Chemo vs Immunotherapy

[ChickenWrangler]

Howdy all. In the last three weeks or so I have been diagnosed with very aggressive stage 4 prostate cancer. It is has spread to my lymph nodes, innumerable lesions on bones from neck to knees with most centered around ribs. I am currently on Nubeqa and Lupron with docetaxel starting next week. I was diagnosed in Germany and the doctor there wanted me to take the Nubeqa and Lupron but use an experimental immunotherapy drug and stay away from chemo for the first few months. Has anyone else been in this sort of situation? I am a performer and have many big gigs coming up in the next 4-6 months. Has chemo affected anyone’s voice on this forum? How tired were you after stopping chemo? How long to recover strength? I am torn between this “miraculous” immunotherapy drug and starting chemo. I realize that there are individual reactions to chemo, but I’d like to get a generalized idea before starting and/or choosing which path to take. Thanks in advance!

[Tall_Allen]

Chemo will be ineffective if you put it off. It has to be started around the same time as Nubeqa. There are no immunotherapies approved for your situation unless you are msi-hi/dMMR.

[RyderLake2]

Hello,

You might also want to consider a radiopharmaceutical like Lutetium-177 as an alternative to chemotherapy. Germany has been a pioneer in this form of treatment

[OzzieJ]

Chemo is generally 6 blocks of 3 weeks. So in total 18 weeks. As I remember it I was very tired for 2 weeks but in the 3rd week I had recovered before the next cycle. Although it is cumulative so once you get to cycle 5 and 6 you will be more tired. During chemo I was still able to go skiing and worked through most of it. I had no voice impacts but taste was impacted during treatment. By about 4 weeks after chemo I had recovered although I caught pneumonia and ended up back in hospital. So you do have to be aware that your immune system can be compromised by the chemo treatment. Best of luck with your treatment.

[TomsD1]

In Australia I think they are starting with lutetium in chemo-naive cancer.

[Cape1]

I’m at a very similar place and will get Stand alone Immunotherapy tomorrow morning. I was diagnosed 18 months ago, with metastatic PCa, and went on Relogolix and Darolutemide and quickly went down to .02. Stayed on for 10 months, and granted. Holiday when PSMA PET scan showed nothing in prostate and just one bone met, whereas there had been three. ( was told they NEVER see that)

During the holiday, my testosterone bounced back in 3-4 weeks to 500 and PSA rose to 18, over 4.5 months, at which time I went back on Relogolix and Darolutemide, and again PSA dropped rapidly. I, was at .125 last week. All scans and panels appeared normal as recently as May.

I thought I was in a good place, but 2-3 weeks ago had pain under right rib and scans and biopsy showed small cell spread to liver, even though panel remained good. Brain scan showed clear.

My MO at famous Boston hospital at first poo pooed it, as highly unlikely to go so fast in a bad direction, but then he seemed almost panicked, called me last Sunday morning, almost demanding I go on platinum based Chemo.

I declined the chemo, over his repeated objections, but said I’d consider stand alone Immunotherapy, at which point he agreed to “add that in”.

I said Stand alone, or nothing, which he reluctantly agreed to , although saying he NEVER does stand lone nd doesn’t expect it to work.

surely, all cancers are different, as are all patients, so it’s like Forrest Gump and Life as the box of chocolates ( you never know what you’ll get), but I turned up two points of light.

One being Dr Li, who has books and many YouTube video. He cured his own 80-year old mother with stand alone for eight years, and a family friend who is an RN infusion nurse at another famous Boston hospital specializing in melanoma, and yes I know that isn’t small cell, as I have.

However, she said they NEVER do Chemo, only Stand Alone, and are getting MANY total cures after 2-3 infusions.

This is Chess in 1000 dimensions, and this is my current direction, and time will tell. 🙏

[dhccpa in reply to Cape1]

What type of immunotherapy is this?

[Cape1 in reply to dhccpa]

Wrong thread? I’m not doing chemo. Only Immunotherapy called Atezolizumab

[dhccpa in reply to Cape1]

No, human error. I meant to ask the type of immunotherapy, which you answered. Sorry for the confusion.

[dhccpa]

I could do chemo, but I chose immunotherapy (Provenge) first. The Prostate Cancer Foundation says in their guide that Provenge seems to work best if done before chemo, which influenced my thinking at least partially.