer is also capable of testing ctDNA. I would talk with the MO to see under what conditions these additional tests could be ordered and with intent to see if there are any relevant biomarkers that can guide treatment options.
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BC Cancer is very much by the book (Canadian Guideline for management of CRPC):
In this article scroll down to Fig. 1 in the conclusions to see the standard plan for your brother.
He is currently on 1st-line treatment in mCRPC setting (Abiraterone) and they are trying to give it some to time to see if your brother responds. It doesn't seem to be going well since PSA is still increasing.
It also sounds like they are ready to move onto 2nd line treatment. Based on the treatments he has already received and genetic testing results, he is eligible for chemo: cabazitaxel (Jevtana) or radiotherapy: Radium-223 (Xofigo) or Clinical trial.
As you look at the trials, or learn about them with discussions with your MO, pay attention to the inclusion and exclusion conditions since this will impact current treatment options. If you become aware of a trial that you want to apply for you need to make sure that your current or upcoming treatments don't invalidate you for the trial.
Maxone73, in a previous response, has identified some trials at Vancouver that may be applicable in your case.
Thank you so much for your time and information. Unfortunately I don't know the details of his genetic test. I just know it was something about DNA to see if he is eligible for a clinical trial ( SCREENING FOR:
A PHASE I STUDY OF PALBOCICLIB, A CDK4/6 INHIBITOR, IN PATIENTS WITH
METASTATIC CASTRATION-RESISTANT PROSTATE CANCER
Trial CodeIND.223
OR FOR:
PROSTATE CANCER BIOMARKER ENRICHMENT AND TREATMENT
SELECTION (PC-BETS) STUDY
Trial Code IND.234)
And he was not eligible. After that his M.O. told him they don't have any clinical trial for him now and if he wants to get Lu177 he has to pay 25000 for every dose. But in the link that you sent there was a clinical trial with Lu177.
and take it to your MO and ask him/her to explain why your brother is not eligible. It looks like enrollment is open and the trial has not started or is just starting.
Be aware, this is a phase 1 trial and the primary research endpoints are toxicity and dosing levels. Phase 1 trials historically have been offered to patients who have run out of other SOC treatment options.
The next steps is for the provinces to approve it. I don't know how long that will take but lets assume 18 months from CADTH approval. Here is a CTV article from Manitoba that describes the process:
A provincial spokesperson tells CTV News, PLUVICTO has also received a positive recommendation from the Canadian Agency for Drugs and Technologies in Health (CADTH) but it still needs to undergo national negotiations through the panCanadian Pharmaceutical Alliance.
“Only after those negotiations are completed and an agreement is in place with the manufacturer, will Manitoba (and other provinces) list the product in the oncology drug formulary."
At this point Pluvicto will be added to the BC Cancer Drug Formulary and be part of the SOC. You will be able to receive the treatment and not have to pay for it. The Drug Formulary is updated every month and I am watching it for the inclusion of Pluvicto.
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Questions I would bring to the MO, if this was me (and it probably will be eventually):
1. Does the MO have any insight into when Pluvicto will be covered in BC?
2. What does the MO recommend as the next course of treatment from SOC:
a. Chemo: Docetaxel rechallenge or Cabazitaxel.
b. Radium223: Is Xofigo indicated?
Note: he can still take Pluvicto after any combination of Chemo and/or Radium223, if he is PSMA positive.
c. Is there any indication that Olaparib would be effective?
3. Clinical Trials:
a. Can the MO recommend Vancouver Clinical Trials, bring your print out.
b. Can the MO recommend US/Intl Trials that your brother could qualify for.
Finally
Should your brother pursue SOC and hope for Pluvicto approval in a timely fashion, or, pursue clinical trials. I want to emphasize that the trial you selected is Phase 1/2 which only has efficacy as secondary endpoint.
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