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Do We continue Docetaxel or move on? Input please

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Posted 4/8/2015 2:46 PM (GMT -5)
Hello all. I am hoping that some of you out there can offer advice/experience about what to consider
about Frank's treatment plan. When he was diagnosed, he was immediately put on Lupron/Casodex and
reached PSA nadir 7 months later. Casodex was discontinued but PSA continued to rise. Cycle #1 of docetaxel
was 12/18/14, cycle #5 is planned for tomorrow. PSA rose between cycles 1 and 2, then dropped by
50% at cycle #3, now has continued to rise and is much greater than when he started docetaxel.
Medonc is "disappointed" with PSA results and Frank and I are trying to decide whether to finish cycles
#5 and #6 or move on. Do we try cabazitaxel? do we add cabazitaxel to the docetaxel? or do
we stop chemo and have Frank start abiraterone? Even though his PSA is rising, are we still buying
chunks of time that he wouldn't have otherwise? I have been reading and reading and still can't
answer the question of what to do? Any help will be appreciated...

Lisa
Posted 4/8/2015 4:02 PM (GMT -5)
Jevtana is specifically for cases like this - when Taxotere no longer works. If he can get Zytiga and Xtandi, why not do all three - or as many as they will pay for?

He might be eligible for Provenge and Xofigo too.

At this stage, PSA alone isn't always the best indicator. You have to look at other biochemical indicators, and radiographic indicators.

(You can't add Jevtana to Taxotere - two taxanes would be too toxic - Jevtana replaces Taxotere.)

- Allen
Posted 4/8/2015 6:42 PM (GMT -5)
Lisa,

You might ask about adding carboplatin to the taxotere mix. Our medonc seemed to think because of the short time before becoming castate resistant, that he may have the brca gene. Our insurance company wouldn't cover the genetic testing, so he treated John as if he had it. Even though we stopped a cycle early, it brought his PSA down from 30 to 8. He is now on Zytiga and PSA has dropped to 5.

Best of luck with the decision making. It is a tough call!

Take Care,
Barb
Posted 4/8/2015 7:49 PM (GMT -5)
Allen and Barb,
Medonc is planning on a new set of scans before Frank starts with a different treatment plan.
So, we will have more information on the state of his mets, probably next week. I have been
thinking about Zytiga/Xtandi combo and will talk with doctor about it tomorrow. Also, the
carboplatin that Barb suggested. I know Frank's sister was tested for the BCRA gene and she
was negative. I wonder if that is suggestive for Frank? Will also ask that...Every chemo cycle
we meet with the medonc for about an hour before we head down to the infusion center, so
have enough time to get ?'s answered. He did state at our last appointment that cabazitaxel
is a harder chemo than the docetaxel, in his experience. And the docetaxel has been no
picnic! So much to think about...

Thanks for responding, I very much appreciate both your inputs. Lisa

P.S. Barb, how's your week going with the hubby at mom's? or was that last week?

Post Edited (redheadskier) : 4/8/2015 6:53:38 PM (GMT-6)

Posted 4/8/2015 8:06 PM (GMT -5)
Lisa,
It's such a difficult position to be in as a caregiver, learning the language, reading medical papers, and trying to come to some understanding of what is best for your loved one. That is a heavy weight. I feel woefully inadequate in that department and I truly mean that.

Don stopped Taxotare after 5 cycles due to SE's and he's now on Jevtana. Taxotare did a good job of lowering his PSA and the CTC but right after stopping his numbers began to rise again. So here we are.

I think Tall Allen has good advice for you. I wish you all the best in moving forward, Lisa.

Susan

2005 Husband dx at 63 yo Gleason 4+3
2006 LRP First post surgery PSA 11.8 Stage IV Start Lupron
2010-2014 Casodex, Provenge, Nilandron, Zytiga, Orchiectomy, Xtandi.
PSA cont rise. Spot on spine & enlarged lymph nodes.
2014 Xgeva & Taxotare
10/31/2014 Last Taxotare due to SE’s PSA was 14.82 now 1.3
2/27/15 PSA 10.48
3/20/15 PSA 13.68 Multiple lesions found in liver
3/27/15 Start Jevtana w prednisone Neulasta 24 hrs after chemo
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