FDA approves Erleada for metastatic hormone-sensitive prostate cancer

[Tall_Allen]

Joining Zytiga, and docetaxel. Probably Xtandi too very soon.

pcnrv.blogspot.com/2019/05/...

[Sherpa111]

Thank you.

[SPEEDYX]

Good news hope more drugs on the way

[cesces]

So after how do you choose between Zytiga, docetaxel and Xtandi? And Aberiterone?

Do you use them concurrently with traditional ADT or in its place or sequentially?

[rust in reply to cesces]

I think the order depends on your age, DNA and case and unfortunately right now the majority of clinicians are not well informed and willing to think outside the box beyond their standard of care.

Maybe docetaxel combined with secondary salvage radiation therapy based on highly accurate imaging followed by Zytiga, Xtandi or Elreada after primary androgen deprivation therapy failure?

[cesanon in reply to rust]

You seem pretty knowledgeable. I hope you keep posting.

[Tall_Allen in reply to rust]

What has age or DNA to do with the choice?

[Tall_Allen in reply to cesces]

Docetaxel is the easy one - multiple mets. If you are hormone responsive, Xtandi isn't yet approved- but will be soon. Apalutamide (Erleada) is the new drug, so less experience with it, but it may reduce upgrading of the androgen receptor so it may last longer - who knows? Yes, ADT is always used concurreently.

[rust]

Glad that these drugs are becoming more available but there is no silver bullet here for non-clinical met hormone sensitive cancer. When Erleada and Xtandi fail the mutant cancers that remain and prosper are possibly much more resistant to possible future currative therapies (Taxotere, radiation).

In other words if you are hormone sensitive and still hoping to benefit from a chance at a long lasting progression free survival, starting an androgen receptor blocker may reduce your chances.

If you are over the age 70 the game is different and maybe the blocker is the way to go. If you are age 52 like me though I want to exhaust all currative options first. Pending FDA approval of the PSMA-11 radiotracers is where I am placing my hope for the bro fight.

[Tall_Allen in reply to rust]

There is no back-up for your assertions. In fact, previous use of Zytiga has not been found to increase resistance to docetaxel. Androgen receptor blockers have been found to increase PFS.

There are no known curative options after metastases have been discovered. Advanced PC is a disease to be managed, not cured. You are just making up your assertions about age. It is not helpful to your survival to make up such things.

[rust in reply to Tall_Allen]

I was told that because of being on Xtandi (and when my disease becomes resistant to it) that I would put myself at risk of future failure of docetaxel and nodal radiation which may result in a long term remission. When androgen blockers fail what comes back apparently is much more difficult to treat - SUPER DISEASE.

[Tall_Allen in reply to rust]

Probably a better idea to do cabazitaxel (Jevtana) after Zytiga/Xtandi/Erleada.

"Overall Survival was not significantly different for first-line Chemotherapy vs androgen therapy" (2017)

meetinglibrary.asco.org/rec...

"cabazitaxel appearing to retain its activity whatever the therapeutic sequence" (2018)

sciencedirect.com/science/a...

"Cabazitaxel and AR-pathway inhibitors are not cross-resistant. " (2015)

europeanurology.com/article...

"The antitumour activity of cabazitaxel, a chemotherapy agent, was studied in prostate cancer resistant to conventional hormonal therapy and to more recent endocrine therapies (abiraterone or enzalutamide). Cabazitaxel retained anticancer activity in more than half of the cases." (2015)

europeanurology.com/article...

"We do not observe differences in clinical outcomes based on alternative sequencing of abiraterone and docetaxel in men with mCRPC. " (2015)

onlinelibrary.wiley.com/doi...

However, it makes sense to me to do chemo first when there is a high metastatic load. As cancer progresses, it will always become more difficult to treat, whatever therapy was used.

[depotdoug in reply to rust]

Me too PSMA-11 Ga68 PET Scan is what I got 8/01 and will get another PSMA-11 in ~~ 5 months. Post ADT LUPRON shots. And normal standard ADT treatment. Yes I’m part of a Clinical Research Project for 68Ga-PSMA -11 and am being watched monitored closely( I think)... Let’s see how successful my 2nd time around with ADT LUPRON is this time 1st time was 2008-2012.

[6357axbz]

So which is more effective, Erleada or abiraterone acetate or Docetaxel?

[Tall_Allen]

No comparative data with Erleada. Zytiga and Taxotere are equivalent:

academic.oup.com/annonc/art...

[SPEEDYX]

Agree...managing with ever increasing options

[Farmer-joe1]

Do you think all those drugs will actually cure this cancer once and for all or do you think it will prolong it ?I am using xtandi have had docetaxel which almost killed me and I don’t know what Zytiga is if it’s xgiva well I’m on that too as well as Eligard every three months I’m starting to feel like a walking chemist shop or do you guys call it a drug store.

[Tall_Allen in reply to Farmer-joe1]

Metastasized prostate cancer is incurable by current methods. The hope is to manage it as a disease one can live with. Zytiga is a homonal treatment. It is different from Xgeva, which strengthens bones. I know many men who take multiple drugs for HIV. They are glad to - what is the alternative?

[Drphil1938]

Any idea as to cost comparison with Zytiga

[Tall_Allen]

no - if you hear, let me know.