At the crossroads (again)

[rsgdmd]

My profile is up to date, but, briefly, have failed chemo, ADT (am castrate resistant), failed Keytruda and now Pluvicto. Scans yest. & today show progression along with PSA rise. All my mets are in bone. So, my SOC choices are cabazataxel or radium 223. Other options are trial, which are a crapshoot or go overseas for Actinium. BTW, diagnosed less than 2 years ago with denovo high volume metastatic, Gleason 4 & 5, PSA 28.2. Any thoughts?

[God_Loves_Me]

Try to ask your doctor about Enzalutamide or darolutamide. if Zytiga is not helping you.

[Tall_Allen]

Any analysis of biopsied metastases?

[rsgdmd in reply to Tall_Allen]

One of my questions for my MP is about biopsy for a met.

[Big_Mcc]

Can you try AOH1996 ? Seems promising but still in phase 1 trials.

[Maxone73 in reply to Big_Mcc]

please, no...biggest disappointment ever...

[Woodstock82]

As I mentioned on the call last night, I got excellent results from cabazitaxel, but the side effects were harsher. I hope it works well for you! -- David P.

[crony]

I am in the same situation. Talking to Doctor Goodman in a few minutes. I will see what he has for me

[Lizzo30]

What about estrogen patches ?Estrogen patches may be your best way forward

[KocoPr in reply to Lizzo30]

How would estrogen patches work ? He is on ADT and he is at castrate levels and yet his PSA is climbing. I thought the estrogen patch as an ADT would lower T as it’s mechanism of action against PCa.

[rsgdmd in reply to KocoPr]

My understanding is that estrogen patches can cause T to go to castrate levels and therefore, I wouldn't need Lupron. I'm castrate resistant so my cancer cells are a. making their own testosterone and/or b. have amplified the AR to the point that a whiff of testosterone is drawn in.

[KocoPr in reply to rsgdmd]

But if your PSA is climbing while already at castrate levels how is substituting lupron for estrogen any different?. You won’t get your MO to swap lupron with estrogen as it isn’t SoC. You would have to do that on your own and you would lose your MO. That is to risky at this point.

TA had it right. Get a biopsy and get it genetically tested, then go from there.

[rsgdmd in reply to KocoPr]

That’s the plan. MO put in the referral and I talked to Boston Gene about sequencing. Looking into whether anyone can do functional testing from bone tissue.

[Maxone73]

any germline/somatic mutation?

[KocoPr]

reading your bio you had genetic testing done. Was that before chemo and pluvicto?

You bio said

“Genomic testing showed MMR-d and MSI-h with TMB high, “ and keytruda failed.

Boston gene is an excellent step to understand what is going on and then you can address it from there.

[rsgdmd]

I had testing done on my biopsy sample shortly after diagnosis by Caris. They found MMR-d, MSI-h and high TMB. That's why I tried Keytruda. Not long after that failed, I was able to have original biopsy sample tested by Boston gene. They did not find MSI-h, high TMB.

On questioning, the company (& my MO) felt due to heterogeneity that possible for one sample to show one thing, another show something else. Another possible reason for Keytruda fail is BostonGene tested microenvironment & showed high TREGS, which has been shown to interfere with immunotherapy.

Hoping sequencing of met will show something actionable.

[KocoPr in reply to rsgdmd]

I hope so also! Well you’re in the right groups this group and Cancer Patient Lab to find solutions. I will see you on CPL and maybe you can share your Boston Gene results with the group.