Advice re: Addition of Arbiraterone or Enzalutamide with Docetaxel chemotherapy

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User

Posted 02 Jun 2022 at 21:17

Hi all just looking advice and some clarity as to whether my OH should ask about triple therapy of Arbirareone or Enzalutamide when he commences docetaxel chemo next week.As read on forum where a member started this triple treatment regime when commencing Docetaxel and have been having good results re PSA for past 6 years on one of these meds mentioned above. My OH is also on Decapeptyl so maybe this may be the reason why triple therapy was not mentioned by Oncolgist. Appreciate any clarification regarding same. Hope this makes sense. Regards Ann

User

Posted 03 Jun 2022 at 11:23

Hi Ann, just bumping your post back to the top of the list.

Dave

User

Posted 03 Jun 2022 at 11:44

Hi Ann my husband had early chemo and is on both Abi and Enzo but he is on a trial .

He’s had fantastic results ,6.5 years and PSA is still undetectable.main problem is fatigue and muscle loss . He does still work (he’s 62) but it’s getting harder plus he needs 2 knee replacements which he is holding out till retirement.

Best wishes

Debby

User

Posted 03 Jun 2022 at 12:12

This is a slide from the Oncology Professional Care conference last week.

https://twitter.com/andy_gabriel/status/1530120908395974656

This suggests the triple therapy has been shown to be advantageous in the context of men who are metastatic at original diagnosis with high volume disease (≥ 4 bone mets or any soft organ mets away from the prostate, excluding pelvic lymph nodes). (The actual definition of high volume disease is more complicated than this.)

ARSI = Androgen Receptor Signalling Inhibitor = Abiraterone, Enzalutamide, Daralutamide, Apalutamide. (Strictly also includes Bicalutamide, but I'm not sure if that's intended here, and the initial 28 day anti-flare dose doesn't count.)

Edited by member 03 Jun 2022 at 12:15 | Reason: Not specified

User

Posted 03 Jun 2022 at 13:55

Thsnk you Dave for doing that..really appreciate it and hope by our are keeping well. Regards Ann

User

Posted 03 Jun 2022 at 14:07

Hi Debby..thank you for replying..yes I think it was actually your thread that I first noted this. However the oncologist who we met for our 1st. Appt begining of week when we enquired re availing of a clinical trial. He said that would be to early and something for later down the line. However we are of the opinion that triple therapy is better initiated at early diagnosis. My hubby is Gleason 9 4+5 with extracapsular extension 3 pelvic nodes and supra pibic bone involvement. Andy62 has noted this in his thread to me as above also but I note he states excluding re pelvic lymph node involvement so maybe that's why the Oncologist didn't recommend my hubby.

Thsnks so much Ann

User

Posted 03 Jun 2022 at 14:43

I didn't know what your diagnosis was, but what you just described is low volume metastatic disease (1 met excluding pelvic lymph nodes).

The pelvic lymph node involvement is often handled with chemo. The other thing you might consider is having radiotherapy to the prostate, as with low volume metastatic disease, zapping the main tumor (prostate) often slows progression of any mets. (This is shown as beneficial in the table.) They might be willing to zap the pelvic lymph nodes too. There is obviously risk of side effects from the radiotherapy, so that's something you would need to discuss with your oncologist.

Edited by member 03 Jun 2022 at 14:44 | Reason: Not specified

User

Posted 03 Jun 2022 at 16:06

Hi Andy...thsnks so very much for explaining of all of this really appreciate it. Yes will have a further chat with Oncologist. He did mention low burden Howevet I forgot to mention he has also para aortic involvement in my earlier threat. Regards Ann

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