Had a consult with med onc about 3 weeks ago concerning starting Taxotere. Was told that because husband is already castrate resistant he does not meet protocol for early Taxotere cycles.
I agree that he does not meet the CHAARTED protocol, which is for hormone sensitive cases with multiple mets. However, Taxotere was approved for use in metastatic castrate resistant PC in 2004, and can certainly be started now, if your medical oncologist agrees. The fact that the survival advantage starts at 17 months while hormone sensitive and goes down to 2.5 months when castrate resistance, seems to argue for using it sooner rather than later, whatever the hormone responsiveness level.
As he is already on Xtandi and there are no studies of patients on Xtandi receiving Taxotere there is no protocol for treatment at this point so he must start to fail Xtandi before Taxotere can be started.
He is correct that chemo is effective after Xtandi and Xtandi has been FDA-approved for that use. It is also true that Xtandi is more effective used earlier (as most drugs seem to be) compared to how it used to be used - only after chemo.
Waiting for one medication to fail before starting another has been the standard of care. It reflects a sequential
approach. The alternate POV is what I call the "cocktail approach." While there are no published studies yet on the cocktail approach, it is in numerous clinical trials. On the other hand, we know
the failings of the sequential approach. Xtandi and Zytiga create cross resistance to one another when used sequentially, with or without docetaxel in between. Waiting for failure means waiting until the cancer has devised strategies for getting around the other medications as well. Will the "cocktail" approach work any better? I certainly can't guarantee that. It's just a shot.
All we have so far is the early results of a small pilot study that showed that the combination of Zytiga and docetaxel was effective at reducing PSA by more than 50% in 90% of patients, and by more than 90% in 70% of patients. These are higher levels than we would expect from either alone.Phase 1b study of abiraterone acetate (AA) and docetaxel (D) in patients (pts) with metastatic castration-resistant prostate cancer (mCRPC).
We will certainly be talking to the, though about adding Zytiga along with the Xtandi. Do you have any documentation to studies showing the advantage to the combination?
So far all we have are the interim results of one of the clinical trials of the combo in patients with mCRPC. PSA was reduced by more than 50% in 76% of the patients, and by more than 90% in 45% of the patients.Enzalutamide (ENZA) in combination with abiraterone acetate (AA) in bone metastatic castration resistant prostate cancer (mCRPC).
I think you can start to see why I suspect a cocktail of all 3 agents might work better than a sequential approach.