Treatment for mets to the liver - has anyone heard about this?

[ken12491]

My Dr is going to use cabazitaxel and carboplatin to treat me.

3 rounds, 1 shot once every weeks - total 3 rounds - taking scans along the way..

Has anyone heard of this combo, used it?

Dr tells me it more aggressive and less likely to have really bad side effects -- loss of hair, fatigue.

Know the side effects?

Thanks..

[Hidden]

That's a commonly used combination for liver mets. From what I've heard, the side effects are not that bad for most. There are people on this forum that have had it so hopefully they will post.

I had Docetaxel, similar to Cabazitaxel and it was quite tolerable. I don't have any experience with Platinums.

[Tall_Allen]

My good friend is doing exactly that now. He's scheduled for 6 rounds, possibly 10. The side effects (mainly fatigue) come and go, but he is so far tolerating it well. He uses an ice cap to prevent hair loss. He has one of those kinds of PC that don't put out much PSA, so frequent scans are necessary to assure the tumors are shrinking.

[ken12491 in reply to Tall_Allen]

Thanks, Allen...Do you recommend an ice cap? - Dr tells me I should have none, to very litte...

[Tall_Allen in reply to ken12491]

He says it's very cold - painful at first - but then the scalp gets numb. It's working so far, but he's only had 2 of his treatments. He uses an electric heating pad to keep his core warm. He decided against ice packs on his hands and feet, or chewing ice chips. His nails like OK so far, and no loss of taste.

[ken12491 in reply to Tall_Allen]

thanks, Allen, my quick story from just yesterday - first trip for chemo.

Went to have both ( cabaz and carbo a substitute Dr came in and said my billirum was too high ( 3.3 ) to do the cabazitaxel, so they could only do the one, carboplatin.

Can't locate the mfg levels for the recommendations, or perhaps that's the Dr's call?

Do you recall your friend's levels were?

This Dr had never consulted with me before ( was pleasant ) but did not paint the brightest picture ahead for me. My Dr was out of town that day.

The original plan was 1 shot every 3 weeks and check labs - new plan every week with a shot and labs..

Any thoughts/ideas for me? I was the one that actually suggested cabazitaxel to my dr - might have gotten it from our forum.

Any other drug to be used in place of cabazitaxel?

I m going for a second opinion somewhere in NYC that treats both PCa and liver issues? As you might recall I'm with MSK but am know longer hesitate to challenge

just anyone hospital.

Hope your friend continues to do well - Ken

[Tall_Allen in reply to ken12491]

In NYC, there's William Oh at Mt Sinai and Charles Drake at Columbia Presbyterian. Farther afield, I know that MD Anderson is looking at multiple chemos. You may wish to reach out to Oliver Sartor at Tulane, Tia Higano at U Washington Seattle or Maha Hussain at Northwestern, all of whom treat a lot of this kind of thing and have interesting trials.

I think the problem is that adding any kind of chemo cocktail now may compromise your liver. Docetaxel and cabazitaxel are both taxanes. They both stabilize microtubules (which must "collapse" (depolymerize) before the cell can divide) - when the cell can't divide, it dies. There is a head-to-head trial of the two running now to see if one is significantly better than the other. Meanwhile there are trials of new taxanes, new formulations (some taken as a pill), and other microtubule-stabilizing agents. But you would have to be in a clinical trial to get any of them. Your doctor is worried about liver failure - hopefully, your liver indicators will recover as the tumors there are destroyed, and you will be able to use the cocktail in future infusions. My friend's liver panel was good with the exception of LDH.

[ken12491 in reply to Tall_Allen]

thanks, Allen

[ken12491 in reply to Tall_Allen]

Allen ---- you have helped before...

question ---- had SRT and was on ADT for about a year, non-detectable PSA..

PSA showed up 12/17/118 at .19 --- .28 ----- .48 ( 5/19 ) 2.0 (7/19 ) ---doubling time was less than 4 months..

What would have been a good time to go back on ADT? Now have mets to liver.

I was under the impression with aggressive cancer (gs 9 ) the dr might have put back on ADT much sooner to help cut down the risk of mets which I have now.

thanks

[Tall_Allen in reply to ken12491]

Have you had any of the liver mets biopsied?

