Seems like options are narrowing, anyone else in similar condition?

[Newdiag-NC]

Hello! My husband and I are waiting for his first Jevtana infusion.

We learned today that his PSA jumped from 1.9 a month ago to 3.55 today (not had a high jump like that maybe ever?). Also learned he is castrate resistant. NP says Jevtana is the ‘med’ for this….sounds like his life is hinged on this? She said if there’s poor results after 4th infusion, they will add Carboplatin.

I welcome all knowledge for a guy in this condition.

Hope our fellow warriors are staying strong and winning!

Thanks!

[vintage42]

In the bio, who is the age for?

[Newdiag-NC in reply to vintage42]

Good very relevant question I left out! My husband is 72.

[EdBar]

why not have SBRT to the PSMA avid tumors and see if that drops PSA?

Ed

[dk73]

my husband is in his 8th year, stage IV, castrate resistant. Last year he started Pluvicto with PSA 27. After 4 rounds, his PSA and ALP were over 230. A scan showed major progression of bone Mets, skull to femurs. He has done 7 rounds of Jevtana and yesterday PSA was 39. He will be on this treatment indefinitely- might get spaced out to every 6 weeks eventually as his numbers plateau. He takes prednisone with it, eligard shots every 6 months, zometa infusion every 3 months. This is his third time with chemo, first for Jevtana. He is now almost 72

[Seasid in reply to dk73]

Did they consider xofigo (alpha radiation) in combination with low dose chemotherapy?

[Seasid in reply to Seasid]

Adding Xofigo (Radium-223) after Pluvicto (Lutetium-177-PSMA) and while on Jevtana (cabazitaxel) chemotherapy is a complex decision that should be carefully considered by your husband's oncology team. There are a few factors to weigh:

1. **Bone Marrow Suppression**: Both Jevtana and Xofigo can cause bone marrow suppression. Since your husband is already receiving Jevtana, which can lower blood counts, adding Xofigo could increase the risk of severe side effects like anemia, leukopenia, or thrombocytopenia. The cumulative effect on the bone marrow needs to be carefully monitored.

2. **Timing and Sequencing**: There isn't a standard protocol for combining these treatments, as each patient’s situation is unique. However, it's common to avoid overlapping Xofigo with chemotherapy because of the heightened risk of bone marrow toxicity. Some oncologists may recommend completing or pausing one treatment before starting the other.

3. **Clinical Evidence**: Xofigo is typically used in patients with bone-only metastases and symptomatic disease to improve quality of life and potentially extend survival. Given that your husband had significant progression in bone metastases after Pluvicto, Xofigo could be a consideration if Jevtana alone doesn't fully control the disease. However, the decision to introduce Xofigo should be based on a thorough evaluation of his current health status, including blood counts and overall response to Jevtana.

4. **Consultation with Specialists**: Given the complexity of his treatment history, a multidisciplinary approach involving his oncologist, a nuclear medicine specialist, and possibly a hematologist would be advisable. They can help determine the best timing and whether it's safe to introduce Xofigo in conjunction with or after Jevtana.

It would be best to discuss this possibility with his oncology team, as they can provide personalized advice based on his specific medical condition and treatment history.

[Seasid in reply to dk73]

Why did they continue with Pluvicto if it was not effective and ALP was going up? Could you ask for a liquid biopsy (Guardant 360 cdx or similar?) maybe it could qualify him for a clinical trial?

[dk73 in reply to Seasid]

They stopped after 4. Both RO and MO agreed there was no need to continue

[Seasid in reply to dk73]

It sounds like your husband is going through a challenging time with his treatment. Jevtana (cabazitaxel) seems to be stabilizing his PSA levels after the significant progression seen with Pluvicto. The fact that his PSA has decreased to 39 after 7 rounds of Jevtana is a positive sign, especially considering the previous rise during Pluvicto.

The indefinite continuation of Jevtana, with possible spacing out of treatments, suggests that his doctors are aiming for long-term disease management. Combining this with other treatments like prednisone, Eligard, and Zometa is a comprehensive approach to managing both the cancer and associated complications like bone metastases.

If you have any specific concerns or need more detailed information on his treatment plan or potential side effects, feel free to ask.

[dk73 in reply to Seasid]

His MO is looking to get the PSA under control but feels it’s unlikely to hit zero as it did under doxetaxel (2017 and 2022). Once his PSA plateaus, they will determine if he moves to either a lower dose every three weeks or the same dosage every six, being monitored in between. He takes prednisone daily with this. His ALP is getting close to normal range too. We are with Northwestern Medical System out of Chicago and feel lucky to have our team close by

[Newdiag-NC in reply to dk73]

I’m hoping and the best for your husband. I’d love to hear updates. The Jevtana my husband just started seems to be hitting him a bit worse than Docetaxel did. How is your husband doing with it?

[Seasid in reply to Newdiag-NC]

Jevtana should be milder than docetaxel. Are you getting 20 mg per square metre dose?

[Seasid in reply to Seasid]

You're right that Jevtana (cabazitaxel) is often considered somewhat milder in terms of side effects compared to docetaxel, although it can still be quite taxing depending on the dose and individual response.

The typical starting dose for Jevtana is 25 mg per square meter, but for those who are older or have had significant prior chemotherapy, a reduced dose of 20 mg per square meter is often used to minimize side effects while still maintaining efficacy. If you're asking about the dose for your husband, this is something his oncologist would have tailored to his specific situation, especially given his extensive treatment history.

Are you considering or currently using a reduced dose of Jevtana, or is this information for a general understanding?