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Xtandi vs Zytiga-- no brainer

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Posted 12/4/2016 10:55 PM (GMT 0)
I suspect I've asked this before, but can't remember.

Eventually, I suspect I will have to go on one of these.
Zytiga requires prednisone, right? Pred is a drug with possible very harsh SE. Why would I choose Zytiga, then?

It would seem Xtandi would be the best first shot.

Am I missing something? (Cost? Insurance?)

Mel
Posted 12/5/2016 12:05 AM (GMT 0)
Your insurance company might want you to do Zytiga first simply because it's a little cheaper. They both are eight large a month...The predisone required with the Zytiga is a very low dose so SE's are minimal if at all..You have to take the Zytiga on an empty stomach.. So when the time comes, try for the Xtandi and see what happens..

If the copays are burdensome, there are "foundations" that will help you with those..

With either drug, it's almost impossible to get insurance approval until you become "hormone refractory"..
Posted 12/5/2016 12:21 AM (GMT 0)
lesson learned...no shame ...no blame...tis all a game...
the winners lose...the losers win...pass a fin...begin again
...up with the chin...bristled or skinned...
we fly...we die...we fall...we rise
always on...never gone...ever born...always torn...


John Keats:" if poetry comes not naturally as leaves to a tree, then it better not come at all. " one man's opinion...seems true to me...but...then again...I'm not a tree..


Someone... staap me!!!...my heart is strong...my spirit weak..." I pray the lord...my souls to keep"...

I just discovered...just now...just now... faith for others effects more than faith for self....whodathunk...can you see what that means...can you see...can you see...the perfect symmetry .... OK...OK....I feel like Borgnine In "Marty" with his new found love..."I'm ugly mom...I'm ugly"..."I can't stop talking"... {actually a blend of words to the mom and the girl...rightly so...say I....}
Posted 12/5/2016 1:41 AM (GMT 0)
Fairwind:

I am currently on ADT2 (actually ADT3 as Dr. Lam wants me to continue on the Avodart too).

I assume that I would get on the other drugs when my current drugs no longer first. That is, I WILL be castrate resistant.
So, would MediCare then approve it?

Mel
Posted 12/5/2016 1:46 AM (GMT 0)
For what it means, Dr Lam put me on Zytiga as part of my initial HT. Lupron, Casodex and Zytiga. Surprisingly, my insurance did pay for it, which surprised me since it's not an approved indication for the drug. (As far as I know.) The low dose of prednisone wasn't an issue for me, although we did cut the Zytiga dose in half since it was giving me some liver inflammation.
Posted 12/5/2016 1:51 AM (GMT 0)
I've been on both and got good results from both but prefer Xtandi because I do not need to take it on an empty stomach and prednisone is not required.
Posted 12/5/2016 1:56 AM (GMT 0)
Michael:

That's interesting. I wonder why Dr. Lam just did the Casodex/Lupron thing with me?

Perhaps he was more aggressive due to your G9. I am G 4+3.

Mel
Posted 12/5/2016 2:50 AM (GMT 0)
Mel,

Are you currently on hormone therapy? I thought you were on a HT vacation, but in this thread it looks like ADT2/3.

CVS is somewhat forcing patients to go to Zytiga first seeing that they aren't covering it anymore starting Jan 2017.

Thanks,
Jerry
Posted 12/5/2016 3:23 AM (GMT 0)
I am on HT vacation. But I WILL be on ADT3 VERY soon.

Mel

Post Edited (compiler) : 12/4/2016 11:35:13 PM (GMT-7)

Posted 12/5/2016 5:53 AM (GMT 0)
The goal of hormone treatment is to get your PSA as close to undetectable as possible. If Lupron and Casodex accomplish that, then there is no need for the Xtandi or Zytiga..When the PSA starts to climb, they will stop the Casodex and switch to Xtandi or Zytiga...which act like Super Casodex..If you are on Medicare Part D drug plan, get your Medicare book out, go to Part D and do the math on the deductable, copays and doughnut hole..It's a real wake-up call.....
Posted 12/5/2016 6:38 AM (GMT 0)
Fairwind:

I have a MediCare Advantage Plan as a retired teacher here in Michigan.

Advantages of the Plan:

1) It covers everything that MediCare does, and then some

2) No donut hole

3) Max. annual expenses

Nevertheless, it is hard to ascertain every little feature.

I am not sure of what the coverage would be, or IF they would cover these newer drugs.

OK, I just got on my drug insurance site (Optum Rx). It is a Tier 2 drug. They normally quote a price, but they did not, saying prior authorization needed. This was for Xtandi.

Guess I'll worry about it when the time comes!

Mel

Mel

Post Edited (compiler) : 12/5/2016 6:48:02 AM (GMT-7)

Posted 12/5/2016 6:57 AM (GMT 0)
Mel,

I read a study that came to the conclusion that Zytiga followed by Xtandi lasts a little bit longer than the other way round. New studies may have different results.

