xtandi plus talzenna

[Apd66]

Has anyone else been down this treatment to add Talzenna to their adt treatments? I started only a few days ago. Side effects seem to be severe. Kidney pain, back pain, brain fog, fatigue. I stopped after only day three. Awaiting my MO to respond to the call for help. I feel way too medicated. Coming off of some beam radiation to hit hotspots after a pluvicto 6 rounds, which did not last very long after treatment before I was started on the extandi. My blood counts were low from the radiation so a shot to increase wbc counts before starting the talzenna. I have a PALB2 mutation (was told is very close to the BRCA mutation). I feel like this is a very strong and powerful drug. Long term use seems to be very difficult for me to perceive after only a couple of days feeling like a truck ran me over. Everyone is different as we all can see by hanging around this forum. I was also told that a immunotherapy could work on me due to certain mutations that are good targets.

I was hyped up for months about this parp inhibitor being a great next treatment but if I cannot get out the gate, what’s the point. Hoping to hear others that may have tried or are on this treatment plan.

[Tall_Allen]

Yes, PARP inhibitors are very toxic. What is your indication for immunotherapy?

[Apd66 in reply to Tall_Allen]

I d-not know what that means, but it sounds like I should. We were so focused on the parp. Dr did call me today and trying a lower dosage of the talzenna. If still too toxic then abandon parp for keytruda. What can I ask to know my indication for immunotherapy.

[Tall_Allen in reply to Apd66]

Just ask: "What is my indication for Keytruda?"

[Apd66 in reply to Tall_Allen]

this is what it was based on. Sorry if I posted this twice to you. I appreciate your information and knowledge

Guardian

[Tall_Allen in reply to Apd66]

Thanks! High tumor mutational burden (TMB) might indicate a response to Keytruda. Maybe you can get both Provenge and Keytruda.

"the mutational burden in metastatic prostate cancer is generally low (median, 2.9 mutations/megabyte), and only 3.0% to 8.3% of advanced prostate cancer tumors have high TMB [note:yours is 61.4 mutations/megabyte - very high!]. In a small retrospective series of 12 patients with high TMB (defined as more than 10 mutations/megabyte), four (57%) of seven patients treated with an anti–PD-1 antibody had a PSA decline greater than 50%. Treatment with ipilimumab [Yervoy] and nivolumab [Opdivo (similar to Keytruda)] resulted in an ORR [objective response rate] of 56.3% in patients with a TMB above the median (74.5 mutations/ patient) in the CheckMate 650 trial as well as longer radiographic progression-free survival when compared with those who had a TMB below the median (7.4 months vs. 2.4 months). It is plausible that high TMB may be a genomic manifestation of dMMR. However, given the limited data demonstrating the association between TMB and response to CPIs in randomized clinical trials, TMB is not considered a biomarker of response validated for clinical use."

ascopubs.org/doi/full/10.12...

[Apd66 in reply to Tall_Allen]

Thank you for that information. A pretty dry read and a lot to decipher . Is there a precursor to The Provenge strategy? You mention both, is that a combination? Your reply has me started on the research for the provenge therapies and if I am a candidate. Some others on this forum maybe have gone this route. I’ll search that as well. If my particulars are aligned for pronenge, it sounds much more inviting than 2 years of ketruda infusions, that still could be on the table if provenge fails? You are a wealth of information and your advocacy is really appreciated.

[Tall_Allen in reply to Apd66]

Provenge works well with radiation, since you are playing whack-a-mole and getting Pluvicto:

prostatecancer.news/2016/08...

Keytruda can sustain the beneficial effects of Provenge, so using it after makes sense to me.

[Apd66]

until I ask him specifically, he based it on this information

[j-o-h-n]

Again I will say it. Keytruda worked for me on my Melanoma that metastasized to my lungs - NOT Pca related (treated at MSK in NYC).

Good Luck, Good Health and Good Humor.

j-o-h-n

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

Thanks John. This is new territory for me. My research has just begun.

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

Do not get discouraged, there's a lot of info and help on this site. Also Do Not rush into decisions.... investigate first........(haste makes waste)...

Good Luck, Good Health and Good Humor.

j-o-h-n

[God_Loves_Me]

One suggestion, Ask your MO to send biopsy sample to Keytruda and Keytruda team will tell dr immediate whether Keytruda going to work for you or not. Thank you.

[Apd66]

that’s a great tip. God loves me too!