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coronavirus and chemo

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User
Posted 13 Mar 2020 at 16:55

My partner, who has metastatic prostate cancer grade 5, has been offered chemo once he's been on the Zoladex a bit longer. Does anyone have an opinion on whether the risk of getting coronavirus while on chemo and ones immune system is compromised outweighs the risk of leaving the chemo until the hormone therapy stops working?

User
Posted 13 Mar 2020 at 22:18
Many hospitals have already published COVID-19 plans which include not providing any non-essential chemo for the time being. I think that a case such as yours would be considered non-essential and might be safely delayed until the situation is more stable. The risk of getting a serious virus while immuno-compromised by chemo is far greater than the risk of not having chemo for a few months.

I noticed that one of the oncologists tweeted today that they are not offering any chemo, are reviewing all men on Zometa and will be holding as many clinic appointments as possible by phone.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 19 Mar 2020 at 20:58

Chemo used to only be offered when HT stopped working. Bringing it forward to the beginning of the HT treatment is relatively new. You could ask about having Abiraterone or Enzalutamide instead. You will probably be refused, but no harm in asking, as these are strange circumstances. Normally, these are only given on the NHS after chemo (they are very expensive). Leaving the chemo a few months while you are on HT probably won't do any harm. Get regular PSA tests though, so you can quickly spot when additional treatments are required.

User
Posted 20 Mar 2020 at 12:01

Covid 19 - Prostate Cancer UK Information

Here is a link to some information about coronavirus (COVID-19) for people who have, or have had, prostate cancer.

This information aims to answer some of the questions you may have at this time. We will update this page in line with any official advice changes and to make sure it answers common questions. You can also contact our Specialist Nurses for further information and support.

As always, it’s important to follow the advice of your doctor, nurse or other people in your medical team.

https://prostatecanceruk.org/prostate-information/coronavirus-covid-19-and-prostate-cancer

Help us to support you at this time

We want to know from you how we can best support people affected by prostate cancer during the coronavirus outbreak. Please complete our short survey  to let us know what support and information would help.

 

Sue

Peer Support Manager

User
Posted 13 Mar 2020 at 22:11

I have no idea how this dilemma can be resolved but my oh is on zoladex and is in the middle of his chemotherapy treatment ( he has already had radiotherapy, hormone treatment and arberatitone ). We have noticed that he has been affected more with each treatment and has very little energy so we are very worried about the danger of his contracting the virus. It is hard but we have decided to minimise contact with other people, even family, for the time being.

Only your medical practitioners can really advise you as it will depend on many factors, including age, general health and progression of the cancer.

I wish you both all the best and hope you stay well.

User
Posted 14 Mar 2020 at 18:11
User
Posted 20 Mar 2020 at 00:25
Technically, Abiraterone and Enzalutimide are also forms of chemotherapy and men taking them may be more susceptible to infection so probably safest for your dad to stick with just the HT for now. Once this is all calmed down, he may be able to have the chemo and I don't think there is any significant evidence to say that it extends life if given 3 months after HT started but is a waste of time 6 months after HT started. Your dad and other men in the same situation may be the start of a new protocol!
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 20 Mar 2020 at 12:16

As it stands, my partner has said he's willing to go ahead with the chemo, and is scheduled for his pre-chemo information appointment in 3 weeks. Of course things may change between now and then, the oncologist may have second thoughts, so we wait and see.

User
Posted 30 Apr 2020 at 09:51

Hi. My husbands planned chemo was cancelled due to virus. He has mets in chest lymph nodes. Currently on decapeptyl. But he has been told chemo wont now happen at all as he will be outside the 3 months from starting hormone therapy even if it's safe say by the end of the year. He is still we think in castrate sensitive phase but I cant understand why chemo would not still be useful after 3 months? I know this, was the criteria for entry to stampede but is there any evidence for the 3 month cut off? Our oncologist says 'biological reasons. What does this mean? Not being offered abi by the way. 