George
Posted 12/5/2016 10:21 AM (GMT 0)
Mel, I did Xtandi for 15 months before chemo. It was great and I had no side effects from it. Best I had felt in years.

Don
Posted 12/5/2016 6:38 PM (GMT 0)

Jerry L. said...
Mel,

Are you currently on hormone therapy? I thought you were on a HT vacation, but in this thread it looks like ADT2/3.



Mel, the reason for the confusion (above) is that you are really on IADT, not ADT...you can add the 2/3 to either, as you wish, but the I for Intermittent is an important indicator.
Posted 12/5/2016 8:14 PM (GMT 0)
Mel, since I was on Provenge, the 5 Mg Prednisone twice a day with Zytiga could have adversely affected my Immune system. So Dr Lam's associate, Dr Turner prescribed 50 Mg Eplerenone (Inspra) once a day in liue of the Prednisone.

Empty stomach was easy to manage as I just took the 4 Zytiga pills when I got up to pee at night and then could eat when I reawoke and take the Inspra (Eplerenone) with my first meal along with my other morning pills.
Posted 12/5/2016 8:31 PM (GMT 0)
Jack:

Yeah, I should have just said IADT!!

Mel
Posted 12/5/2016 8:52 PM (GMT 0)
Xtandi seems to work a little better, but insurance usually wants Zytiga first because of cost. The prednisone is low dose to replace what the Zytiga is preventing. Maybe apalutamide will be approved by the time you need a second-line hormonal.
Posted 12/5/2016 9:07 PM (GMT 0)
What is apalutamide?

(OK, I looked it up -- it is ARN509, in Phase III trials -- looks quite promising!)

Mel

Post Edited (compiler) : 12/5/2016 2:12:32 PM (GMT-7)

Posted 12/5/2016 9:14 PM (GMT 0)
It's an investigational second-line hormonal agent, as I said. It may turn out to be better than Xtandi or Zytiga, and may not be as susceptible to resistance. That's the hope, anyway. Used to be called ARN-509. There are several more in the pipeline. It's fruitless to ask your question now because you have no idea what will be available when you are ready for it. As I always preach: Live in the present --take things as they come.
Posted 12/5/2016 9:30 PM (GMT 0)
Fairwind,

Randy is participating in the EMBARK clinical trial, which combines Xtandi with Lupron prior to becoming hormone refractory. The hope is that combining the two earlier will extend metastasis free survival.

Donna.
Posted 12/5/2016 11:01 PM (GMT 0)
I used to think like TA {present living}...till I started separating airplanes for 42 years....God may be a pilots co-pilot...but not the AT controllers...now as I think about...I think the ATC was the pilot and the co-pilot's...copilot...doh!!
Posted 12/6/2016 12:15 AM (GMT 0)
Mel,

I have OptumRx as my mail Rx provider. They will send you to BriovaRx for the specialty stuff. My current Xtandi is $9444 per month (4 pills daily, standard dose).

The Zytiga (last year) was $8060 per month.

Clearly my out of pocket is all over the map depending on where I am in deductible / co-pay scheme of my employer insurance, but regardless, January will be truly ugly with an Xtandi refill and a 6 month lupron shot in a ten-day window.

I was only allowed to move to Xtandi after Zytiga basically shut down my liver.

The Zytiga + prednisone actually brought my PSA down further / faster, but with a failing liver, that was no longer important.
Posted 12/6/2016 12:26 AM (GMT 0)
142:

Did your liver recover?

Also, do you have MediCare Advantage?

Yes, I think Briaxa is also my specialty pharmacy. I guess it would go there.

I know my Plan has an OOP maximum, but I don't recall if it is only for medical or includes pharmacy. (I think it is just medical).

Mel
Posted 12/6/2016 1:06 AM (GMT 0)
Mel,

Yes, it took about three months, but liver functions came back to normal. It was a bit dicey at first, as the numbers stayed bad for about 45 days, then came suddenly back to normal levels over a two week period. I was getting extensive blood work done once a week there for almost six months.

I'm not on medicare yet, not having hit 65, so I'm still working, primarily to keep the employer insurance plan. But they use OptumRx for mail order.

OptumRx bought BriovaRx and consolidated all the specialty pharmacy stuff there. Briova has generally been more responsive and helpful than Optum. Even proactive in a courteous and useful manner, rather than the previous badgering to use mail order at all costs.

My deductible / out of pocket is blanket, all services / Rx included, at about $13,000. It will go up for 2017. Like I said, January (and February) will at least suck, if not worse.
Posted 12/7/2016 12:50 AM (GMT 0)
After the first of the year, the "foundations" that provide support for Zytiga and Xtandi co-pays and deductibles may get refunded and start accepting new applicants again. They have very liberal income limits and can lift that burden off your shoulders.. But their 2116 program is closed to new applicants..
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