Abiraterone Alone

[6357axbz]

Anyone tried abiraterone alone for HSmPCa? I’m just off a medication holiday and having trouble getting orgovyx.

[GP24]

You can take Abiraterone with Prednisolone without ADT. Adding ADT is just a little more effective.

[6357axbz in reply to GP24]

Thanks

[Derf4223 in reply to GP24]

Is Abiraterone+Prednisone alone in NCCN guidelines?

[GP24 in reply to Derf4223]

Its not in the NCCN guidelines. But you can start with Abiraterone and add Orgovyx later when it is delivered.

[JohnInTheMiddle]

My understanding is it's almost a must that you should take Prednisone (or Dexamethasone etc. - correction from reply below!) with Abi.

Abi cuts off the top of the steroid tree after it is nourished from cholesterol. And yes that means that you don't get testosterone further down. Bravo. But you also stop all the other products manufactured in this tree, most importantly the corticosteroids.

These other steroids or hormones are completely unrelated to your prostate cancer and are needed for your body to function properly. So prednisone is just an "add back" because of what Abi does. This is non-controversial. And it is very serious as well.

The consequences of not having any corticosteroids or whatever are quite serious. If you're in a social/medical situation where you can have Abi without prednisone you have to ask yourself about the quality of the advice you have available to you. Also Abi by itself is almost always combined with an ADT. You are shooting yourself in the foot if you don't have them together.

Now whether you have reached resistance or not then that may be a different situation.

[6357axbz in reply to JohnInTheMiddle]

I take dexamethasone instead of prednisone

[JohnInTheMiddle in reply to 6357axbz]

Right!

[swwags in reply to 6357axbz]

why specifically? Don't they have different mechanisms of action? I know dex with Abi has been studied in men with castrate resistant PC but not HS as the OP is. So curious.

[Gearhead in reply to swwags]

FYI, I'm HS and take dex (and eplerenone) instead of prednisone because it seems to result in less hypertension.

[swwags in reply to 6357axbz]

asking again. Why specifically do you take Rex instead or prednisone. Please reply.

[6357axbz in reply to swwags]

My MO, at the time with MD Anderson, recommended it. Given some of the more knowledgeable here, including TA if I’m not mistaken, had acknowledged it was a viable alternative I accepted her recommendation.

[Tall_Allen]

You can get a monthly Firmagon shot until you get Orgovyx.

There was a small trial of abi+Pred monotherapy in mCRPC which showed it wasn't significantly worse statistically, but a recent trial showing enza monotherapy in recurrent men didn't perform as well as enza+ADT makes me wary.

nature.com/articles/s41391-...

nejm.org/doi/full/10.1056/N...

[6357axbz in reply to Tall_Allen]

Thanks TA

[BruceSF in reply to Tall_Allen]

Recently there was a small (N=39) study on abiraterone+prednisone “alone” vs abi+p+ADT combination therapy. Abstract at pubmed.ncbi.nlm.nih.gov/373.... It was highly suggestive that you don't need to take Lupron or Firmagon or Orgovyx with ABI and prednisone. Emmanual Antonarakis, a highly respected researcher, was one of the authors. The study was retrospective and too small to be statistically significant, so hopefully someone will do a prospective trial. However, there really appeared to be no difference between the progression or survival results for the two groups of patients.

[6357axbz in reply to BruceSF]

Very interesting. Thank-you Btuce

[Tall_Allen in reply to BruceSF]

I'm not sure why they even bothered with an inferior retrospective study after there had already been a prospective randomized trial. But unless someone can come up with a convincing reason whi abi and enza should have different outcomes, EMBARK shows the monotherapy is inferior.

[PCaWarrior in reply to BruceSF]

• Moffitt Study Shows Adaptive Therapy Improves Outcomes, Reduces Care Costs for Prostate Cancer Patients | Moffitt moffitt.org/newsroom/press-...

• Adaptive Abiraterone Therapy for Metastatic Castration Resistant Prostate Cancer - Full Text View - ClinicalTrials.gov classic.clinicaltrials.gov/...

