Moving on...to olaparib

[Arcticfox44]

I recently updated to ask about chemo options, mainly cabazitaxel with or without carboplatin, or a second round of docetaxel, this time with carboplatin. I had been discussing these with my Mayo doctors, Kwon and Orme. Then earlier this week, Dr. Orme phoned me to report that after another genetic test result came in, we now have the option of olaparib. I live in Nicosia, Cyprus, but travel to the Mayo in Rochester when necessary. If possible, I would prefer to stay in Cyprus, where I have lived for nearly 21 years, rather than returning to the U.S. or Canada.

I had not yet started any further chemo here, and one question is how soon I can start olaparib. Cost may be an issue but Aetna insurance under my former company's U.S.-based plan may cover some of it.

I'll be having further talks with Drs Kwon and Orme, but wonder about the various options, e.g.: could I have olaparib at the same time as cabazitaxel or docetaxel (with or without carboplatin)? Or would it be better to go with olaparib alone as soon as possible?

When I had docetaxel in Cyprus from December 2021 to April 2022, my PSA fell from about 60 to 8, but then started rising again and at last testing in early April this year was 40. This was despite three treatments with Lutetium-177 at the Anadolu Clinic in Istanbul, where I was referred by Dr. Kwon. The last Lutetium treatment was in January 2023.

There has been no spread to bones, and the tests I had at the Mayo in late March and early April -- including PSMA PET CT scan and MRI of the abdomen, showed very little. I am on Zoladex injections every three months and have been for some years. I have chronic pain in my lower back, which appears to be the result of scoliosis and unrelated to prostate cancer. My appetite has improved somewhat in recent weeks. I had been taking 0.50 mg of dexamethasone daily to help with this and now hope that I can reduce it safely to perhaps 0.25 mg a day. I had RP at Sloan-Kettering in May 2002, salvage radiation there in 2008, abdominal lymph node removal in London in May 2014 and again at the Mayo in July 2017. PSA went down after both of those surgeries.

[Tall_Allen]

It's been noticed that olaparib often works in patients who responded well to cabazitaxel+carboplatin. Olaparib is very toxic, so I think it is better to sequence them than to take them concurrently.

[Arcticfox44 in reply to Tall_Allen]

Thanks. Very good to know.

[tango65]

If your cancer has BRCA mutations you could discuss having olaparib plus abiraterone.

prostate.uroonco.uroweb.org...

urologytimes.com/view/fda-p...

evidence.nejm.org/doi/full/...

[Arcticfox44 in reply to tango65]

Thanks. I had abiraterone in 2020-21 which seemed to hold PSA down to around 8 but it fluctuated and didn't get below that.

[tango65 in reply to Arcticfox44]

It may be different if it is combined with olaparib and the cancer is BRCA positive.