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Jevtana question

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Posted 7/27/2017 5:27 PM (GMT 0)
Hopefully someone has a bit of experience on this, haven't seen anything anywhere.
My husband's PSA was 4.4 when he started Jevtana, now before his 5th treatment, it was 4.8. Has this happened to anyone else and if so, what was the next step? His oncologist wants to think it is just delayed in working, but we are wondering. After his 2nd taxotere treatment he showed a decrease in PSA.
Thanks for any and all comments!

Sue
Posted 7/27/2017 5:55 PM (GMT 0)
Sue -

Why did he switch from Taxotere to Jevtana if taxotere was still working for him? It may be a delayed reaction, it may be that his PC is more sensitive to docetaxel, or he may be experiencing taxane resistance.
Posted 7/27/2017 7:10 PM (GMT 0)
Tall Allen,

Sorry I can't get my signature to show up. My husband had radical surgery in 4/2001, 35 radiation treatments following in 8/2001 and has had Casodex, Ketoconazole, then in 2012, 6 treatments of Taxotere, a month on Zytiga, which caused liver trouble and then he was on Xtandi from Nov. 2012 until April, 2017. He's been having Lupron shots since diagnosis in February 2001. Not sure why he wasn't given taxotere again, maybe that isn't done. Maybe this is helpful as to why he is having Jevtana? Anyway, I am also trying to figure out what the next line of treatment might be. I think the doctor was hoping he could go back to the Xtandi since it had given him such good results. When we were in the office today, the doctor is gone for the week and we saw the PA who said the doctor would talk to us more next week when we see him.
Posted 7/28/2017 2:32 AM (GMT 0)
I'm guessing that his PSA started rising again after being on Xtandi and that's why the doctor is suggesting going back to chemo. He could have suggested rechallenging Taxotere, but that does not have a good record of success. Jevtana is considered by many to be the best "second line" chemo. Here's an article about it:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3063116/

I would probably being the same thing in his situation. I don't think you know yet that it's not working until the PSA clearly shows a trend. But I would also be looking at genetic testing to get a better idea of exactly what you are dealing with. Certain gene mutations can be exploited with targeted treatments.
Posted 7/28/2017 3:48 PM (GMT 0)
Starfinder, thanks for your reply.
While my husband was on Xtandi, his PSA started to rise and the doctor said we needed to give it some time and sure enough it dropped back down and he got almost 1 1/2 more years of success with it, so that could be what is happening with the Jevtana as well.
I just read the great report on Keytruda, and I am extremely excited about the news, hopefully my husband's doctor will be willing to look into something like this if we need it!
I think the genetic testing will for sure bring great things in the future! I can harley wait to see when it becomes standard protocol for treatment!
Again, thanks for your reply, I appreciate it!
Posted 7/28/2017 4:58 PM (GMT 0)
When Taxotere works, it is almost always cycled again until it stops working. I've met a man who has remained responsive to it for 2 years - everyone is different. I don't know why they switched him to Jevtana - ask his MO. There are clinical trials for adjunct therapies that may help overcome taxane resistance, if that is what happened.
Posted 7/28/2017 5:38 PM (GMT 0)
Thanks Tall Allen
We were to see the oncologist yesterday but he is out for the week so we saw his PA and she said he would discuss the findings with us next week when we see him. My husband's next treatment and should be final treatment of Jevtana will be on the 10th of August, so I can imagine he will want him to have it and then go from there.
This is an interesting disease!
Posted 7/28/2017 9:25 PM (GMT 0)
I just want to clarify my comment above regarding rechallenging Docetaxel chemotherapy. There has been some data that suggests that there is no OS with Docetaxel rechallenge, but As TA has correctly indicated, it really depends on the individual. Here's some information from an article on the subject:

"Docetaxel rechallenge may still have a role in mCRPC, but a carefull selection of patients has to be performed. Most studies reported that ≥ 50% PSA response to first-line docetaxel was the main predictive factor for the favorable outcome on the reintroduction of the same drug. A progression free-interval (PFI) of > 6 mo after first-line docetaxel was associated with high fequency of good PSA responses and symptomatic responses on docetaxel rechallenge in a large retrospective study, and encouraging 20.4 mo median OS was reported[21]. Another study described a longer median PFS (6.3 mo vs 3.4 mo) and median OS (19.4 mo vs 12.8 mo) with docetaxel rechallenge in mCRPC patients progressing at > 3 mo after the last docetaxel cycle with respect to those progressing within 3 mo[22]. In a study of 46 patients with CRPC rechallenged with docetaxel, the PSA response was 66%, and the median OS was 32 mo. In this study a docetaxel rechallenge was safely repeated sveral times, and the good responders had a median PFI of 6 mo[7].

