Am I correct that when a patient becomes resistant to either enzalutamide or abiraterone, or has to stop due to arrhythmia one cannot be substitued for the other?
Other than docetaxel (chemo) are there other commonly used treatments after enzalutamide or abiraterone resistance?
No. The other may work, but probably not for long because of cross-resistance.
Thank you TA
I stopped with enzalutamide last April because it wasn’t working anymore after almost 6 years .
Currently on 10 doses of cabazitaxel , one more to go …
PSA is going down, as well as activity in the bones , so it is doing some good .
My MO said that according to studies enzalutamide after abitarone showed better results.
Yes, enzalutamide works a bit longer after abiraterone than the alternative sequence. But maybe enzalutamide works a bit longer as the first drug than abiraterone. I do not know if there are trials how long apalutamide works after enzalutamide or abiraterone.
Dr. Attard presented this graph at the ESMO 2024. It shows that Enzalutamide is more effective after Abiraterone.
Thank for reply. Did the presentation say how long it was effective?
That might be that ABI works so effectively initially. It has for me for the past 10 years, undetectable, at <008 . I do not believe Enzalutamide was available as a first line treatment 12 years ago, i might be wrong, not a doctor!!! i am also convinced my ONC Doc made the preferred choice 10 years ago between ABI and Docetaxel for me at least.
Wings
great results! On Enz my PSA dropped from 19 to 14 in 8 months and now almost back to 19.
The data I presented refers to the question what to do when Abi or Enza fails. Should you take the alternative drug then? The data I had showed that Abi works for about two months after Enza and Enza works for about four months after Abi. Meanwhile I read another article which states six months for Apalutamide after Abi.
I did not want to make any recommendation whether to initially start with Abi or Enza.
I don’t know, haven’t searched for those.
I’m currently being treated at the Erasmus Medical Center, more precisely the Rotterdam Kanker Institute, by one of the 5 oncologists who specialize in prostate cancer. They do a lot of studies there, currently adding darolatumide to cabazitaxel to determine if this adds to higher survival rates.
Too bad there website and weekly newsletter is mainly in Dutch , the homepage is also in English stichtingduos.nl/foundation...
What medicines are you on. Has he advised any supplements too ?
Enzalutamide on hold. Lupron every 4 months. Gliclacide and metmorphin for diabetes; candesarten and rosuvastatin high blood pressure, cholesterol; bisoprolol for irregular heart; zopiclone for sleep as needed; trying mirtazapine for appetite and sleep.
Oxycodon against the pain, prednisone with the chemo and monthly shot of Firmagon ( Degarelix ) . Only supplement is Calcium tablet , otherwise a healthy variety of foods : the disc of 5 as we call it in Dutch :
Lots of fruit and vegetables, whole wheat, less meat but more fish and plant based ,less fat only” good fats “ , no sugar and lots of water .
How much calcium and in what form do you take it ? Do you have site reactions from the firmagon ?
You can castrate yourself it is very convenient and no chemicals and pain and money.
Yes in India Orchiectomy is popular. As of now dad is on Orgovyx which is one pill a day - if T levels remain low I think he prefers to stick with that for now. Have done a T test today. Will know later. Btw what are your T levels
It goes up and down because not only the testes produce testosterone but usually between 0.6 to 0.9 up to 1.85 what happened only ones. The minimum was 0.3 but I don't have that anymore. I am also on doxycycline and that kills gut bacteria which could start producing testosterone. It is only my speculation.
Hello,
You are incorrect. There is no reason why you can’t take Abiraterone after Enzalutamide or vice versa when one fails. I did. The problem is the second one doesn’t work for long. When the ARPI drugs fail, an alternative to chemotherapy is Lutetium-177. Good luck!
When Xtandi failed after 66 months we took a shot at Zytiga plus prednisone. They figured about a 10% chance of success but had to give it a try. 1 year later PSA is still dropping so we are getting some good therapeutic results. Trying to postpone Chemo or Lu177 as long as possible and hoping more 2nd line ADT drugs hit the market soon.
