after xtandi and zytiga fail-

[Chris52981]

after xtandi and zytiga fail- anyone still doing well and with what? Also after those fail what is the normal medications to try?

[GoBucks]

Have you had genetic testing done?

[Chris52981 in reply to GoBucks]

Yes -

Somatic Brca 2 gene- I guess that qualifies for parp - but worried about side effects being 82

[kaptank in reply to Chris52981]

I have just completed the Magnitude trial of Abiraterone (Abi) plus the PARP Niraparib. Side effects were minimal and hard to distinguish from the side effects of Abi. A result of that trial has been US FDA approval.

[MarylandGuy in reply to Chris52981]

parp is working for me. Primary side effect is nausea.

[Tall_Allen]

The combination of xtandi+docetaxel can work even after xtandi fails:

prostatecancer.news/2022/10...

If your metastases are BRCA+, PARP inhibitors may work

[CocoTheAlphaCat in reply to Tall_Allen]

Encouraging study. On my own journey (Stage 4, Lots of Mets) , abiraterone was starting to fail after two years. Switching the steroid from prednisone to dexamethazone brought PSA back down and is buying me extra time. Name of the game....

[wolverine11 in reply to Tall_Allen]

Would adding carboplatin along with docetaxel with xtandi have a better outcome? Would side effects be more intolerable? Will Medicare cover latter triple treatment?

[Tall_Allen in reply to wolverine11]

I doubt side effects would be more tolerable - platins almost always cause nausea. But it might (or might not) be more effective.

[wolverine11 in reply to Tall_Allen]

Thanks Tall Allen

[Chris52981]

are the effects of docetaxel terrible for

Someone 82 with lower platelets to being with

[Mw921000000 in reply to Chris52981]

You won’t know unless you try— my dad has aggressive castrate resistant prostate cancer he’s 60. He was against docetaxel since the beginning but he’s on cycle 4 and tolerating it incredibly well. It’s different for every person but I think it’s worth a try. You can always stop the treatment if side effects become too severe

[RyderLake2]

Hello,

When Xtandi (enzalutamide) and Zytiga (abiraterone) fail you probably need to seriously look at a cytotoxic therapy. In other words, moving to drugs that kill the cancer as opposed to suppressing it or putting it to sleep. The most common cytotoxic drug is chemotherapy but there are others. When this happened to me last year I chose to go on Lutetium. I have received the first infusion and in April I receive the second. So far (touch wood), no side effects. My thinking then (and now) is if Lutetium fails then I can always switch to chemo. Trying the theranostics approach gives me a few more options. Good luck and stay positive.

[Chris52981 in reply to RyderLake2]

did you have many side effects with lutetium

[chipspesto in reply to Chris52981]

I have completed six Pluvicto treatments. So far results are good and side effects are minimal. Below is a brief video

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youtube.com/watch?v=Th42pFO...(Not working as expected?)

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Best to you

[RyderLake2]

None, no nausea, no dry mouth, no feeling sick. nothing. The hardest part was being radioactive and sleeping in the basement for a week. We bought a hand-held geiger counter and my wife wouldn't let me upstairs until I stopped beeping! 😊

[john510185 in reply to RyderLake2]

Lol!

[j-o-h-n in reply to RyderLake2]

I understand that you liked the peace and quiet down the basement so much, that you now wear a vintage radioactive watch that you bought on ebay.....

Good Luck, Good Health and Good Humor.

j-o-h-n

[RyderLake2 in reply to j-o-h-n]

Hello John,

Being the "Basement Lab Rat" is not quite the hardship you might think it is. Our big screen television is in the downstairs rec room. I can watch hockey and other sports to my hearts content. I don't have to worry about waking up my good wife when I get up to pee. I can turn the light on instead of stumbling around in the dark. Lots of advantages. 😊

[Chris52981]

So there still are other options and many things that can prolong one's life

[kaptank in reply to Chris52981]

