Mid Taxotere Therapy meeting with my Onco - WOW WHAT A MEETING- long but I think worth the read

I have had a lot of good meetings with my Oncologist, but yesterday's has to rank right up there with one of the best. There have been times when I thought about following the lead of some other HW members in seeking out the big names in Pca to deal with my own brand of this crud.

Then, I have one of those meetings with my Onco that tells me maybe I don’t need to go anywhere. In my mind, yesterday was one of those meetings.

Here’s a little background for clarity, as to why I scheduled this meeting after treatment #4 of my Taxotere 6-treatment regimen. I started the year with an extremely elevated PSA, after having taken a year off from my first year (2014) on Lupron, (first year bringing my PSA down from 92.5 to 3.84). The decision we made was to do Lupron again, this time coupling it with the Taxotere treatment. Blood work is being done at the beginning of each treatment to verify that my system will tolerate the infusion. My first pre-treatment showed a PSA drop of 60%; 2nd treatment showed a decline of 6.0 points; 3rd treatment showed a decline of .6 points, and treatment #4 showed a RISE of 6 points.

So, I immediately scheduled an appointment for yesterday, which is a week before Tax treatment #5 is due. I sent an email to my Onco telling him about a number of things I wanted to discuss and asked that we schedule an extended meeting to really talk about where we go from here: Do we stop the Taxotere regimen, do we change to something else (i.e. Jevtana), do we move on to drugs like Xtandi or Zytiga, and/or what the he!! do we do?

I did a pre-meeting PSA and testosterone blood test, which was ordered STAT on both testing and posting of the results. The results weren’t back before we finished our meeting, however were back before I left the facility. The results showed a T level of 20 and a PSA DROP of 1.2. For sure these “farkin” numbers can drive you crazy!

WOW! The things we discussed in the meeting confirmed to me that my guy is “on the ball” (in my estimation), and was fully prepared.

One of the first things we talked about was my desire to look into Provenge. While he didn’t start jumping up and down about it, he did say there was no downside. He suggested we need to do further discovery about my Pca and the history I have shown in its stubbornness. In 2014, after 2 rises of PSA, while on Lupron and TAK 700, he referred me to another local facility where a colleague was doing Provenge treatment. The only problem was that when they ran the PSA test, it showed a down result, which disqualified me for Provenge. Expecting yesterday’s PSA to show 2 consecutive rises in PSA, my Onco agreed to again make the call for me and made sure that I still had all of the contact information for the Provenge doc.

Then, I shut up and let him talk. The first thing he talked about was wanting to biopsy one of my involved lymph nodes. I have one that is really easy to get to, which will be the target node. It is actually part of a huge Study and Trial being coordinated by the NIH/NCI. Each patient will initially enroll for screening in which samples of their tumors will be removed (biopsied). The samples will undergo DNA sequencing to detect genetic abnormalities that may be driving tumor growth and might be targeted by one of a wide range of drugs.

/www.nih.gov/news-events/news-releases/nci-match-trial-will-link-targeted-cancer-drugs-gene-abnormalities

Allow me to share a “warm fuzzy – feel good” moment about this biopsy and trial. When I researched the lead investigator for the trial at my facility, I nearly fell out of my chair. Her accomplishments and credentials are out of this world. She and her husband (a renowned Orthopedic Surgeon) have been personal friends of mine for last 15-16 years. Their son and mine played baseball together from early teens through high school. She was also very supportive and provided tremendous information to my late wife in dealing with her cancer. I have to call this “A Guiding Hand” for sure.

Then, my Onco gave me information about Olaparib (Lynparza), a drug that has shown great promise in attacking these mutated cells. When I researched the drug, I found something that was, to me, VERY encouraging. In February 2016, the FDA announced that Olaparib was granted Breakthrough Therapy Designation for mCRPC


TOPARP: A Phase II Trial of Olaparib in Patients With Advanced Castration Resistant Prostate Cancer (TOPARP)

/www.clinicaltrials.gov/ct2/show/NCT01682772


www.cancertherapyadvisor.com/prostate-cancer/prostate-cancer-mcrpc-olaparib-lyparza-fda-breakthrough/article/469575/

You folks who have interest may read these articles and documents for yourselves. As for me, I am all for putting on a “full court press” with my Onco to learn as much as I can about my own “brand” of Pca. I WILL HAVE THE BIOPSY!

The last thing we discussed was about the “what next” for me after either stopping the Taxotere treatments, or completing the treatment based upon the PSA test from yesterday. Since these results showed a 1 point decline, I am fairly confident that he will say let’s finish this, and I am good with that.

The “what next” was a discussion about Zytiga or Xtandi. He stated that Zytiga and TAK 700 (which didn’t work for me), were in very close alignment to one another, so he would prefer that I use Xtandi. I defer to him on this one.

So, for my meeting yesterday with my Onco, that is it in a “nutshell”. As I said, this meeting was one that gives me even greater confidence in him. We are moving forward. We are not sitting on our hands, and I am encouraged that there are still things out there for me to try.

I would consider yesterday as one of my more exciting “Bonus Days”.

Sonny

Good session and discussion today Sonny. I want to allude to one statement above where I have some interesting understanding:

"The “what next” was a discussion about Zytiga or Xtandi. He stated that Zytiga and TAK 700 (which didn’t work for me), were in very close alignment to one another, so he would prefer that I use Xtandi. I defer to him on this one."

Maybe and maybe not. Clearly I was monitoring your case closely for reasons you already know, but was it the TAK700 that failed or was it the Lupron? This is where the trial is still ongoing and will reap results we need to see. Clearly Lupron was not working when your PSA peaked over 140. What I defer to is that it is possible another CYP17 Liase inhibitor such as Zytiga could in fact be effective after docetaxel. But going with Xtandi is not unreasonable either.

One other piece that you and I talked about before, did you get your CTC counts from the S1216 trial? Can you run CTC moving forward? I think both are reasonable questions for your next visit. S1216 has given us some great information on CTC that made ASCO news. But drawing it in trial was defined in the trial guidelines with the only exception being that unless it was geographically difficult to do.

Sonny,
I am so glad that you had a meaningful conversation with your oncologist. Best to you.

Sonny,
Happy to see all that enthusiasm pouring out of my computer screen. Hang in there and good luck on the new steps!
SC

John Keats.... I wonder if he knows ho much his experience has helped folks on this forum...Like the song from air supply "making love out of nothing at all" He sure knows when to hold ya and when to let ya go... The synchronistic event in this experience..s is the most uplifting part of the initial post/thread...it means something ...you know this...ride it...thats why its there...there are no coincidences...only missed windows..."believe Bole...believe" lost episode of twilight zone from a little boy whose faith turned the life around of a down and out boxer...whose name happened to be Bole{coincidence of course tee hee}...Zufus Knows... he always did.....

Great update.

Keep the bonus days coming.
Andrew