Olaparib? Chemo? or both ?

[dudubaya]

Hi All,

Fathers latest PSA reading is 3.87 (up from 2.3 in 9/23) , he was switched from Enza to Abi last month but apparently it hasnt worked. He was also tested for germline mutations and found to be BRCA 2 +. His blood counts are relatively low with Hgb at 10.7 and RBC at 3.9

What are the options for us right now ?

1. Go for Olaparib alone

2. Go for Chemo alone

3. Go for both , i guess that would be Chemo followed by Olaparib

We are not considering Lu-177 as of now as our MO has clearly stated that Lu-177 comes after Chemo , should we also be considering on this right now?

Will be having a call with our MO sometime next week, would be great to have some feedbacks at hand before that

[Seasid]

Live olaparib as a last resort drug when everything else fails as it will work 100% for some time maybe 18 months but after that he may have bad blood results.

Why his blood is so bad? Maybe bone marrow involvment? You should do what your doctor say as we don't know his situation fully.

[Seasid in reply to Seasid]

Did they sbrt his visible Mets if any is visible on the PSMA pet scan? When did you have your last scan and how many Mets did they detec?

[dudubaya in reply to Seasid]

It has been so since initiation of ADT 2 years ago, it was SE of ADT

[Tall_Allen]

Olaparib can cause anemia, so Pluvicto may be a better choice. In India, can't you get Pluvicto before chemo?

[dudubaya in reply to Tall_Allen]

Not sure about Pluvicto but I can try to push for normal Lu-177 , even there our MO wants to use it as the last option. Ideally what is the sequence we should be pushing for ? Lu-177 > Chemo> Olaparib ?

[Tall_Allen in reply to dudubaya]

Lu-177 is not a medicine, it is just a radioactive element, Pluvicto is a medicine that is approved in the US that uses it (Lutathera, a different medicine used for GI cancers, also uses Lu-177).

The point I was trying to mmake is that your red blood cell production is a risk factor for olaparib. Indeed, it must be watched closely with any of those medicines.

[dudubaya in reply to Tall_Allen]

Ok , so the choice for next therapy should be based on the lowest possible side effect especially blood counts , that would mean try Pluvicto first then chemo and finally olaparib when all other options are exhausted, is that the right order ?

[Tall_Allen in reply to dudubaya]

There is no "right order." You have to make the decision with your oncologist after discussing risk factors and benefits.