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Abiraterone not working. Next choices?

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Posted 11/27/2014 9:57 PM (GMT 0)
Happy Thanksgiving to our American friends.

Don's PSA and ALP are rising significantly. PSA over 19 and ALP over 500. When we saw Dr. Myers (when his PSA appeared to be dropping), he said he thought taxotere should follow abiraterone (but he did ask us if we had Ra 223 and I said I didn't think it was available). Up here, both the cancer agency and our local oncologist say to try enzalutamide. However, I assume Don has the AR-V7 variant going on and this is why Snuffy prefers chemo to enzalutamide. We have asked him via portal, if he has alternative suggestions.

I am wondering if anyone has gone directly to Ra 223 (Xofigo) following failure of abiraterone and what your results are/were. Don will also be having Xgeva and is on estrogen patches as of today. I understand a lot of guys here have had chemo and I know that advocates on this and other forums recommend it and have study refs and what-not. However, it is not Don's choice at the moment, for better or worse. I am currently looking into spot Ra for whatever area is causing the trouble. We have a new bone scan that I haven't seen yet and a CT scheduled.

Thank you...

Update** Bone scan came in with yet more mets and larger ones, including the skull. This is since he went on abiraterone. Local oncologist has put him on enzalutamide right away and said this was his choice rather than Taxotere. He did not prescribe Xgeva, but is having an X-ray done of the femur. He is also calling the RO at the cancer agency to see if Don can get into the revamped Radium 223 program in January. Oh, and yes to estrogen patches!
Posted Yesterday 7:21 PM (GMT 0)
Moonlitnight, Sorry to read of Don's advancement while on abiraterone. Even though there has been some recent evidence that suggests if aberaterone is not effective, then enzalutamide will also likely not be effective, there are so many PC variants, I would still give it a shot. I failed enzalutamide, but have no hesitation sometime in the future giving aberaterone a shot at it. The two do have different mechanisms of action, so I would think that in some cases, one may work even if the other did not. I hope and pray that you will be able to report to us that Don is such a case.

When I went to see Myers after failing on the enzalutamide/prostvac trial, he was real encouraged with his patients responses to aberaterone and Xofigo . At that time, Myers was not much of a chemo advocate, and told me that only 5% of his patients required it. However, when he saw that I had new spots on my liver and adrenal gland, he was concerned that any further PC advancement there could be life threatening. He knew that I might not respond to aberaterone, and Xofigo would do nothing for the threatening soft lesions, so recommended my going forward with the chemo/xl184 trial.

I'm not going to try and sell you on chemo, and understand the hesitance, but if you and/or Don ever want to talk to me about my experiences on Taxotere, please do reach out. Assuming Don's CT scans don't show anything of concern, and his advancement is mainly within his bones, Xofigo sure does seem like a great option for him, a long with the enzalutamide.

BTW, you probably already found this out; Xofigo was approved in Canada the end of 2013 Canada Approval

My best to you and Don,
Posted Yesterday 9:46 PM (GMT 0)
Adjust, thank you so much for this very helpful and thorough response. Coincidentally, I printed out your experience on taxotere and cabo thread yesterday, and put in my chemo binder.

When Don picked up his script for enzalutamide this morning, he also was given one for Xgeva. I have emailed the oncologist to find out when this starts.

The cancer agency was not keen to give Don Ra 223 earlier this year and actually said it didn't work very well. Our general oncologist disagreed. We got the impression the cancer agency was trying to push Don into another trial for OGX, which doesn't impress us. The agency is going to be starting up with it again in January and both Don and his oncologist are pressing for it.

I have to admit I was a little shocked to hear Dr. Myers say chemo should be next. I know he was impressed with the CHAARTED trial, but Don is way past "earlier on in the progression." His reasoning was that he had put a few guys on it and they had durable remissions.

The CT scans might show soft tissue mets and so Xofigo will be out of the picture. I recall the last scan mentioned small patches on the lungs and adrenals but it was brushed off as "probably scar tissue." Obviously this is a very great concern. He hasn't put on any weight either, following the 40 pound loss and subsequent gain of three pounds.

