Zytiga/Prednisone and Provenge

Your opinions please.

My husband was diagnosed in December 2016. Lupron started in January 2017, taxotere through the spring of 2017, no rising PSA but started Zytiga/prednisone in December 2017.

Medical Oncologist is saying now that he's PSA is stable (.06) and his bone mets, lymph and tumor are greatly reduced, it's the best time to start Provenge.

I, of course, start to research. The other day I found some articles, and info on the Provenge prescribing .pdf that are a little concerning. My take away is that Provenge strengthens the immune system while prednisone weakens the system. I found a couple of articles, written a few years back that suggested taking a prednisone "break" of three months before starting Provenge. But that would also include stopping Zytiga.

I have all the links to the articles, and the one study done on 69 men who were taking Zytiga/predisone while doing Provenge. There were no toxicity issues with the combined treatment but it doesn't look like they did any long term followup (or haven't published it yet).

The .pdf says:

"4. Can I receive other treatments while being treated with PROVENGE?

You should carefully discuss all of your treatment options with your doctor before starting any cancer treatment. Your doctor will describe the best course of action for your particular situation.

The use of either chemotherapy or immunosuppressive agents (such as systemic corticosteroids) given at the same time with the leukapheresis procedure for PROVENGE has not been studied. PROVENGE is designed to stimulate the immune system, and using immunosuppressive agents at the same time may alter the effectiveness and/or safety of PROVENGE. Therefore, patients should be carefully evaluated to determine whether it is medically appropriate to reduce or discontinue immunosuppressive agents prior to treatment with PROVENGE."

From what I've read, the Provenge study showed an average of 14 extra months when men had low tumor burden and low PSA. With a higher tumor burden, and higher PSA, I think it was 3 months.

Thank you in advance!

and there you have it from our Provenge rock star. Todd's had great success. Listen to him.

This is the part that is concerning: "...using immunosuppressive agents at the same time may alter the effectiveness and/or safety of PROVENGE."

To me it sounds as if even Provenge isn't sure if it's a good idea. . .

And yes, Todd is a Rock Star.

Union,
Robblee makes an excellent point. Zytiga is taken with a very small dosage of prednisone. Zytiga works by shutting down the adrenal gland. The adrenal gland is responsible for producing the Body’s natural steroid as well as adrenaline and a few other oddball things. One of the things that the adrenal gland produces is residual testosterone. The low-dose prednisone is only prescribed to Supplement what the body can no longer produce on it’s own.. In higher doses prednisones can be an immuno suppressent. At only 10 mg a day I doubt there is need for concern. If you are truly worried about it speak to your physician. He may recommend going off of the Zytiga while receiving Provenge.

Post Edited (Todd1963) : 7/26/2018 9:50:39 PM (GMT-6)

Thanks everyone - and Todd and TA - I didn't think about the dose, just the drug. That's a very good point. His doctor tends to look at the big picture rather than the details - drugs and side effects - or even going off the path that is standard best practices. We've already taught him that the path can alter and get a bit curvy - luckily when that happens he listens, researches and comes back to us if not in agreement at least doesn't condemn.