On the other hand, it was reported that PFI < 3 mo was associated with no benefit from Docetaxel rechallenge, probably because of early development of complex mechanisms of resistance to the drug[23]."

The full article is here:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4600198/
Posted 7/29/2017 4:22 PM (GMT 0)
Starfinder,
Thank you for the information and article. I plan to look at it and try to comprehend what it says!

Sue
Posted 7/29/2017 5:00 PM (GMT 0)
Yes, these articles are often difficult to read. My question is usually simple: Does this work or not? But quite often, the answer is much more complicated than that. I think the answer to the question regarding trying Docetaxel a second time is: It works sometimes.

I am really curious to know why your doctor prefers Jevtana (Cabazitaxel). Please let us know. I'm just finishing Docetaxel and I am hoping to be able to do another chemo in the future if and when I need it. I plan to discuss this with my Medical Oncologist at the next appointment.
Posted 7/29/2017 7:49 PM (GMT 0)
The best predictor of whether docetaxel will work the next time is how well the response was the previous time. There is no reason to stop using it or switch to Jevtana unless it didn't work well the last time.
Posted 7/30/2017 12:27 AM (GMT 0)
I'm going to ask the doctor on Thursday when we see him what his reasoning was for changing treatment. I hate to think my husband has gone through all the side effects of this drug and may have to do taxotere and endure that again as well! My hat is off to all the men who have and are enduring this disease and all the treatments!

Thank you gentlemen for your responses, you don't know how much it means to me!!!
Posted 8/1/2017 6:00 AM (GMT 0)
I just talked about this with my Medical Oncologist who specializes in prostate cancer. As TA has correctly said, he said you should try Taxotere first and use Jevtana only if Taxotere doesn't work. I asked why and he said Jevtana is more toxic.
Posted 8/1/2017 1:26 PM (GMT 0)
You might ask about getting into a BAT trial..Even if it doesn't work as well as expected, it tends to "reset" the cancer so it will once again respond to failed treatments like Xtandi....

If he has any active bone mets, he is not a candidate for BAT trials.
Posted 8/1/2017 3:46 PM (GMT 0)
Starfinder,
Interesting! I wonder if my husband will be able to return to Taxotere if indeed this Jevtana isn't working??? I hope and pray we haven't messed up! Also wondering what the next treatment will be as I'm sure he wouldn't be able to go right to the Taxotere without some sort of a break. Not sure he could survive that! After having such good results with the taxotere 5 years ago, I wish that would have been given again.
As I said before, we see the doctor on Thursday, 8/3, but there won't be another PSA taken until next week, 8/10, right before his 6th Jevtana treatment. I'm sure he will have the treatment no matter since they won't have the PSA results until the following day.

Fairwind,
He does have active bone mets in his pelvic area, so guess that counts him out. Thank you for the suggestion, though! At this point, we may need to take anything we can get!
Posted 8/1/2017 8:47 PM (GMT 0)
As far as I know, your husband could switch back to Taxotere and may get a good response.

As a note of interest, a small study was done where patients were switched between the two chemo agents according to how good the PSA response was. Patients who had a <50% drop in PSA were switched to the other chemo and some got an improved response. It was a small study and not conclusive in the opinion of most, but still interesting. Heres an article about the study:

http://ascopubs.org/doi/abs/10.1200/JCO.2017.72.4138?journalCode=jco
Posted 8/4/2017 5:47 AM (GMT 0)
Saw the MO this morning and it was decided that Jevtana treatment #6 would not happen next week due to the rise in PSA before treatment #5. So, my husband is having a CT scan next week to see if there is anything going on in the lungs, abdomen or pelvis and then we will see the doctor on Thursday for the new plan. Hopefully there is one!
I asked what made him decide on Jevtana instead of Taxotere since my husband had had such good results before and he said that he didn't think there would be much benefit since there were obviously cancer cells that weren't killed with the Taxotere. He said he would be looking into some trials that my husband might qualify for and of course I imagine a lot depends on what the CT Scan shows.
My husband is relieved he doesn't have to have another treatment. Today is 2 weeks since #5 and he is still feeling pretty crummy. So, the adventure continues.
I will post again when I find out more! Until then keeping the faith!
Posted 8/15/2017 6:42 AM (GMT 0)
Just wanted to update for anyone interested.
My husband had his CT scan done last Wednesday then a visit Thursday with the oncologist. Only thing spotted were some maybe fatty deposits on his liver. The doctor is thinking they aren't cancer, but we are going in the morning for an ultrasound, just to be sure.
We see the oncologist this Thursday for a followup PSA test and also Lupron shot, then next Monday we will go to the hospital and my husband will have a biopsy of the spot in his pelvis that was seen in the bone scan prior to the start of the Jevtana. The tissue is going to be sent in for gene testing and from there, the next type of treatment will be decided.
So for now, we are waiting.
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