We will most certainly reach out if Don goes on Taxotere and thank you again for your help. Moon.
Posted Today 4:07 AM (GMT 0)
Moonlit -- I don't have any advice as you're in terrain I have no experience with, but still wanted to at least let you know how sorry I am you and he are going through this. Know that you have a lot of friends out here pulling for you
Katie
Posted Today 4:45 AM (GMT 0)
Moon,
I know your concern. As you can see by my husbands stats he's been through a lot of treatments in 9 years. We'll know more fully how chemo went after his MRI & CT on 12/12 with results the following week.
Chemo was not easy and it will take some time for the SE's to ease up but he feels it was the right move.
I so hope your husband has a good durable result.
Best,
Susan
Posted Today 3:18 PM (GMT 0)
Katie, so great to hear from you. Hoping T. and you are OK. The oncologist has put him on Xtandi and Xgeva with hopes for Xofigo in January. Spoke to Dr. Myers via portal and he says Xofigo as well (assuming results of scan show no soft tissue involvement). Praying extra hard there. Bone scan shows mets accelerating "significantly" since going on Zytiga. Susan, your husband's results look really encouraging. Thank you.
Posted 11/30/2014 10:11 PM (GMT 0)
my experience with PCa drugs has been perhaps different than some others, different drugs may work for some patients but not others, I tried keto high dose and low dose and in combo with leukine and estradiol and it didn't seem to work as Dr. Myers says many respond to such, however I did respond to zytiga for a while and it is similar to Keto in concept. I had used Xtandi prior for awhile and went to zytiga, now back on Xtandi and it is showing results in psa, so some of this stuff you just have to try the drugs if you can get them. I would say the same goes for trying DES, emcyt, flutamide, nilutimide and other drugs.
Posted 12/1/2014 1:17 AM (GMT 0)
Zufus! It's good to see you here as I know you've been having some increased troubles lately. It really is a "try this, try that" thing, isn't it? Dr. Myers mentioned a patient whose PSA wasn't behaving. The patient read the studies on ginger and took 3 oz a day, and it went to undetectable (the PSA, not the ginger). That is one heck of a lot of ginger. I assume it is the concentration of gingerols that somehow plays a role. We buy the organic ginger from Hawaii, available at Whole Foods. Whether it will help Don, we don't yet know. Our oncologist also put us in touch with a non-profit, government OK'd broker for the green leafy stuff as well. (In our province, medical oncologists can do this.) Don is having withdrawal symptoms from prednisone today, so he's not feeling too merry and doesn't look at all well. He starts Xtandi tomorrow.
Posted 12/2/2014 5:44 PM (GMT 0)
moonlitnight.....if you read the signature below you will see what all husband has been on during our PC journey.

I understand from a couple of oncologist that enzalutamide (Zytiga) may work when abiraterone (Xtandi) doesn't or vice- versa. Sometimes one (abiraterone) will work for awhile and stop working and then try the other (enzalutamide) and it will sustain the PC for awhile and again stop as well. Husband was only on Xtandi (enzalutamide) for about 10 months and as you can see it stopped working on the PC. You can check the thread "Jevtana and Beyond" was a posting that another PC warrior and I kept logging in data about the chemo treatments and side effects. Husband is currently on Xofigo/Radium 223 and is responding well, fatigue and loss of strength is so ever evident with him though.

There is a clinical trail going on currently for candidates who haven't been on chemo. Combining Ipilimumab (Yervoy) with (abiraterone acetate (Zytiga) plus prednisone. contact Dr. Daniel Danila (646) 422-4612. location Memorial Sloan Kettering, N.Y, NY. Their are several requirements for admission. I found this one on the Prostate Cancer Research Institute web site on November 13, 2014.

Feel free to e-mail me and I can add whatever information that I have available. This is a great forum to get current up to date information and support. These men and women have been so helpful to me since I stared reading on posting my husbands condition.

Another thread is "Caregivers".....

Peace Hope and Love.....

sal
Posted 12/2/2014 6:10 PM (GMT 0)
Sal, thank you very much for this info. Don has a pre-radiation (spot radiation) CT on Friday and then Ra starting Monday for his collarbone and (?). I guess we will know then if there is soft tissue involvement and whether he can go on Ra 223. The collarbone is where the mets are most concentrated. He broke it when he was 18 in the exact spot.

I have downloaded trial info on Yervoy. Not sure if it is the same one as I haven't checked your ref yet. It is being done in Portland. Not sure how going back to abi would work though after just starting enza, but it is good to keep in mind. Our local oncologist (general) is excited over a PD-1 inhibitor and sent me away to "do (my) homework" on that as well.

Just looking at your stats...Ted seems to have the same met distribution, even in the R. femur. I worry about the fact Don had neuro issues with his eyes. We were told that it was the pressure of lytic mets against the abducens nerve, which doesn't mean it has actually entered the nerve. Since Ra, the situation seems to be better, with the vision improving somewhat (but this could simply be the response of the brain forming new pathways to enable more accurate vision).

On a happier note, Don is feeling much better since he stopped abi last week. However, our oncologist told us his "younger" patients on Xtandi seem to have more intense SEs than his older patients, primarily brain fog. He starts that today.

We carry on. I am deeply appreciative of your input and that of others here. Moon.
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