[ken12491 in reply to Tall_Allen]

Allen - I did / maybe still do - got treated with regional chemo directly to the liver with a single dose of some form of chemo that was 300 times the strength of a regular dose --- 3 days later they took a biopsy, and found all dead cells and the genetic profiling labs could not make a recommendation as to what chemo drug to use so my doctor picked docetaxel.

The two Labs that came back with no actionable plans were -- Weisenthal and Caris.

Also, I hope your friend did well in chemo --- you mentioned he used a cooling cap, did it work, do you/he recommend it? Just your thoughts, but since I and others consider you an SME, they are of value to me. In the end, I along with my Dr would decide, but again your thoughts to me would be appreciated. thanks

[Tall_Allen in reply to ken12491]

He's had 3 infusions of cabazitaxel/carboplatin + Neulasta with the cooling cap. So far, no hair loss, neuropathy, dysgeusia, or nail changes. He does get dehydrated though (in spite of high fluid intake) and feels much better after 2 liters of water by infusion. He gets his MRI this week, so we'll see what has shrunk.

[ken12491 in reply to Tall_Allen]

thanks

[MontyB]

I had two treatment rounds of the cabaz and carbo combo. I didn't experience any hair loss and the fatigue and nausea I experienced...can't say they were due to the infusions with this combo or not as I was already experiencing fatigue and nausea. For both of my rounds I felt best the day after the infusions which I believe was a result of the add'l meds infused/given during the days of my cabaz/carbo infusions to reduce the side effects.

Take Care, Monty

[ken12491 in reply to MontyB]

thanks, Montay my quick story from just yesterday - first trip for chemo.

Went to have both cabaz and carbo a substitute Dr came in and said my billirum was too high ( 3.3 ) to do the cabazitaxel, so they could only do the one, carboplatin.

Do you recall was your levels were?

This Dr had never consulted with me before ( was pleasant ) but did not paint the brightest picture ahead for me. My Dr was out of town that day.

The original plan was 1 shot every 3 weeks and check labs - new plan every week with shot and labs..

Any thoughts/ideas for me?

thanks and best to you going forward...Ken

Ken..

[MontyB in reply to ken12491]

Hello Ken,

Sorry to hear that you were only able to get the carboplatin. I believe my bilirubin level was .4 .

Ditto TA's suggestions about trials. I'm currently on Xtandi. My MO is talking about Keytruda as the next treatment option for me.

Keep fighting the good fight!

Take Care, Monty

[ken12491 in reply to MontyB]

thanks again Mondy, read your chat...

did u have mets to liver too?

[MontyB in reply to ken12491]

Hello Ken,

I did not have liver mets. Have mets on spine, pelvis, ribs, skull, scapulae, sternum, humeri, right forearm, femurs, lymph nodes, and adrenal glands.

Take Care, Monty

[dougnola]

Hey Ken. Sorry for my delayed response. I had 6 rounds of both taxotere and carboplatin (w dextramethasone and bicalutamide). Followed by lupron and Zytiga/prednisone. My Dr is Sartor as mentioned above. I didn’t have liver mets but except for gobs of bone tumors and a psa of 500, I was an otherwise healthy 50 year old male. So, They nailed me and monitored all my levels very frequently and carefully. Lost my hair and had major fatigue. Got a weird serious inexplicable major fever and skin reaction along the way. Results are very good so far almost 3 years later so I’m personally a proponent.

[dougnola]

Ps. Read the thread again. My bilirubin never got higher than 0.8, FYI.

[dunde8889]

My dad is nearly in an identical predicament as you. Same month and year diagnosis and just recently found liver mets that have significantly worsened. Tried Jevtana (cabazitaxel) which didn’t work. Now on keytruda but worried that his liver will fail before it even gets a chance to work.

Is carboplatin helping your liver?

[ken12491 in reply to dunde8889]

I honestly don t know ( but should ) what med they used on my liver - but again, it was targeted only at the liver. other chemo is probably in my future as well. it was 300 times the strength that the other facility was using and was not targeted only at the liver.

keep fighting

[scarlino]

MD Anderson did a Clinical Trial using Carboplatin and Cabazitaxel and found it to have great success in treatment. My doctor, who was involved in the study - Dr. Zurita, has prescribed that for me. I had one treatment so far and waiting on results. I have tried both taxotere and cabazitaxel alone and neither worked. My PSA is 139, lymph node involvement and uptake to a rib bone this past set of tests. I’m hopeful I will see lymph node reduction, PSA reduction and possibly bone met reduction.