Taxotere Repeat Questions

Dads PSA is doubling on Xtandi and tumor activity is starting. Dr has hinted at going back to Taxotere at a smaller dose. Anyone have experience with this approach. We children are wondering if Dr is possibly moving towards palliative care. Seems strange to not go back with full dose. Dad is in good shape and claims NO pain. We see him show some signs but he seems to block it.

Dad has decided that he does not want to go the route of Jevtana (risk of it knocking him down - does not want to end it that way). Beyond this, he has had it ALL!

Has your dad had Ketokonazole? It is used as a second-line hormonal therapy, and can be very effective.

I am not sure what your reason was for eliminating Jevtana, but it has been approved for advanced PC because it has been proven that it prolongs life post-Taxotere. There is another chemo drug Mitoxantrone, that has been given to PC patients in the past, but that chemo drug did not improve survival, only symptoms. Jevtana actually improves both. Best to you and your dad.

Thank you both for your thoughts and help! It is a tough road we travel. The children are at peace with palliative care - more so than dad. Our main issue is making sure he realizes that this is the path he is deciding to walk and has no regrets. Being direct with the Dr is what we all decided was needed - even if dad says no.

Thank you both!

Pat, can you share anything helpful about brain radiation - side effects etc.? Our journey seems to be similar and the direction of movement seems to be heading that way.

preacherman,
It's hard to have the one on one conversation with the oncol when the patient (dad for you) has made it clear that he does not want you to do that (that's what I got from your reply) I bridged the gap when it was time by saying to the oncol with my husband in the room that although he did not want me to speak for him, it was time for me to speak on behalf of both of us. Oncol are very adept at picking up the 'conflict' signs. I took this approach with both the regular oncol and rad oncol.

For Mark, the brain radiation was relatively easy, 4 weeks, 5 days, 36, maybe 40 gys? Few immediate side effects, except he lost his hair again. The concern we had was long term SE, early onset dementia. The rad oncol will talk with you about the potential for reduced cognitive ability which can show up rather soon. Expected benefit was 12 - 18 months before mets would take off again. Looking back it was probably 9 months before either the cognitive effects or additional brain area mets became an issue, don't know for sure because we stopped doing brain scans at that point. The stroke he had in August could have related to the radiation, or not, again no way to know for sure. The very, very positive side of brain radiation -- his vision was almost back to normal, so important because he was an avid reader, and his mouth, for eating and speech regained about 80% pre radiation. It was however the same area in the lower brain area that gave Mark the most trouble in the end, causing confusion, extreme weakness in limbs, seizures (petit mal type) that caused him to have what looked like sleep apnea while he was awake and disorientation after the episodes. Knowing this after the fact shed new light on his sometimes difficult behavior as the PC progressed.

Dad is so fortunate to have children who are covering his back, whether he thinks he wants it or not.

My email is open in profile if you would like to have conversation off site.

Pat

PreacherMan12.......I agree with all of the responses that you have received. Two of our oncologist's said that they would not put husband back on taxotere once his PSA rose/doubled, that would mean he was not getting the response that the taxotere was suppose to give. Jevetana (Cabazitaxel) was what was next in line after failure to other meds oral (Xtandi) or infusion. Check thread of "My Journey with Jevtana"....Rob is giving reports day by day, treatment by treatment side effects and levels. I also posted my husbands as well. SE are minimal, but their still are SE. My husbands are usually about three days after the infusion, total fatigue, lose of appetite, constipation, depression, to name a few. However, after about five to seven days, he starts to gain momentum. I think that protein is very beneficial in the "scheme of things', he seems to benefit from a meal with protein.

We have also talked about QOL, if side effects overwhelm and QOL is worse when taking infusion and PSA levels are not lowering, then there has to be another avenue/path to take or discuss, possible clinical trials, etc.

Hello ......

   I have my Oncologists explanation of a nearly identical situation.

   I did not have any luck with either oral meds (see below)! In between the two oral meds, I was on taxotere for 30-weeks and it did work for me by reducing my PSA by close to 80%.

   However, after Xtandi (which did not work for me) - my Onco put me on Jevtana - since it had been only about 6-months since being on Taxotere for 10-treatments.

   As he said, Jevtana is very close to Taxotere in composition. I was on Jevtana for 6-treatments (every three weeks)! It worked well for me, but in order to slightly reduce the SE's, he said he was putting me onto four week intervals with Jevtana - and called it maintenance.

   The purpose of extending three weeks to four weeks, in his opinion, is to slightly reduce the SE's - which can get to be pretty strong on Jevtana - even more than on Taxotere. The first 7-treatments of Jevtana did reduce my PSA by about 82% ... but the 8th treatment barely made a difference in either the PSA or catscan.

   However, his current guideline is when my PSA doubles from the current 15.3 - he will likely put me bacck on the Jevtana and for 4-week intervals.

   Summary .... try not to read too much into the 4-week intervals. I do believe the purpose is to slightly reduce the wear'n tear on the body - by the chemo.

   Wish you the best for your Dad.

Rob & Gizmo