User
Posted 30 Apr 2020 at 11:39

When we saw the oncologist in March, he gave the impression that they either do the chemo early in the hormone therapy, or wait till it's no longer working - they don't "do it half and half", he said. What the evidence is that there's no advantage having it, say 6 months after starting hormone treatment, I don't know.

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User
Posted 13 Mar 2020 at 22:11

I have no idea how this dilemma can be resolved but my oh is on zoladex and is in the middle of his chemotherapy treatment ( he has already had radiotherapy, hormone treatment and arberatitone ). We have noticed that he has been affected more with each treatment and has very little energy so we are very worried about the danger of his contracting the virus. It is hard but we have decided to minimise contact with other people, even family, for the time being.

Only your medical practitioners can really advise you as it will depend on many factors, including age, general health and progression of the cancer.

I wish you both all the best and hope you stay well.

User
Posted 13 Mar 2020 at 22:18
Many hospitals have already published COVID-19 plans which include not providing any non-essential chemo for the time being. I think that a case such as yours would be considered non-essential and might be safely delayed until the situation is more stable. The risk of getting a serious virus while immuno-compromised by chemo is far greater than the risk of not having chemo for a few months.

I noticed that one of the oncologists tweeted today that they are not offering any chemo, are reviewing all men on Zometa and will be holding as many clinic appointments as possible by phone.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 14 Mar 2020 at 17:50

I take it our oncologist will advise my oh after his ct scan next week whether he will be able to continue with his treatment. It is very worrying.

User
Posted 14 Mar 2020 at 18:11
User
Posted 19 Mar 2020 at 19:46

My dad has advanced prostate ca, lymph, lung and bladder mets. He is starting his hormone treatment tomorrow and was due to start chemo in 3 months. He has just been rang by his oncologist to say he won’t be getting chemo now due to coronavirus. Said that the risk is too high on chemo if you were to catch corona. I don’t know what that will mean more longer term only having hormone treatment at the moment, it’s very worrying all of this. 

User
Posted 19 Mar 2020 at 20:58

Chemo used to only be offered when HT stopped working. Bringing it forward to the beginning of the HT treatment is relatively new. You could ask about having Abiraterone or Enzalutamide instead. You will probably be refused, but no harm in asking, as these are strange circumstances. Normally, these are only given on the NHS after chemo (they are very expensive). Leaving the chemo a few months while you are on HT probably won't do any harm. Get regular PSA tests though, so you can quickly spot when additional treatments are required.

User
Posted 20 Mar 2020 at 00:25
Technically, Abiraterone and Enzalutimide are also forms of chemotherapy and men taking them may be more susceptible to infection so probably safest for your dad to stick with just the HT for now. Once this is all calmed down, he may be able to have the chemo and I don't think there is any significant evidence to say that it extends life if given 3 months after HT started but is a waste of time 6 months after HT started. Your dad and other men in the same situation may be the start of a new protocol!
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 20 Mar 2020 at 12:01

Covid 19 - Prostate Cancer UK Information

Here is a link to some information about coronavirus (COVID-19) for people who have, or have had, prostate cancer.

This information aims to answer some of the questions you may have at this time. We will update this page in line with any official advice changes and to make sure it answers common questions. You can also contact our Specialist Nurses for further information and support.

As always, it’s important to follow the advice of your doctor, nurse or other people in your medical team.

https://prostatecanceruk.org/prostate-information/coronavirus-covid-19-and-prostate-cancer

Help us to support you at this time

We want to know from you how we can best support people affected by prostate cancer during the coronavirus outbreak. Please complete our short survey  to let us know what support and information would help.

 

Sue

Peer Support Manager

User
Posted 20 Mar 2020 at 12:16

As it stands, my partner has said he's willing to go ahead with the chemo, and is scheduled for his pre-chemo information appointment in 3 weeks. Of course things may change between now and then, the oncologist may have second thoughts, so we wait and see.

