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Stage 4 Guys, Have You Tried This One ??

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Prostate Cancer
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Posted 10/3/2018 9:35 PM (GMT 0)
Sooner or later the ADT (Lupron et-al), the Zytiga, the Xtandi and the Doxetaxel all stop working..Things can start to look pretty bleak..My Onco suggested I try Cyclophosphamide, an older, cheaper, almost forgotten oral chemo (one pill a day along with Prednisone) that has proven very effective in treating advanced prostate cancer..It is well tolerated and carries a low side-effect load. When you are running out of options it's certainly worth a try. Ask your Onco about it...
Posted 10/4/2018 1:45 AM (GMT 0)
Never heard of it. Dr Google says it is used for a lot of other cancers. Hope it works great for you. Did your Doc think retrying Zytiga or Xtandi after chemo was worth a try?
Posted 10/4/2018 2:19 AM (GMT 0)
I'm surprised he is suggesting cyclophosphamide. Usually the response rate is 10-20%. Most sources would start you on cabazitaxel (Jevtana). This is chemically related to docetaxel but has been shown to have activity in patients that have failed docetaxel.

I would ask your onc about this drug.

Thanks
Paul
Posted 10/4/2018 3:22 AM (GMT 0)
Yeah, after dosetaxel failed I did retry Zytiga for a month but got little response..When cyclophosphamide was approved for PC, 48% of patients got a good response along with a quality of life improvement..So it all depends on who's reports and studies you read..

"PATIENTS AND METHODS:

From 2005 to 2010, patients with HRPC who failed at least docetaxel-based chemotherapy were proposed metronomic cyclophosphamide-prednisolone regimen, and were prospectively registered. Twenty-three patients received 50 mg cyclophosphamide and 10 mg prednisolone per os daily until disease progression. Treatment tolerance and efficacy on PSA decrease and pain were studied.
RESULTS:

Metronomic cyclophosphamide prednisolone was safe, well tolerated, and demonstrated interesting clinical activity, yielding a prostate specific antigen decrease by ≥50% in 26% of patients and decrease by ≥30% in 48% of patients, but also favorable palliative effects on pain in 43% of patients. The median progression-free survival was 6 months (95% CI: 4-8 months) and the median overall survival was 11 months (95% CI: 7-19 months).
CONCLUSION:

For this patient population, low dose metronomic cyclophosphamide prednisolone might be a viable alternative. Its convenient oral administration, low cost, and lack of toxicity justify further studies alone, or in combination with other agents in HRPC patients.

As far as trying right after dosetaxel, two onco's both agreed I should try something else first. The chances of success were marginal and the side-effect load was major...Next on the list for me will be carboplatin, a weekly infusion..

Also on the list are a fresh bone scan and MRI...Using that information, perhaps a new biopsy to look for genetic markers that might make immunotherapy worthwhile..
Posted 10/4/2018 1:28 PM (GMT 0)
I wish the best for you in the next steps, Fairwind. I am about to prove resistant to Zytiga I fear and, barring a clinical trial enrollment, will likely face decisions similar to those you make now in my near future. Please keep us informed on how the carboplatin and/or cyclophosamide treat you, and what you learn from these experiences.

I believe john16 went through some cyclophosphamide treatment last year. If the side effect profile is low and one gets some relief for a while... well that sounds llike a good deal.

enjoy this coming fall on the Front Range- these are beautiful days of late-

rf
Posted 10/4/2018 3:36 PM (GMT 0)
Starting to progress while on Zytiga. Xtandi, Erleada or maybe a clinical trail before infusion. There are a lot more options out there now.

Best wished.
Posted 10/4/2018 10:42 PM (GMT 0)

Fairwind said...
Yeah, after dosetaxel failed I did retry Zytiga for a month but got little response..When cyclophosphamide was approved for PC, 48% of patients got a good response along with a quality of life improvement..So it all depends on who's reports and studies you read..

"PATIENTS AND METHODS:

From 2005 to 2010, patients with HRPC who failed at least docetaxel-based chemotherapy were proposed metronomic cyclophosphamide-prednisolone regimen, and were prospectively registered. Twenty-three patients received 50 mg cyclophosphamide and 10 mg prednisolone per os daily until disease progression. Treatment tolerance and efficacy on PSA decrease and pain were studied.
RESULTS:

Metronomic cyclophosphamide prednisolone was safe, well tolerated, and demonstrated interesting clinical activity, yielding a prostate specific antigen decrease by ≥50% in 26% of patients and decrease by ≥30% in 48% of patients, but also favorable palliative effects on pain in 43% of patients. The median progression-free survival was 6 months (95% CI: 4-8 months) and the median overall survival was 11 months (95% CI: 7-19 months).
CONCLUSION:

For this patient population, low dose metronomic cyclophosphamide prednisolone might be a viable alternative. Its convenient oral administration, low cost, and lack of toxicity justify further studies alone, or in combination with other agents in HRPC patients.

As far as trying right after dosetaxel, two onco's both agreed I should try something else first. The chances of success were marginal and the side-effect load was major...Next on the list for me will be carboplatin, a weekly infusion..

Also on the list are a fresh bone scan and MRI...Using that information, perhaps a new biopsy to look for genetic markers that might make immunotherapy worthwhile..

In the OP you said "an older, cheaper, almost forgotten oral chemo (one pill a day along with Prednisone) that has proven very effective in treating advanced prostate cancer..It is well tolerated and carries a low side-effect load."

Sounds worth a try to me! In many cases, a cheaper alternative is not going to be popular, at least with some providers. Unless you have data showing better results with the newer stuff, and hopefully also with at least no worse SEs, I can see why you would want to look into it. There are a lot of older treatments out there for a variety of illnesses, that are often pushed aside by the newest- but not always better- treatments that are still under patent and not generic. So good for you for at least investigating it, and kudo's to your doc for bringing it to your attention.
Posted 10/5/2018 12:09 AM (GMT 0)
It was a VA oncologist who can write scripts for almost anything who suggested it..The VA doctors are not exposed to the pressures and enticements that are frequently offered by drug salesmen working for Big Pharma....They tend to base their medication choices by what has worked well for them in the past..They get nothing, no "incentives" or kick-backs for prescribing one drug or treatment over an other..

You must keep in mind, every year, Big Pharma spends more money on Marketing than they spend on research..
Posted 10/5/2018 7:42 PM (GMT 0)
Great 'Back-Pocket' Item... Thanks for mentioning it to us.
Posted 10/7/2018 8:20 PM (GMT 0)
Fairwind,

do you still have plans to join the VISION trial for a Lu177 treatment?

George
Posted 10/7/2018 8:37 PM (GMT 0)
Fairwind.. hoping for all the best outcome for you.. Ed
Posted 10/7/2018 10:58 PM (GMT 0)
George, yes, I would love to get into the Vision trial (Lu-177) Hopefully they will open a location in Denver before much longer...That was their intent..We are behind the curve on this one..It's fast becoming a standard treatment in some European countries, Australia too. If anything needed to be fast tracked this is it..
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