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  • Taking Xtandi (enzalutamide) following Zytiga's diminshing returns

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    Old 02-11-2020, 08:21 AM   #1
    RobertsWife
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    Taking Xtandi (enzalutamide) following Zytiga's diminshing returns

    Hi Everyone,
    My husband was diagnosed with Stage IV Advanced Metastatic Prostate Cancer in 2018. I've almost lost him a couple of times but he is such a TROOPER, he just keeps at it. He's been on Zytiga with prednisone plus regular Luperon shots successfully until Jan 2020. Now his PSA is at 800 again, nearly where he started. His doctor is advising chemo with Docetaxel for 4 months. I've been reading research in Xtandi (enzalutamide) which he says is an option but prefers to do chemo as he believes Xtandi is not as effective following Zytiga. I'm concerned the chemo will simply be the end of the road as some research indicates that Xtandi doesn't work following Docetaxel. So, my question has anyone here taken Xtandi following Zytiga and if so, was it effective? We have to make a decision quickly so I appreciate your feedback.

    Thank you!
    Deborah

     
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    Old 02-12-2020, 04:03 AM   #2
    Steve135
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    Re: Taking Xtandi (enzalutamide) following Zytiga's diminshing returns

    Robertswife, Hi welcome to the forum, sorry you are here with all of us. While I can not vouch for the difference between Xtandi after Zitiga. It was my undertanding they are both in the same category in the treatment regiment. It was told to me I would be on one or the other and insurance dictated Xtandi for me. This was probably do to cost alone! It would be quite helpful to all of us to have some Roberts prior treatements/results age how long of a journey you've both been through. Keep up the faith and some others will have some great responces as soon as we see some more info.
    steve d

    _________________
    Diag. 56 DOB 2/59 PSA 01/14 2.0 6/15 2.4
    Biopsy 6/15 5 Gleason Score 8
    RP 10/15 Path 54g 5x4.2x2.8cm 4+3=7 Tumor location quadrants Bilateral
    Extra-capsular extensions present,SV no invasion
    Vascular invasion none, PNI ,Multicentricity multifocal
    Margins NP lN's 5 neg pT3a,N0
    PSA 10/16 0.1 1yr 02/7/17 0.4 02/15/17 0.5
    Pet Scan 2/17 Neg PSA 03/17 0.6 Axumin trial 17.4mm BCR rt. SVB Casodex + Trelstar
    04/17 SRT (42)
    08/17 PSA 0.1 Last 6 uPSA 0.006 uPSA 2/19 0.030 2nd BCR 5/19 0.235 5/30 0.32 6/19 0.34 7/19 0.06 8/19 0.08 9/19 0.056
    10/190 0.08 11/19 0.07 12/19 0.07 1/ 27 0.06
    7/19 Trelstar, Xtandi, Zoledronic Acid
    12/19 (3) SBRT Iliac bone liasion

    Last edited by Steve135; 02-12-2020 at 04:06 AM. Reason: add,sp

     
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    Old 02-12-2020, 01:08 PM   #3
    Michael F
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    Re: Taking Xtandi (enzalutamide) following Zytiga's diminshing returns

    Hi Deborah! Dropping in to extend best wishes to you & Robert to achieve an optimal outcome.

    There are multiple enzalutamide scenarios in the literature:

    - Hormone sensitive setting
    - In combination with ADT
    - Castrate Resistant setting
    - Prior to chemotherapy
    - Following Chemotherapy

    NCI has a quick concise overview that may help:

    https://www.cancer.gov/news-events/cancer-currents-blog/2019/enzalutamide-apalutamide-metastatic-prostate-cancer

    Can we assume Robert is being treated at a major medical center?

    - If so, you can ask his URO Medical Oncologist to present Robert's is case at the next MO Rounds and get a consensus opinion on what to do next.

    - If not currently at a major medical center, you could set up a consultation at a "center of excellence" institution for guidance.

    Also visit the website:

    https://clinicaltrials.gov/

    and search "advanced metastatic prostate cancer." Several trials will pop up. The key is to look at all of the trials including those that are "completed" or "terminated" => the institution and the investigators will be listed along with their contact info. They may be willing to do a phone consultation if there are travel and timing issues.

    Stay strong and optimistic! Keep asking questions and seek correct answers - exactly as you are doing.

    MF
    __________________
    PSA: Oct '09 = 1.91, Oct '11 = 2.79, Dec '11 = 2.98 (PSA, Free =13%)
    Jan '12: Biopsy: 1/12 = G7 (3+4) & 5/12 = G6
    March '12: Robotic RP: Left: PM + EPE => Surgeon went back and excised additional adjacent tissues on Left side down to (-) Margins
    Pathology: Gleason (3+4) pT3a pNO pMX pRO c tertiary pattern 5 / Prostate Size = 32 grams / Tumor = Bilateral: 20% / PNI: present
    uPSA Range: 0.017 - 0.039 at 105 Months Post Op: Mean = 0.023 (n = 26)
    LabCorp: Ultrasensitive PSA: Roche ECLIA
    Continence = Very Good (≥ 99%) ED = present

     
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    Old 02-12-2020, 01:38 PM   #4
    IADT3since2000
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    Re: Taking Xtandi (enzalutamide) following Zytiga's diminshing returns

    Quote:
    Originally Posted by Steve135 View Post
    ... While I can not vouch for the difference between Xtandi after Zitiga. It was my undertanding they are both in the same category in the treatment regiment.
    Hi Steve, this is kind of a quibble, as both are used in some of the same treatment situations, which is essentially what I think you mean. But they are in different classes of drugs. Xtandi/enzalutamide is in the antiandrogen class, which primarily blocks the fueling ports on the cancer cells, while Zytiga/abiraterone acetate is more like a very high powered Lupron type drug that basically suppresses androgen production, in other words: cancer fuel production, no matter where the fuel is produced, not just from the testes. Actually, Xtandi was the first of a new generation of antiandrogen drugs, and two more are now available.

    Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low at <0.01; apparently cured.. Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs.

     
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    Steve135 (02-12-2020)
    Old 02-12-2020, 01:53 PM   #5
    Steve135
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    Re: Taking Xtandi (enzalutamide) following Zytiga's diminshing returns

    Quote:
    Originally Posted by IADT3since2000 View Post
    Hi Steve, this is kind of a quibble, as both are used in some of the same treatment situations, which is essentially what I think you mean. But they are in different classes of drugs. Xtandi/enzalutamide is in the antiandrogen class, which primarily blocks the fueling ports on the cancer cells, while Zytiga/abiraterone acetate is more like a very high powered Lupron type drug that basically suppresses androgen production, in other words: cancer fuel production, no matter where the fuel is produced, not just from the testes. Actually, Xtandi was the first of a new generation of antiandrogen drugs, and two more are now available.

    Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low at <0.01; apparently cured.. Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs.
    Thanks by all means I only have my nearly five years of this journey under my belt I only can try and make connection based on whats come accross my plate. I have done quite of bit of reading and just pass on positive help. Thanks for the information this is how I pick things ups.
    steve d

     
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