Erleada or Nuqeba after Zytiga / Xtandi failure?

[blabanieh]

Father has mCRPC to many areas in the bone. After Jevtana and Pluvicto fail, recommendation was to start Xofigo but his hemoglobin level is currently low at 7.8-8.0

Anyone have any success switching to other ADT type therapies in the meantime? Goal is to get some time to recover those hemoglobin numbers before starting something like Xofigo ?

[speranza10]

Sorry to say, but erleada and nubeqa after the failures of zytiga and xtandi hardly work. Your reasoning however has a logic, try one of the two hoping that it keeps the disease stable for a few months and that the hemoglobin increases, and then switch to xofigo. That said the 2 drugs have a very similar efficacy, so I think it doesn't make much difference if you choose one or the other. Maybe darolutamide can be preferred, it usually has fewer side effects than apalutamide. I wish your father good luck

[blabanieh in reply to speranza10]

thank you for your reply and well wishes 🙏

[Tall_Allen]

Has he had Provenge yet?

[blabanieh in reply to Tall_Allen]

no! doctor hasn't really mentioned much on Provenge surprisingly

[dhccpa in reply to blabanieh]

Actually, not surprising. If a clinic doesn't do Provenge, they not only don't mention it, they sometimes badmouth it if asked about it. I had it last fall, but I'm still puzzling over that issue, I may post separately my thoughts on the Provenge situation.

I had to contact the manufacturer (Dendreon in Washington State); they'll inform you of the closest providers.

[blabanieh in reply to dhccpa]

wow - excellent point, we are getting another opinion with UCLA at the end of the month so will ask about Provenge during our visit with them. Very helpful, thank you and PLEASE post your thoughts on Provenge as it would be immensely helpful for anyone considering.

[dhccpa in reply to blabanieh]

Will do. I believe UCLA helped develop Provenge so I assume they still use it.

[Tall_Allen]

That would kill him.

[blabanieh in reply to Tall_Allen]

what do you mean?

[Tall_Allen in reply to blabanieh]

Sorry, I meant that as a reply to a suggestion that he take a PARP inhibitor that has been deleted. PARP inhibitors cause anemia, and he is already anemic, so that would kill him.

[spencoid2 in reply to Tall_Allen]

I have low hemoglobin due to bleeding bladder and also the fact that i am on chemo jetvana and carboplatin in fact getting an infusion today. it was proposed to add Ketruda but this might be put on hold due to low hemoglobin. i am getting two units of blood about once a week when hemo gets low. this will happen in a few days .

isn't ketruda a parp inhibitor and would it kill me if my hemoglobin is low? if they keep it up with transfusions might i be OK? i have surgery soon to address the bladder bleeding?

[Tall_Allen in reply to spencoid2]

Keytruda is not a PARP inhibitor, it is an immunotherapy.

[spencoid2 in reply to Tall_Allen]

Thanks. Whatever it is they will be infusing it any minute now

[blabanieh in reply to spencoid2]

best wishes! please keep us posted on your hemoglobin and the bladder bleeding.

[j-o-h-n]

Another request. Please update you dear Dad's bio. Thank you!!!

Good Luck, Good Health and Good Humor.

j-o-h-n

[kainasar]

Any possibility of a transfusion b4 such treatments?

[blabanieh in reply to kainasar]

We did do 1 bag last week but hemoglobin still showing at 8 at the moment. I believe Xofigo requires a minimum hemoglobin level of 10 before proceeding.