Chemo.... curative or pallative

Good piece, Goodlife. But gee, when I expressed my own Oncologist's view on the possibility of using Chemo with me, vs. HT, I was labeled a fool, mis-guided, following the wrong path, etc. This is something my doctor suggested to me a full year ago. And to re-fresh memories, my oncologist only deals with advanced prostate cancer and advanced breast cancer.

He told me then (and still believes), that chemo can be used to strongly shock any remaining prostate cancer cells, he didn't use or insinuate the word "cured" per say, but said that even using something like Taxotere could shock the cancer into a very long remission, without the short and long term side effects of HT. He felt the use of the chemo was less damaging short term, then using HT long term.

When I see him again in about 10 days, I will engage the subject again, and see if he can provide me with any evidence of this thinking that can be shared openly. But he told me that he had seen great results by-passing HT altogether, and using Chemo instead, especially for those with difficult and aggressive strands of PC.

Just like other primary treatments are starting to take over surgery as the "gold standard", perhaps there will be other advanced treatments that will take over HT as the "standard" for advanced cancer, and this could include aggressive uses of early chemo.

David in SC

She also told me they gave her Lupron. Here I thought that was for males and testosterone.

nope.  my guess is more women have taken lupron than men.

ed

 

I have had this same discussion at great length with both uro and oncologist. There are pros & cons, but for me, because of insurance, I have to go refractory on HT (or prove to be unable to take HT at all - allergy, etc) before they wil pay for any chemo treatment.

We were hoping for the zytiga study to complete, but since it was stopped early, it won't be considered by insurance until Lupron is out of consideration.

My opinion was if the chemo works better, why not take the SE hit now, while I am in better general health, instead of dealing with HT for an indeterminate time, then piling on chemo. Uro agrees, Onco wants HT. Uro has a quality of life orientation, Onco has quantity of life orientation.

I get frustrated with the seemingly outdated treatment strategies in prostate cancer, especially when one compares it to all the work that has been done in breast cancer. It seems like the medical community continues to reinforce the old "try this, wait for it for it to fail, then try this, wait for failure, etc." Even the new drugs require a man to go hormone refractory. The dream is for an expert prostate cancer medical oncologist to sit with a newly diagnosed patient and plan an integrated treatment strategy from the beginning. The integrated strategy can include AS, surgery, radiation, chemo, HT, diet, etc. Some day.

Robert,

I must have been asleep when this Nature article appeared in late June, but it must be what you're referring to. Would that cocktail hour started this week.

www.nature.com/nature/journal/vaop/ncurrent/full/nature11219.html

Nellie

good life just a couple of points...

It is my understanding...

1> Women and Lupron. Lupron has been long used to treat endometriosis and other gynecological conditions. You might recall seeing some stuff in the press that women were suing Abbott to put an end to Lupron. Of course this was not considering that folks with various forms of cancer needed the drug.

2> You gave us two options for Chemo ~ Pallitive or Curitive. But there's more options available:

a> Pallitive. Taxotere, Cabazitaxel, and Mitozantrone are all used in palliative care. They can bring pain relief and extend lives. Not so much for mitozantrone but it can be used in combinations to help relieve pain by shrinking tumors that have already become refractory to HT and other chemo options.

b>Curitive. Not typically for a metastatic prostate cancer survivor. In fact pretty much not curative in these cases at all. But investigation and trials have been conducted to see if early adjuvant taxotere have been and being conducted in patients that do not have metastatic conditions detected. It is not known at this time that it is effective in that way. The trials that resulted in the drugs release were in stage 4 terminal cases that showed refraction to hormonal ablation. The time frame of prostate cancer specific survival was 19 months compared to the control arm of placebo. But that was a median and not the law. Some patients responded and some did far better. Just a note that Taxotere and Jevtana are brand names of the drugs docetaxel and cabazetaxel respectively.

c> This may fall under palliative but there are many cases where a cure is not likely, and disease control is all that is needed. Such as outlined above in cases where conventional HT is not an option. In these cases a cure is not necessary, at least at the time of treatment, and the patient is likely to die of something else. This is still under investigation as to whom is the right patient for this.

Other drugs that qualify as chemotherapy options include Radium 223, cisplatin (very rarely useful in PCa), and others are available in compassionate care situations.

Hope this helps...

Tony

Tony,

Thanks. I guess several of your points mentioned metastatic or hormone refractory situations. As I said, introducing chemo at that point is a hail Mary pass.

Someone in this thread mentioned a 10 % curative possibility with chemo. I have not researched it yet, but I would assume that it is achieved by doing it prior to exhausting all other possibilities.

It is my belief that it may be more effective and possibly curative if we employ it sooner.

Goodlife

GL,
The topic of and approach to curative chemotherapy is highly controversial. Chemo has some of the worse SE's and long term studies of effects on other soft cell organs are not available. In other words if a patient lives 19 months longer in the extreme advanced cases it's reasonable to undergo such aggressive therapy. But if the Chemo "cures" a small cancer that may have been addressable in other ways but causes issues ten to twenty years down the road the question remains ~ was it reasonable to have had it in the first place?

Sanofi-Aventis ~ the developer of both docetaxel and cabazetaxel ~ has run a series of adjuvant chemotherapy studies for guys like us that achieved a remission after initial therapy but had very high risk factors. The results of that study could take well over a decade since achieving a remission in the first place will lead to survival over ten years in 99% of cases. So it is an expensive process and it is an arduous task to see how well it works when used early. We've got study participants here such as Southern Comfort, whom are still on HT and we don't know if the reason he is stringing the undetectables is due to the HT or the adjuvant chemo. I believe it helps and in his case it was reasonable. But the controversy will be ever present for him...

Tony

Post Edited (TC-LasVegas) : 7/13/2012 12:10:30 AM (GMT-6)

Found this on New Prostate Cancer site.

This is asking the same question I am.

prostatecancerinfolink.net/2010/06/08/the-conversation-behind-the-scenes-at-asco/