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Zytiga and Prednisone approved for patients with metastatic high-risk castration-sensitive PC

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Posted 2/8/2018 2:53 PM (GMT -5)
https://www.prnewswire.com/news-releases/zytiga-abiraterone-acetate-plus-prednisone-approved-for-treatment-of-earlier-form-of-metastatic-prostate-cancer-300595759.html

See the link
Posted 2/8/2018 3:15 PM (GMT -5)
Made it clickable.
/www.prnewswire.com/news-releases/zytiga-abiraterone-acetate-plus-prednisone-approved-for-treatment-of-earlier-form-of-metastatic-prostate-cancer-300595759.html
Posted 2/8/2018 3:55 PM (GMT -5)
That's pretty awesome! I wonder if my Onc will go that direction.
Posted 2/8/2018 4:29 PM (GMT -5)
It will probably/unfortunately take some time for the insurance industry to accept this approach...
Posted 2/8/2018 5:28 PM (GMT -5)
Appeal appeal appeal constantly telling them it has been approved by the FDA
Posted 2/8/2018 7:29 PM (GMT -5)

alephnull said...
That's pretty awesome! I wonder if my Onc will go that direction.

Its unclear if oncologists will add Zytiga if one is already on HT for some time since the studies were on newly diagnosed patients and its unclear now much life extension it adds if one is already on HT. More likely, they will wait until castrate resistance before adding Zytiga.
Posted 2/10/2018 5:09 PM (GMT -5)
Did your insurance company cover the Zytiga? I've heard many don't, and its very expensive. I have heard similar success stories. That's wonderful!
Posted 2/10/2018 6:38 PM (GMT -5)
alephnull -

The FDA approved it based on the LATITUDE study for metastatic high-risk PC.

/www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm596015.htm

The STAMPEDE study also included a small sample (n=60) of recurrent patients like yourself. Unfortunately for that group, adding Zytiga did not have any effect on overall survival. However, there was an effect on failure-free survival. The follow-up so far was only 40 months, so it is entirely possible that a difference will emerge after longer follow-up.
Posted 2/10/2018 10:43 PM (GMT -5)
All,
I glad for the FDA approval. However, maybe I am missing something in reading this. My Insurance covered this for me 38 months ago. I don't really care if the studies show how much life extension it may have. I am already far better off for being on Zytiga and prednisone than on HT. DX being High Risk with metastatic , G 4+3 =7 in 80% of two cores, in 2012, HT failed and I was castrate resistant within 1 1/2 years in 2014.

Perhaps the official FDA approval makes insurance coverage easier to obtain. I feel the system is warped if patients were turned down earlier.
keep the faith
Wings
Posted 2/11/2018 11:01 AM (GMT -5)
As I posted above Dr Sartor in New England journal of medicine review of new treatments says that these meds showed no additional benefit over standard ADT to guys age 70 and above . True?
Bob
Posted 2/11/2018 1:17 PM (GMT -5)
In STAMPEDE, there was no significant overall survival benefit in men >70. There was a significant progression-free survival benefit, however. Treatment decisions should be made on physiological age, not chronological age.
Posted 2/11/2018 7:01 PM (GMT -5)
Allen--
Is there an agreed standard in the medical community for determining physiological age for purposes of treatment decisions?
Posted 2/12/2018 3:28 AM (GMT -5)
I'm not aware of a standard questionnaire. An accurate assessment would include lifestyle/medical history as well as age biomarkers (e.g., immunoglycans and telomere length). Here's one such survey :

/www.vitalityage.com/

MSKCC has a really good nomogram that tells one the odds of dying of untreated PC and of something other than PC in the next ten or fifteen years. It incorporates actuarial tables as well as the odds of various diseases causing death. It's for men who have not been treated for PC (as in the STAMPEDE study), but I think it supplies useful info even if one has been treated.

/webcore.mskcc.org/survey/surveyform.aspx?&preview=true&excelsurveylistid=4

here's an article about ageism in prostate cancer treatment:

/pcnrv.blogspot.com/2016/08/ageism-in-prostate-cancer-treatment.html
Posted 2/12/2018 8:36 AM (GMT -5)
I'm not sure if Zytiga is a viable option for me with N1?

Been on HT since August 2016, SRT that finished December 2016. Planning to stay on HT at least till August 2018, maybe longer.

PSA <0.1 since starting HT, but had persistent PSA > 2 after surgery.

So not sure Zytiga would be any benefit at this point since don't know if SRT worked?

Bobby Mac
Posted 2/12/2018 8:13 PM (GMT -5)
I had been under the impression that Zytiga and prednisone were my next treatments but now I wonder if it’s worth it. I’m still on ADT3, metformin , Crestor , calcium , D3 , estradiol and xgeva. Bone density is good and CBC (taken every six weeks) is in normal range. PSA has increased to .175 from <.1 in three months so it’s still low. I’m not doing anything else until PSA is much higher (2.0) in three months at which time I’ll get another CTPet scan with one of the newer radio pharmaceutical agents.
Meanwhile all is good.

Bob
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