User
Posted 20 Mar 2020 at 12:22

This is super, Sue - thanks to the team for pulling it together

Edited by member 20 Mar 2020 at 13:26  | Reason: Not specified

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 20 Mar 2020 at 17:49

 Hi, I’ve got grade 4 and I’m waiting to start chemotherapy in April. Currently on hormone treatment. I spoke to a urology nurse today who said the oncologist will take a decision based on the balance of risks. It sounds quite likely the chemo will be postponed until this coronavirus is under control. I’m currently self isolating and so is my wife because she’s got asthma. I feel sorry for our 16-year-old daughter who has to isolate with us, poor girl. 

Edited by member 20 Mar 2020 at 17:54  | Reason: Typo

User
Posted 30 Apr 2020 at 09:51

Hi. My husbands planned chemo was cancelled due to virus. He has mets in chest lymph nodes. Currently on decapeptyl. But he has been told chemo wont now happen at all as he will be outside the 3 months from starting hormone therapy even if it's safe say by the end of the year. He is still we think in castrate sensitive phase but I cant understand why chemo would not still be useful after 3 months? I know this, was the criteria for entry to stampede but is there any evidence for the 3 month cut off? Our oncologist says 'biological reasons. What does this mean? Not being offered abi by the way. 

User
Posted 30 Apr 2020 at 11:39

When we saw the oncologist in March, he gave the impression that they either do the chemo early in the hormone therapy, or wait till it's no longer working - they don't "do it half and half", he said. What the evidence is that there's no advantage having it, say 6 months after starting hormone treatment, I don't know.

User
Posted 30 Apr 2020 at 13:28

Originally Posted by: Online Community Member
He is still we think in castrate sensitive phase but I cant understand why chemo would not still be useful after 3 months? I know this, was the criteria for entry to stampede but is there any evidence for the 3 month cut off? Our oncologist says 'biological reasons. What does this mean?

 

The dramatic success of docetaxel in the Stampede trial depended on the man being hormone naive - it wasn't about being castrate dependent or castrate independent. There are years and years of evidence that prostate cancer becomes resistant to docetaxel at some point so if it isn't introduced while the man is still castrate naive it is simply reducing his options later down the line. Also, other trials have shown that a) half of prostate cancers are docetaxel resistant and b) chemo can cause chemical changes in the cancer cells (e.g. cribriform pattern) which make them more resistant to other treatments. That is why, until Stampede, chemo was only used at the end of life stage. 

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 30 Apr 2020 at 15:18

Thanks for your reply.  I think I meant hormone sensitive- which I assume he is if his PSA has responded well to Decapeptyl  - or perhaps I misunderstand. It has gone down from 24 to 2. If this is still the case within say 6 months and it's safe vis a vis the virus situation (maybe unlikely I know), I still dont see why docetaxel wouldn't still be the useful option? That is, if things are as they are now, then why not?  Any views on abi now (or then) instead of doce? 

User
Posted 30 Apr 2020 at 15:27
Because hormone sensitive is not the same as hormone naive. Early docetaxel has only been trialled in hormone naive men - that's where the possible extension of 22 months was seen - and there are no planned trials for docetaxel in men already on HT partly due to funding and partly for the reasons I gave above ... evidence shows that docetaxel only works for 50% of men anyway and can make the cancer more resistant to treatment, leading to earlier death.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 30 Apr 2020 at 15:51

Thanks. So why was it scheduled for early April in the first place?  I think I'm  Not understanding something here -  "that's where the possible extension of 22 months was seen " 

User
Posted 30 Apr 2020 at 17:15
I am only guessing - you would need to get clarification from the oncologist - but I don't think your husband was being offered early chemo anyway, because he had HT for 18 months or something like that when first diagnosed?

Stampede found that for some newly diagnosed men with metastatic PCa, giving them chemo in the first 3 months while they were still hormone naive could extend their life by an average of 15 months. Some men on the trial did better than that (as much as 22 months) - some men did significantly worse than that.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

 
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