Am mCRPC and will be starting Docetaxel soon, after apparent failure of Zytiga. Would like to know if I should continue the ADT (zoladex), which I have tolerated well for 3 years.
Most trial info I have found (STAMPEDE, CHAARTED) tests ADT alone vs ADT + Docetaxel, where the combination outcome is superior.
Is there any info on Docetaxel alone vs Docetaxel + ADT; or what is generally recommended? Thanks.
Hi Ian. I was given ADT + Docetaxel, 6 rounds each one 3 weeks apart. ADT continues for LIFE. I asked what's next, my Onc said enzalutamide and when that fails another 6 rounds of Docetaxel. That's the end of the line. Im hoping by then there will be another treatment available to me. I found the Docetaxel infusions were manageable but the long term effects were devastating. My hair grew back and darker than when it fell out but my skin aged 50 yrs lol. Went from a smooth flexible skin to a dry and very wrinkly thin skin. My body pains and aches increased considerably. Would I do it again? Yes but only because the alternative is an earlier death. Life is too precious to miss even a second. I hope it will all go well for you brother.
Thanks for that. When I asked what next, I was told Cabazitaxel.. did your MO not mention it ? Further on I am counting on Pluvicto or some variation thereof, if PET scan results permit. Unlikely to be sanctioned in this country but readily available abroad. So don’t give up, mate!
Not giving up but I am in the UK and that is what is available here under SoC. Ofc I can have anything I desire if I can pay for it privately lol. Most of us can not. Good luck and long life brother.
The only thing I would ask your MO is, What about Docetaxel resistence? I was reading that once you have docetaxel then cancer cells become resistant to docetaxel in future
if you help me to get this answer, It help me in my treatment plan as well.
Does this also affect cabazitaxel? so once you have taken cabazitaxel do the cancer cells become resistant to it in the future?
Cabazitaxel was approved for use in UK in 2016. It is normally given when docdtaxel fails.
Yes, but I think Mcc is up in Scotland. Some differences up there.
In USA, There is concept call "triplet therapy" that inlude ADT + Docetaxel + Nubeqa or Xtandi (both are from same class). It is one of the best results after treatment and great quality of life as well.
I also read from many users that they stay on ADT for life and start Nubeqa or Xtandi before 2 or 3 month before of first chemo infusion to avoid side effects.
Thanks. I have had the impression triplet therapy is usually for hormone sensitive.
Re SEs, I have a list of things to mitigate (cold socks, mitts, fasting). Was unaware Xtandi could also mitigate. But not SOC here.
Here is the source of informations :
prostatecancer.news/2021/05...
prostatecancer.news/2022/10...
Yes, I believe triplet therapy is for newly diagnosed metastatic patients, whereas he is now resistant.
I really like the idea of moving to Xtandi now, as you say, before starting on Docetaxel. I was even unaware of the SE mitigation. Per the PRESIDE trial, Docetaxel could also have the effect of prolonging Xtandi effectiveness. But my MO says there is cross resistance in moving from Zytiga to Xtandi. Tbh I find the views from the medical community vary on this topic.
Yes your MO is correct. Xtandi doesn't work because of cross resistance still you do not need worry about side effect during infusion time. I wish if there is better way to fix with cross resistance without chemo.
I had exactly that cross resistance. A few years back on zytiga. PSA and pet scan showed 1 met so XBRT. and back on ADT xtandi. In three months, my PSA doubled still under 1. But went from .17 to .63. So that’s when chemo look like the best idea for desensitizing.
My MO said the talzenna is a good maintenance option along with spiracell T after. However, I’m going to explore the mistletoe by helixor from Germany. There’s a lot of good from that. And then all of our anti-parasitics for off label. As a The last resort.
Good luck, just sharing what’s in front of me
In my opinion adt+docetaxel and why not change (Arsi )Zytiga to (Arsi ) Nubeqa(darolutamide)?
Thanks for that. But my original post about Docetaxel goes back 9 months. When I went for the chemo discussion with the MO, he informed me that my somatic testing came back BRCA2+, so i preferred to go with Lynparza, which I have now been on for 7 months. Down the road I expect Docetaxel and your comment will be useful. Thanks.
Lynparza is a parp inhibitor. My MO explained this a good treatment as a maintenance treatment with xtandi. After chemo
. latest shows data ( I don’t have) I believe Pfizer published last year xtandi with talzenna ( parp inhibitor like lynparza 2023) had very good outcomes with patients who DID NOT have the mutations and also had the gene sequencing indicators.
I saw somewhere on this site, small study of 11 participants with standard docetaxel therapy 50% lost there ADT resistant. I didn’t see the whole study, but it was very small and I don’t recall the specific ADT . The point was half became un resistant to ADT while the other half continue. I’m guessing specific cell lines that were not re-sensitized after the taxetore. And that makes sense if you have a tumor with its own micro environment, that just was not.fully exposed.
Thanks for these comments. This whole area is evolving so diversely it is tough to keep track of options. Right now I am on Lynparza until it is no longer effective. By then I am hopeful there will be a more targeted version (so less toxic) or an alternative such as NXP800 or Talzenna as you mention. Take care.
Sorry.Your post was 9 months old.Hope you all the good.
Docetaxel timing in CRPC patients who had a poor response on ADT.
Zytiga vs Docetaxel in mCRPC 
Docetaxel 
Cabazitaxel Versus Docetaxel
