Anyone treated with enzalutamide +cabazitaxel?

[BeLikeWater]

Hi, I have stage4b with extensive bone mets. I've had sequentially ADT+abiraterone; docetaxel+carboplatin; Pluvicto. PSA never got below 3. Latest CT bone scan shows progression in a few areas. RO will zap the progressing areas locally. MO suggested cabazitaxel (1st choice) or enzalutamide (discouraged because cancer is aggressive). Any data/experience that combined enzalutamide and cabazitaxel would be better?

[skiingfiend]

No.

The two drugs have opposing mechanisms of action and would not normally be used together.

In order for the chemo to be effective the cancer cells have to be active, trying to divide. Most chemo's attack and disrupt the various ways the cancer cells divide - this causes cell death (both cancer and healthy cells) and shrinks tumors.

Enzalutamide (and other 2nd generation AR inhibitors) causes most of the cancer cells to go to sleep - enter an inactive state. Since the cells are not trying to divide, or prevented from dividing, the chemo will not have any impact.

So its one or the other but not both.

[BeLikeWater in reply to skiingfiend]

Thanks, skiingfiend! I appreciate the explanation.

[Tall_Allen]

There was a clinical trial of enzalutamide+docetaxel that showed the combination did well:

prostatecancer.news/2022/10...

[BeLikeWater in reply to Tall_Allen]

Thanks , Tall_Allen! It seems the PRESIDE trial that you mentioned started with enzalutamide, then upon failure gave docetaxel with or without continuation of the enzalutamide.

[dhccpa in reply to Tall_Allen]

TA, could you take a look at skiingfiend's post above which theorizes the opposite? I gather you're saying there's no similar trial with cabizataxel and Enzalutamide, but you would expect similar good results. Or are you?

I bring this up since getting two such different answers can really throw the OP. Thanks.

[Tall_Allen in reply to dhccpa]

Yes, I would expect similar results from cabazitaxel+enzaluatamide as from docetaxel+enzalutamide.

I have no idea why he would say such a thing. Triplet therapy also works because ARSis act synergistically with docetaxel. People say all sorts of incorrect things on this forum in an effort to be helpful.

[dhccpa in reply to Tall_Allen]

I understand, thanks!

[BeLikeWater in reply to dhccpa]

Thanks, dhccpa and Tall_Allen for the clarification. It is confusing with the different studies and practices that are being used. I appreciate your help on this forum!

[BeLikeWater]

Indeed, I was deemed mCRPC after failure of abiraterone. I was not given triplet therapy at that time

[BeLikeWater in reply to BeLikeWater]

The trial that Tall_Allen referenced was for mCRPC, so not sure whether triplet therapy is precluded.

[JJFR60]

I’ve been on Enzalutamide for almost 6 years together with Firmagon ( Degarelix) . Early this year psa went up and scans showed progression of bone mets . I’ve had Docetaxel in 2015 and my oncologist wanted to start that again. In the meantime we moved to a different city and that gave me a chance to go to Erasmus University Hospital in Rotterdam, more specifically the Rotterdam Cancer Institute . They have 4 oncologists specializing in PC and conduct lots of studies and research. Couldn’t have ended up in a better place. Instead of Docetaxel they started me on cabazitaxel as studies proved it to be more effective after enzalutamide . I had to get all the enza out if my body before the first chemo. Had three now and psa and af going down . Scans in two weeks.

My , non medical , conclusion based on what my oncologist said us that enza and docetaxel do not go together!

[BeLikeWater in reply to JJFR60]

Thanks , JJFR60, for sharing your experience at Rotterdam! Glad to hear PSA going down and hope scans show improvement too.

[JJFR60 in reply to BeLikeWater]

thanks! Hope it works for you too 👍

[j-o-h-n]

You BeLikeWater.....Me NoDrinkWater............ (cause fish fornicate in it)...

Good Luck, Good Health and Good Humor.

j-o-h-n