Hello,
You are definitely part of the 10%. Unfortunately, most of us, including me, switching ARPI drugs only works temporarily. Consider yourself fortunate. Your response is unique.
Ryder, I am very mindful of the providence given to me. There are few explanations other than Divine intervention. My MO told me I am a statistical anomaly. I'll take that. I often wonder what else am I doing that is helping? Anyway thankful to be living in the moment. May good thoughts flow your way!
Do you take any supplements ?
I don’t take regular supplements other than those contained in Boost or Glucerna.
Multi vitamins, D, B12, lots of fresh fruits and vegetables. Very little processed foods. moderate exercise.
Ok thanks. Btw dr snuffy myers says b12 should not be taken if one has prostate cancer
You may need to take vitamin B12 if you are on Metformin and your B12 dropped.
I appreciate that. I don't take much, just enough to keep my levels bouncing on the low side of nornal range. I forgot I also take lycopene.
i forgot I do take Vit D and get B12 injection. I think the jury is still out on multi-vitamin pills.
In Vancouver Canada I am on Abi/Pred with Lupron just over one year all well so far…as next option .do you have a choice Chemo / Lu 177 ?… Seems like the 177 is a better cancer killer ?
Yup, those are the choices. But here in the States you have to try chemo before they will give you Lu177.
In the uk the nhs doesn’t fund Lutetium 177. Chemo is all they will fund after Abiraterone or Enzalutamide 😔
are you able to get Lu-177 as standard of care in Vancouver?
Tell my oncologist😉 . I don’t think he’s wrong , the study published in the Lancet was pretty clear . And if it works only for a short time, is the worth it ? Quality of life vs quantity is definitely something my MO and I take in consideration when discussing next steps. Costs of prescription medication are covered by our national health insurance plan so no worries or obstacles there .
Once Abi fails, (in my case not gonna fail! )Oncs might recommend follow up with Docetaxel
Yes that is what he said he would recommend. Not sure I will go that route after 20 years of dealing with it all.
Greetings MooseJawg,
Would you please be kind enough to update you bio. All information is voluntary, but it helps you and helps us too. Thank you!!!
Good Luck, Good Health and Good Humor.
j-o-h-n
You can check out the NCCN (National Comprehensive Cancer Network) starting on page 49 for other options to treat hormone resistant metastatic prostate cancer after 2nd hormone therapy fails. nccn.org/patients/guideline...
might try Jevtana
is your arrhythmia something new? Is it afib? My husband is being evaluated for this.
It is about two years now and has not responded as well to meds as the Dr likes so now referred to another for possible ablation. However, for me the irregularity is not as onvious as before. Heart left ventricle pumping is at 42% whereas 50% + is normal. Thx for the question.
Docetaxel/Taxotere is often used between them when giving switching a try. Even if after a couple or so Docetaxel infusions if it is found the cancer is still progressing the activity of the Docetaxel in even those few injections can affect cross resistance increasing the chance that switching to the other 2nd gen hormone tx will have effect. Usually in play when going from Abi to Enzi.
Anecdotally it didnt work for me. Abi failed and had 3 Docetaxel infusions which didnt slow progression. Then started Enza. It worked the first month out of 3 and of course stopped the Enza then. Then a trial drug for awhile which I for the most part felt good while on until progression started again.
Finished my Pluvicto treatment last April and lucky to be on cloud nine during and ever since Pluvicto. Kinda like "riding the wave" as I said early in treatment when Abi lasted almost 14 months.
End of October was my 5 year anniversery so to speak. (G-9, 1621 PSA, lymph nodes pelvis to neck, bone mets skull to shins).
Current Understanding of Resistance to Abiraterone and Enzalutamide in Advanced PCa
Enzalutamide or abiraterone
Anyone treated with enzalutamide +cabazitaxel?
Anxiety after coming off Enzalutamide 
Switch to enzalutamide after SbRT 
