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Posted 8/21/2016 12:32 AM (GMT 0)
Has anyone tried CRT? What has been your experience with CRT?

Thank you,

Rick
Posted 8/21/2016 1:44 AM (GMT 0)
Do you mean another cycle of Jevtana/Carboplatin combined with radiation to isolated mets or radiation to the prostate, or both?

In San Diego, they will soon be starting a clinical trial of SBRT to the prostate in men with metastases. You can call to see if you qualify:

Prospective Evaluation of Stereotactic Body Radiotherapy for Metastatic Prostate Cancer

You can read more about this here:

Is prostate-specific radiation still of any value in men diagnosed with distant metastases? Redux

Is prostate-specific radiation still of any value in men diagnosed with distant metastases?

What I really think is a winning combination is either chemo or radiation combined with immunotherapy. The chemo or radiation dumps a LOT of cancer antigens into the bloodstream where T-cells can identify it. If one amps up the T-cell response, it can be a very potent way of destroying cancer cells elsewhere. As an added benefit, chemo or radiation is immune-suppressive and immunotherapy counteracts that adverse side effect. It's a win-win combination. Of course, any immunotherapy can be dangerous too - if the immune system gets over-amped. There are clinical trials now for the combination of chemo + immunotherapy.

- Allen
Posted 8/21/2016 5:00 PM (GMT 0)
Allen,
Thanks for the reply. You have some very good ideas. Perhaps that is what my doctor has in mind. I think he may move me to Ipilimumab and Provenge. A small dose of Yervoy after completion of the Jevtana/Carbo.

My first thoughts, Chemo sandwiched with some kind of radiation. I have read where this combo is not additive, but synergistic. Though the side affects can be daunting.

My last MRI revealed a lesion, or some kind of 2.25 cm shadow has presented in my liver. It quacks like duck so I suppose it's PCa. It's in an easy spot, if there is such a thing. Segment 7. A chip shot for SBRT. I'll have to see if the chemo resolves it.

Rick
Posted 8/21/2016 5:19 PM (GMT 0)
If it's just a single spot on the liver, can't they remove it laparoscopically? Someone on HW was recently talking about chemoembolization by injecting chemo-loaded beads into a nearby artery.

I know nothing about chemo and radiation being synergistic - only either of them with immunotherapy.

How is he going to get you Yervoy? Will your insurance cover that, or is it a clinical trial?

- Allen
Posted 8/21/2016 5:47 PM (GMT 0)
Yes, Laparoscopy is a possibility.

Good question about the Yervoy. Come to think of it Yervoy is only approved for melanoma...I think. Another question to ask him. Maybe he's thinking I can pay for it......Not.

Yes, Those beads are SIR Spheres. They are radioactive about 1/3 the size of a human hair. I guess they go in the femoral artery with a catheter similar to angioplasty. I think they can either inject the "Sphere" or even Chemo directly into the Lesion if the location is good.

Thanks for the links you sent to me about the clinical trials for SBRT/Chemo. Unfortunately I'm disqualified because of prior Proton Beam radiation last year. My profile is updated with 40 proton beam treatments last summer.
Posted 8/21/2016 6:08 PM (GMT 0)
Ah, you've already had protons. Was that at the new Scripps facility? I've heard good things about it.

You can get Ipi (maybe) in the MD Anderson trial that I like a lot:
/clinicaltrials.gov/ct2/show/NCT02703623

The new Keytruda trials look great too, but they haven't yet announced where they'll be doing them:

www.healingwell.com/community/default.aspx?f=35&m=3681010
Posted 8/21/2016 7:11 PM (GMT 0)
Yes Allen, Scripps Proton Beam Center in San Diego. Dr. Rossi is the director there. He had been at Loma Linda for 20 years prior to Scripps. He treated me for a suspicious area in my prostate. The facility is very well appointed. A very new facility, and a good ambiance for a medical building. The staff is great too. As luck would have it my PSA began to rise the week I started treatment. From undetectable in May 2015 it went to 0.79 by June of this year 2016. Since the trend was not my friend my gut told me to get a scan.
Keytruda, Check point inhibitor? Pd-1 PDL-1? This looks very interesting!
You definately are not an average poster here. Thanks for all you do.

Let me rephrase that. There are no average posters here. We all have somthing to contribute. Even a question is stimulating. I think you know what I mean.