Correct. There are still many approaches and more coming down the track. None are cures but life extension is the real aim. Kick the can down the road until a more pleasant death comes along. In your case you should seriously consider docetaxel. When I finished the Magnitude trial I went on docetaxel. I am 75 and a bit frail. I have had 6 of 10 infusions. Side effects are minimal. Diarrhea is worst but controlled with over the counter drugs (gastrostop etc). Use the search function of this site to find some good posts on how to deal with/avoid side effects. These days you will also get drugs to help with side effects. I think they work. Overall, side effects are not the Loony Monster we all think of. Of course some people will have bad experiences but oncologists will adjust doses and if worst comes to worst, stop the treatment and you may end up no worse off and go on to something else. LuPMSA (Lutetium) may then be an option.

[kaptank in reply to kaptank]

One other thing about docetaxel at your stage is that in many cases it re-sensitizes the cancer to previously failed anti androgens like Enza or Abi so you may get another shot with them.

[AlmostnoHope in reply to Chris52981]

Yes there really and truly are. These guys on here are the toughest people in the world.

[john205]

After Xtandi began to fail, I tried a PARP inhibitor, a reasonable next step if BRCA+. Unfortunately it did not work for me and I had intolerable side effects. Now doing Lu177 (Pluvicto) which seems to be working after 3 of 6 planned doses, with minimal side effects. Beyond that, more chemo. And always watching the development pipeline for new stuff. Approaching 6 years out from high burden metastatic disease at the time of my diagnosis in 2018.

[Apd66 in reply to john205]

I’m about to start the Parp inhibitor with Xtandi. Pluvicto worked while taking it for me but came back shortly after stopping the Pluvicto treatment. PALB2 genetics. Already had zytiga fail before the Pluvicto started. I just finished a round of beam radiation to treat the painful Mets. What side effects did you have from the parp inhbitor. I don’t feel like the xtandi is kicking, but have only been on for a little over a month as the parp inhibitor was not to be taken while beam radiation was going on, both reduce blood counts. Yesterday was my last beam radiation treatment and set to start the parp inhibitor.

I did the chemo at first diagnosis with lupron. Was a tough go. Hoping the parp works for a while, concerned with the efficacy and side effects. I’m 58 this year. Diagnosed in 2020. I worry I run out of options before a good treatment for me comes down the pipeline, like alll of us I guess. Seems I get a year out of each treatment before failure.

[gsun in reply to Apd66]

You are way too young for this. Good luck with the treatments.

[john205 in reply to Apd66]

My course was a bit different. On Xtandi for almost 3 years with good response. Added PARP INHIBITOR (Talzenna) in September 2023. Constant nausea, diarrhea, loss of appetite, weight loss, and severe fatigue. I felt awful 24/7. My PSA continued to rise so we stopped the Talzenna after 2 months. Within a few days I felt much better. Many people tolerate PARP inhibitors better than I did. My MO said that PARP inhibitors work in around 50% of appropriate patients. I was not one of them.

[j-o-h-n in reply to Apd66]

Would you be kind enough to update your bio for yourself and for us. All information is voluntary. Yes at 54/55 way too young, but they're coming out with new meds every day. Don't despair and keep fighting those little M.F. bastards...

Good Luck, Good Health and Good Humor.

j-o-h-n

[Ramp7]

After Zytiga / Lupron failed I enrolled in a trial study at Dana Farber with LuPSMA177. It proved not to be durable. I met with Sam Denmeade at John's Hopkins. So far I am doing well on BAT.

urotoday.com/video-lectures...

facebook.com/groups/8909068...

[gsun in reply to Ramp7]

Thanks for the heads up on the BAT/ADT forum. Let us know how it goes.

[God_Loves_Me]

Agree with Tall_Allen, I am NOT DR. I think you are trying to find different options when Xtandi and Zytiga failed

if you have METS less than 5 may consider radiation options

Participate clinical trial, i believe this one is good one

clinicaltrials.gov/study/NC...

FDA grants fast track status for Ambrx’s prostate cancer treatment

pharmaceutical-technology.c...

Recently, it was also acquired from Johson & Johnson for 2B.

Press release :

jnj.com/media-center/press-...