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Radiation therapy combined with cheno

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Posted 8/13/2016 11:18 PM (GMT 0)
Hi to all

For the past couple of months my father's PSA was increasing currently 28. With all the diagnostic imaging and PSMA-PET it was found only one metastasis with diameter of 3 cm on the pelvic bone, confirmed with biopsy.

Prior to this his treatment was:
July 2004 diagnosis psa 36 - radical prostatectomy + HT
May 2005 salvage radiation
2009/2010 docatex
2012/2014 abiraterone
July 2014 resection on the left lung to remove metastasis
January 2015 resection on the right lung to remove metastasis


Today the doctor is suggesting targeted radiation + cabazitaxel

I have been searching the web and I can't find any relevant writing on this combination of drugs, has anyone come across this or somethings similar?
I need to know what to expect.

Thank you

Post Edited (dime) : 8/13/2016 5:25:50 PM (GMT-6)

Posted 8/14/2016 1:17 AM (GMT 0)
Hopefully, that will shrink the mets you can see and the Jevtana will get many of the ones you can't see.

The combination of drugs you're asking about is Zytiga + Jevtana? I know someone who had Zytiga + Taxotere, and had no unusual problems.

- Allen
Posted 8/14/2016 8:13 AM (GMT 0)
Hi Allan thank for your reply,
Zytega stopped working for my father in June 2014, when mets were found on his lungs and surgery was performed.
Since June 2014 until today he had two surgeries on both lungs and no other medication only the 6 months shot of Eligard.

Next week he is scheduled to start radiation on the pelvic bone upper right side along with it the doctor is starting him on cabazitaxel Jevtana.

I can't find anything on the web that will give me some inside on what can we expect.

Thanks
Bianca
Posted 8/14/2016 3:00 PM (GMT 0)
You can expect some relief from pain .They are just spot-treating the pelvic bone mets with radiation, so there are no systemic effects from that. Jevtana has a similar SE profile to Taxotere. Below are the side effects:

www.jevtana.com/

The same precautions are worth taking: ice packs on the hands and feet during infusions to prevent neuropathy,sucking on ice chips to preserve taste buds, watching carefully for fever, nausea medicine if needed, frequent blood tests, etc.

- Allen
Posted 8/14/2016 3:51 PM (GMT 0)
I think it will help destroying the metastasis with diameter of 3 cm on the pelvic bone. Some doctors believe this will increase the benefit of a systemic treatment.

George
Posted 8/14/2016 4:48 PM (GMT 0)
Thanks for the input

My father has no pain at all caused by the metastasis.

The doctor explained to us in broad terms that by radiating the spot and killing the cancer cells they will release some protein and with the cabazitaxel all other unknown micro metastasis will be destroyed. I just don't understand the protein release in conjunction with cabazitaxel.

Thanks
Posted 8/14/2016 6:08 PM (GMT 0)
The proteins he's talking about are cancer antigens that your T cells can help create antibodies against. The antibodies can seek out and destroy cancer cells elsewhere (this is called an abscopal or a bystander effect).

You can read more about the synergistic combination of radiation in the following article. Nomar Lupron, a HW member, had this done and maybe he will comment upon it. There's an ongoing pilot test now at UVa combining SBRT radiation with a checkpoint inhibitor called Varlimumab.


Radiation combined with immunotherapy in the treatment of prostate cancer


For the same reason, I'm hopeful that the combination chemotherapy with an immune enhancer will be particularly effective. There are clinical trials of now of Taxotere combined with immunotherapies like ProstVac, Provenge, DCVAC, and Keytruda. One of the benefits of combining them is that chemo reduces the power of the immune system, while immunotherapy increases it. Thus, it may reduce the worst side effect of chemo.

You can discuss participating in any of these clinical trials with your oncologist. When he does the radiation of the bone mets, he can give your father Jevtana and Provenge without a clinical trial because they are both already FDA-approved for mCRPC.

- Allen
Posted 8/14/2016 8:05 PM (GMT 0)
Thank you Allen again for those details.
We are from Europe and provange is not available to us, we have confidence in our doctor.
I have read the benefits of immunotherapy however I don't see in the option suggest from our Doctor that some kind of immunotherapy drug is added to my father tretmant.

Thanks again
Posted 8/14/2016 10:24 PM (GMT 0)
You can ask your doctor about clinical trials. There are a couple in Europe that your father may qualify for:

Study of Pembrolizumab (MK-3475) in Participants With Metastatic Castration-Resistant Prostate Cancer (mCRPC) Previously Treated With Chemotherapy (MK-3475-199/KEYNOTE-199)

Phase III Study of DCVAC Added to Standard Chemotherapy for Men With Metastatic Castration Resistant Prostate Cancer (VIABLE)

- Allen
Posted 8/15/2016 6:40 AM (GMT 0)
Hi Allen, thanks again

I have been reading, and from what I have found I understand as you have explained that with the abscopal effect distant unknown micrometastasis may be killd by triggering the T cells to recognize and produce antibodies for killing cancer cells.
Now, the T cells are part of the white blood cells, adding chemotherapy especially cabazitaxel which has great impact on destroying wbc in my understanding would kill those T cells and any antibodies created since it has no selective mechanisam. Maybe I am simplifying it too much?!

Though the doctor mentioned that he will be closely watching his blood to find the right timing to administer the chemo drug and he also mentioned that this has been studied and it was a novel approach for sinergetic effects.

Our doctor is a university professor and researcher for urological oncology we have great confidence in him, the only thing here is that I want to be able to understand what's is going on and the past couple of meetings I was present to try and understand my father's situation and the options we have ahead.

Thanks

Post Edited (dime) : 8/15/2016 12:48:17 AM (GMT-6)

Posted 8/15/2016 7:02 AM (GMT 0)

dime said...
cabazitaxel which has great impact on destroying wbc in my understanding would kill those T cells and any antibodies created since it has no selective mechanisam

No, it's not like that. It's true that cabazitaxel does cause some myelosuppression. That means it reduces the amount of white blood cells (and red ones and platelets) produced by the bone marrow. But it is not complete suppression. If it were, everyone taking it would die or get seriously ill. Conversely, immunotherapy increases the output of certain kinds or white blood cells like killer T cells and dendritic cells. So immunotherapy, to some extent, corrects for the deficit that chemo causes. In fact, when people get a dangerous symptom called "febrile neutropenia" from chemo, they are given an immune stimulant called Leukine that is similar to one of the ingredients in many immunotherapies.

Early trials of DCVAC + chemo (in Czechia) looked very good.

- Allen
Posted 3/13/2017 9:29 PM (GMT 0)
Hi to all 😊

I haven't been writing regarding the development of my father's treatment, but today we have some great news to share.
He was done with radiation to the pelvic bone fue to 3cm metastatic lesson, right after the finish, his doctor decided that he stared with cabazitaxel 6 cycles, the last infusion was January 2nd and today's PSA is 0,65 biopsy results show death pc cells in the pelvic area and no activity on the PSMA scan.

I wish you all the best!
Bianca
Posted 3/13/2017 10:46 PM (GMT 0)
That's a great response!
Posted 3/13/2017 10:55 PM (GMT 0)
Thanks Allan we are so happy with the outcome but I believe our doctor is even happier, he was thrilled!
Posted 3/14/2017 12:03 AM (GMT 0)
great news!

Andrew
Posted 3/14/2017 5:37 PM (GMT 0)
It is really great to see the news!

Thanks for posting, Bianca.
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