Post Edited (RicktheRock) : 8/21/2016 2:46:50 PM (GMT-6)

Posted 8/22/2016 8:21 PM (GMT 0)
Rick,

I'm not sure if this applies but my husband, who was diagnosed in March 2015 as a G9, had a combo of radiation/chemo. Initially the intention was to mimic the Chaartered trial and do early chemo and then surgery. He started 6 sessions of taxotere 3 weeks apart. Then, after advice on this site and much more research, we decided that radiation would be a better route than surgery. After chemo was done, he did 44 sessions (81 gy) to prostate and nodes.

So far . . . it has worked out well. He is still on Lupron but his PSA has continued to go down with every test. We hope the trend continues.

As an aside, I like the idea of NOT being on Lupron while doing chemo. If the principal of chemo acting on rapidly dividing cells is true, why would you want to halt their activity with Lupron. Let the chemo do its work and then hit it with the other methods.
Posted 8/23/2016 6:59 PM (GMT 0)
Peanut 307,

Thank you for that input.
I've been on Lupron for 3 1/2 years with no end in sight. Although I have not asked my current DR about discontinuing for awhile. I've had my 4th infusion of Jevtana/Carboplatin last Thursday.

I understand what you are saying about letting the antigens flow while on chemo. Each time I bring up Radiation my MO is concerned about compromising my marrow. Other than 1 lesion in my liver the only target would be bone mets for radiation. My prostate was hit with 40 proton beam treatments last summer and there is no suspisious activity, for now, in what is now probably a ham and cheese.

From what I've read on this sight Dr. King would be the one to consult regarding futher radiation. IDK

Thank you,
Rick
Posted 8/25/2016 4:39 PM (GMT 0)
Interesting discussion. For what it is worth, I had one session of SBRT to the prostate and other bone mets in 2012 and again for another bone met in 2013. Recent C-11 scan in Phoenix reveals no activity with areas that were targeted. However, widespread metastases in the right lung.

I have now failed Taxotere after 16 infusions and my onc wants to infuse Jevtana (without Carboplatin). Any comments Tall Allen? Here in Canada it is unlikely to find oncs who will infuse the combination despite the Phase II study of MD Anderson.

I am also lining up with a trial using PARP inhibitors following the TOPARP trial in London (I hope I have the defective gene that qualifies me for it). Any comments?

Houseboy
Posted 8/25/2016 6:33 PM (GMT 0)
Houseboy,

FWIW, I asked my previous MO what his next move would be regarding my positive bone scans this May. He said he would administer Jevtana and if that didn't work Carboplatin. I said see ya.
I had found a private MO who had already signed on for the Combo Jevtana/Carboplatin before I asked the question.

Hopefully without sounding too opinionated, I think there is an overall issue with "standard of care". Many doctors, in hospitals, have to stay within the "paradigm" and we end up with palliative care. A word I really dislike while I'm battle for my life. I have stated this to previous doctors. They certainly are not going to put their reputations on the line by going for a cure. They would have to be incredibly respected and really know what they are doing in their field to to get away with doing so. There are doctors out there who are working in rarefied air, outside of the paradigm,and I think we would do well to locate them. They are the ones dragging the rest of the medical community uphil trying to change the mindset from palliative to curative. It is our job to find them. I think this forum is a very good place to start.

We have a similar issue going on.
Attached is a clinical trial at MDAnderson that Tall Allen gave me. I also think this is worth looking at.

Have you had a blood biopsy? The blood biopsy is not as revealing as a tumor biopsy, however mine did reveal several Genomic alterations associated with therapy as well as potential treatments. The test is the Guardant 360 tumor sequencing.

From Tall Allen-
https://clinicaltrials.gov/ct2/show/NCT02703623

Best of luck finding those doctors where you reside if possible. I do wish you well houseboy.

Rick

Post Edited (RicktheRock) : 8/25/2016 1:01:38 PM (GMT-6)

Posted 8/25/2016 7:24 PM (GMT 0)
houseboy -

From what I can tell, you've been getting state-of-the-art care (not just standard of care). Platins are very toxic especially in combination with taxanes. The docetaxel worked really well for you (until it didn't) and there's every reason to believe that the Jevtana (cabazitaxel) will pick up where the Taxotere left off. From what I can tell, there's no reason to believe that you have one of those rare types of PC that would not be responsive to taxane therapy. Why go more toxic than you have to, at least for now?

Every case is different, and medical oncology is often an art as much as it is a science. As with all kinds of prostate specialists, an MO who has seen and worked with a lot of different kinds of PC is very valuable.

- Allen
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