• Phase II Randomised Controlled Trial of Patient-specific Adaptive vs. Continuous Abiraterone or eNZalutamide in mCRPC - Full Text View - ClinicalTrials.gov clinicaltrials.gov/ct2/show...

Different mechanisms: Enza blocks androgen receptors and androgen receptor signaling. AA inhibits CYP17 and therefore testosterone biosynthesis in testes, adrenals, and tumors. I would not expect identical results.

[6357axbz in reply to PCaWarrior]

The Moffitt link is a dead end

[PCaWarrior in reply to 6357axbz]

Thanks. I am going to try to find one without the Moffitt center. Commercial links...

In the interim: moffitt.org/es/newsroom/new...

[6357axbz in reply to PCaWarrior]

No, thank-you!

[PCaWarrior in reply to 6357axbz]

Researchers are exploring and verifying. Of note the EMBARK adaptive therapy of enza and ADT has good results. urotoday.com/conference-hig...

My MO worked at Moffitt and currently uses MED and, in practice, uses an adaptive therapy scheme so that QoL can be balanced with cancer therapies.

[Justfor_ in reply to PCaWarrior]

IMO the drug taking pause at PSA50 guarding against a total extinction of the PSA producing cells is the prime beneficial factor in the Moffitt protocol.

[PCaWarrior in reply to Justfor_]

I suspect you are right. The eventual downside is that control is only for cells that display some type of androgen sensitivity.

[PCaWarrior in reply to 6357axbz]

My MO used Zytiga monotherapy. I used estrogen ADT, casodex-dutasteride, high T, and BAT. By SOC, I have technically only used Zytiga and short durations of Xtandi and Nubeqa. Plus an RP in 2018 and SBRT last month.

High T is very risky. BAT less so (clinicals show success but you need to be careful - some guys fare poorly so monitoring is essential). Estrogen ADT is not risky if you monitor T to make sure it is low. Mine was undetectable. But estrogen ADT has the typical low T side effects. Minus the bone loss and some of the hot flash and mental issues. But add to it more gyno.

[maley2711]

What is the problem in obtaining Orgovyx?

[6357axbz in reply to maley2711]

Not sure. I intend to dig down today

[maley2711 in reply to 6357axbz]

Pharmacy shortage?

[Explorer08 in reply to maley2711]

I wouldn’t think there is a pharmacy shortage. My Orgovyx is delivered on time each month…..well, so far anyway.

[6357axbz in reply to Explorer08]

If you don’t mind, what’s the monthly cost? No offense if you prefer to keep that private. Thanks

[Explorer08 in reply to 6357axbz]

My copay for Orgovyx is $72.30 per month. The approving authority is United Healthcare/OptumRX but the pharmacy is with University of Colorado (UC Health).

[Apisdorsata]

I have hormone sensitive metastatic prostate cancer and have been on abiraterone alone for three months. It's too early to conclude much but so far my PSA is undetectable. I still feel the effects of testosterone depletion (I've had a total of 41 months of leuprolide with and without enzalutamide over the last 8 years plus multiple radiation courses scattered about in time). My oncologist wanted to try it because it has rapid onset, rapid offset, unlike leuprolide and I want to take periodic drug vacations.

I understand the theory of developing drug resistance and hormone independence in prostate cancer. My own belief is that it is not correct to use bacterial resistance models. Hopefully large studies will be done on this important issue.

[6357axbz in reply to Apisdorsata]

Thanks

[swwags in reply to Apisdorsata]

Prednisone is to alleviate side effects of Abi. Zytiga blocks the production of cortisol from your adrenal glands. Prednisone helps to replace the lost cortisol that can cause side effects such as low blood potassium levels, fluid build up (edema), high blood pressure or irregular heartbeats. I hope and trust your are having these tested monthly and checking you BP daily.

There have been some studies on the use of Prednisone for MCRPC but not those of us who are HS. Nevertheless Prednisone is prescribed to alleviate side effects and has no impact on you PSA.