I have been on Lynparza since June 1, 2024. Had to lower dosage after 3 months to reduce SEs, especially constant fatigue.
Point of this post is supplements. My bone and liver profiles are both ok. But red blood cells are down (Hg) and MCV too high, despite iron in diet. Am considering B12 supplements. I agree with the general need to prefer getting nutrients from diet, but would nevertheless appreciate any comments or suggested alternatives on this case.
lan99, not to worry too much, but a concern. After my radiation, I had a similar situation. Finally my PCP referred me to a hemotologist who did a bone marrow biopsy. Bad news. It was myelodysplastic syndromes with ring sideroblasts (MDS-RS). It is a blood cancer caused by the radiation. It is rare, but I feel way underdiagnoised considering all the co-morbidities we have. Google it.
Thanks. I googled it, is indeed worrying. Not ready for bone marrow biopsy yet but will keep this scenario in mind.
Hello! What kind of radiation that caused blood cancer? Radium 223?
Don't know the answer to your question, but mine was from my SBRT sessions. I would think that any kind of radiation or chemotherapy could cause it. Again, it is rare, but all of us need to know everything we can about this beast.
Been on Lynparza since December 2023. I am currently on half dose until blood work next week. I too suffer from low blood cell count. I have done B12 injections twice a week since February. Doesnt seem to help me. But, may be worth a try
B12 probably won't help. PARP inhibitors interrupt the biochemical mechanism that creates new red blood cells.
Thanks TA. I have the impression it is still early days for Lynparza. Hopefully a more targeted version will be available before long.
TA is there a reason to continue PARPi if it is interrupting bone marrow production? It seems counter intuitive since one will certainly need their bone marrow to produce immune cells.
It has proven to extend survival if men are BRCA+.
My original testing showed no actionable mutations. After castrate resistance, additional testing showed I had acquired BRCA, BRCA2, and ATM. MO was encouraged and started me on Lynparza. I had no blood work side effects; but had some leg cramping and fatigue. Drug is completely ineffective for me, discontinuing and moving on. Her best guess is because they are acquired mutations. Best of luck to others, there is a lot of hope to these drugs.
Interesting. Mine is acquired. This is the first I hear of a possible difference in the effectiveness of the drug in this context.
In trials, half were innate, half acquired. It worked equally well in both. Perhaps the new generation of PARP inhibitors will work better for you, like Module 5 of the trial below:
My oncologist, Dr. Sartor at Mayo warns against B12, he says prostate cancer loves it.
Ed
Many thanks! You and TA have convinced me to back off this idea.
Can you test your B12 level?
I have 32 items tested of which 14 under Red Blood Cells. Cannot see B12. Is it known by another name?
never heard of the connection between b12 and prostate cancers loving it. Any background info on this subject. I too recently started on lymparza. Psa is dropping steadily since starting but I too see my blood counts dropping as well. I’ve been taking a b complex vitamin and zinc supplements but still see the same side effects. I’ve only been on for 2 months and was hoping the side effects level out a bit. Would love to hear of others experiences with this drug in longer term use. Anybody out there?
No background info, if Sartor tells me not to take it I listen, he is among the top PCa docs in the country.
Ed
I did the first 3 months at full dosage 600mg/day. I was in bed by the end but the PSA dropped 61 to 47. I had to reduce dosage to 400 then 200 before I got some relief. Am unlikely to be getting much benefit from 200/day so need to ramp this up to a level I can tolerate while still getting benefit.
What dosage are you on ?
My PSA was 26. Started on lymparza and was blood tested every week for first 4 weeks. It started to drop in week 4. Today at week 8 PSA is 16.4. Dosage is 400 mg / day. Had a tough time at first with se but has kinda eased up for me. Still fatigue and sweats. Blood work , particularly wbc and rbc counts are low and continue to fall. Anemia is my concern now. I feel good, exercising and eating well. Looking for something in the immunotherapy line that could work for me while I ride this wave. Just had biopsy done. Awaiting results from pathology.
I am stuck taking omeprazole, a stomach acid reducer, for GERD/reflux. For this reason I take B12 supplement sublingually.
Lynparza can be used for treatment when there’s DNA damage. How about without the DNA damage?
I believe it is too toxic to take it without the BRCA genetic mutation. FDA didn't approve its use without the BRCA genetic mutation for that reason.
Maybe for short time in combination with radiation treatment or maybe chemotherapy?
I didn’t take Lynparza after hearing some negative outcomes for those without the BRCA genetic material. Thanks for your kind input.
What do you think about short use of parp inhibitors combined with SBRT radiation? During SBRT radiation it could be useful?
Combining PARP inhibitors with SBRT radiation is an emerging area of interest in cancer therapy, particularly for prostate cancer and other cancers with DNA repair deficiencies. Here's an overview of how this combination could work and what to consider:
Rationale for Combining PARP Inhibitors with SBRT
1. Mechanism of Action Synergy:
SBRT delivers high doses of radiation to a precise area, causing double-strand DNA breaks in cancer cells.
PARP inhibitors (like olaparib or rucaparib) block the repair of single-strand DNA breaks. When these single-strand breaks accumulate, they can evolve into double-strand breaks, which are lethal to cells, especially those with DNA repair defects (e.g., BRCA1/2 mutations).
2. Enhanced Tumor Kill:
By using PARP inhibitors, cancer cells are less able to repair radiation-induced DNA damage, increasing the likelihood of cell death.
This combination can be particularly effective in tumors with homologous recombination repair (HRR) deficiencies.
3. Potential to Sensitize Tumors:
PARP inhibitors may sensitize tumors to radiation, potentially allowing for better control of the disease even in difficult-to-treat sites.
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Timing and Short-Term Use During SBRT
During SBRT: Using PARP inhibitors during the course of radiation could amplify the DNA damage caused by SBRT. This timing leverages the radiosensitization properties of PARP inhibitors.
Short-Term Use: Short courses of PARP inhibitors (initiated shortly before and continued during SBRT) could provide the synergistic benefit without prolonged exposure to the drugs, thereby reducing the risk of side effects like fatigue, anemia, or nausea.
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Clinical Considerations
1. Eligibility:
Best suited for patients with BRCA1/2 or other HRR gene mutations, as these patients derive the most benefit from PARP inhibitors.
For non-HRR-mutated cancers, the benefit might be less pronounced but is still being investigated.
2. Toxicity:
Combining PARP inhibitors and SBRT may increase side effects like gastrointestinal or hematologic toxicity. However, short-term use can mitigate these risks.
Close monitoring by your medical team is essential.
3. Evidence:
While preclinical studies and some early-phase clinical trials show promise, larger randomized trials are still needed to establish the safety and efficacy of this combination definitively.
4. Availability:
Discuss with your oncologist if this combination is feasible and whether any clinical trials are available that align with your case.
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Conclusion
Combining PARP inhibitors with SBRT radiation during treatment could be a highly effective, innovative strategy, especially for cancers with HRR deficiencies. Short-term use might optimize benefits while minimizing risks. However, this approach should be carefully tailored to your specific cancer type, genetic profile, and overall treatment goals. Collaboration between your radiation oncologist and medical oncologist is crucial to ensure the best outcome.
Would you like details about specific trials or examples of cases where this combination has been successful?
ChatGPT said
I’m ready to go for Radium 223 in two weeks time. Hopefully it will go well with my red blood count.
Supplements for metastatic prostate cancer 
Your covid prevention tip?
Recommendations for additional supplements?
Need some guidelines regarding supplements
I need facts on nutrition, vitamins and supplements.
