 |
 | Home | Contact Us | FAQ | Search & Site Map | Link to Us |
 | Sign In | Join | Other 45 Sites in Network |
Medical Forum / Diseases and Disorders / Prostate Cancer / February 2008Chemotherapy for PC
After about a year of PSA readings indicating <0.1 I have begun to develop homorne refractory symptoms. I have nodules in my lungs and they have grown after about a year of "resolving." The most recent Scan showed little, if any growth after beginning Casodex, however, the PSA increased slightly. (from .9 to 1.25) I have had bone scans and CTscans which have not shown any metastases, other than the lungs. I am due to have an MRI of my spine next week to check for hot spots. My question: At what point do the doctors usually switch to Taxoterne, etc.? And....what is the current thinking about the best chemo combinations? I am completely uninformed about any of them. Thanks guys, Ralph Ralph, in May of 2004 my PSA exploded to 32.3 with mets to L2 &T3. I took my first injection of Lupron. On July 5th I started the trial below. Today I my PSA is undetectible and the mets have been replaced with new bone growth. Am I out of the woods, no way, but we follow aggressively and react aggressively. I wish you the best in your fight - and a prayer or two. Gourd Dancer Trial of Chemotherapy plus Hormonal Therapy as Initial Treatment for Unresectable / Metastatic Adenocarcinoma of the Prostate H. Henary, R.J. Amato; The Methodist Hospital/The Methodist Hospital Research Institute/Genitourinary Program, Houston, TX Background: Chemotherapy in a setting of hormone refractory prostate cancer has shown palliative benefit especially with substantial PSA decline strongly suggesting that disease modifying potential exists. Recently, chemotherapy is beginning to show a survival advantage. The stage is set for chemotherapy given earlier in a disease course. As a working hypothesis, we suspect that the transformation from an androgen-dependent to an androgen-independent phenotype is mediated by the expansion of an androgen-independent clone already present at the time of androgen deprivation. If this model is correct, then it would be desirable to bring treatment to bear on the androgen-independent component when the corresponding tumor burden is minimal. Thus, we view the androgen-independent component as analogous to "microscopic residual" or "micro-metastatic" disease for which adjuvant chemotherapy has shown to be effective in other contexts. Methods: Each course of chemotherapy lasts for 8 weeks. Patients were treated in weeks 1, 3, and 5 with doxorubicin 20 mg/m2 as a 24-hour intravenous infusion on the first day of every week in combination with ketoconazole 400 mg orally 3 times a day daily for 7 days. In weeks 2, 4, and 6, treatment consisted of paclitaxel 100 mg/m2 intravenously on the first day of every week in combination with estramustine 280 mg orally 3 times a day for 7 days. After completion of 3 courses of chemotherapy, hormone management [medical castration plus casodex (at the completion of chemotherapy)] is initiated at the start of chemotherapy and for a total of 24 months. Results: Nineteen men have been enrolled with a median age of 63 (48-76). Fifty percent of the men had no prior local therapy, while the other 50% either failed surgery, radiation therapy, or surgery plus radiation therapy. Fifty-nine percent of the men had Gleason 7, 12%/8, 24%/9, and 5%/10. Thirty-five patients presented with bone metastasis and 50% presented with nodal involvement. The median PSA reduction to date has been 95.6%. Conclusion: Enrollment is ongoing. Further information regarding PSA response, associated radiographic response, and toxicity will be presented. > After about a year of PSA readings indicating <0.1 I have begun to > develop homorne refractory symptoms. I have nodules in my lungs and [quoted text clipped - 15 lines] > > Ralph > After about a year of PSA readings indicating <0.1 I have begun to > develop homorne refractory symptoms. I have nodules in my lungs and [quoted text clipped - 11 lines] > And....what is the current thinking about the best chemo combinations? > I am completely uninformed about any of them. Ralph, Nodules are not symptoms, unless they're causing you breathing problems. They're signs. Not all nodules are cancer. Some are benign. For instance, rheumatoid nodules . So be sure you know what you are treating and the goal. It is also possible for a person with cancer to develop a different type of cancer. (which would probably call for a different chemo) So was a nodule biopsied and graded ? The grading says how fast it is growing. Chemotherapy is more effective against cancers when they're in fast-growing mode. Chemotherapy plays a small role in solid tumor type of (adult) cancers. Palliative. (ie shrinking tumors) Docetaxel aka Taxotere is one current treatment based on peer-reviewed clinical trials There's 3 others mentioned here http://www.cancerhelp.org.uk/help/default.asp?page=2905 Almost all (adult) solid tumor recurrences are chemo-resistant. Prostate cancer is known for it's late recurrence potential. The side effect profile of Docetaxel aka Taxotere is here http://www.bccancer.bc.ca/NR/rdonlyres/A169EECB-85A4-4F6E-A8A3-38C95B2DB8E1/1972 3/DocetaxelMonograph_22Aug07.pdf So before embarking on a treatment decision: 1) check what I wrote, above, with your oncologist 2) ask him or her if this is the right timing to start treatment. 3) Ask him/her to answer these questions for you. Steph's "Questions to Ask" http://tinyurl.com/4akk6 Print 2 copies up and discuss it with him/her. Best of luck. J Two posts from you saved in one day. Thanks! > Ralph, > Nodules are not symptoms, unless they're causing you breathing problems. > They're signs. rest redacted > Two posts from you saved in one day. Thanks! > [quoted text clipped - 3 lines] > > rest redacted *************************************************************** Ralph sorry to hear of your PSA rise. If you haven't already reviewed this here is a good summary paper on use of chemo form PCRI....... http://www.prostate-cancer.org/education/andind/Guess_ChemotherapyForPC.html Gourd Dancer cited Amato's study which showed average survival rates increased with Chemo and ADT. I believe was 3.5 months but's that for a full spectrum of patients so results may vary. A similiar phase 3 trial just started for high risk patients with no mets. Previous hormonal therapy is allowed provided that the total duration of therapy did not exceed 6 months? This only requires PSA of 1.0 and no metastatic disease. You mention your lungs not sure about that? Here is the link: http://clinicaltrials.gov/ct2/show/NCT00514917?term=sanofi&rank=8 ClinicalTrials.gov Identifier: NCT00514917 In my discussions with med onc's from notable institutions, the jury is still out on efficacy of Docetaxel for men with early stage PC hence the study. The feeling is prostate cancer is where breast cancer was 10 to 15 years ago. While I have not had ADT thus far I will be participating in this study (not sure what arm I'll get ADT blockade or ADT + Docetaxel). This assumes I have no surprises during my tests and scans later in the week. Wish you all the best. Keep the faith. This disease is very frustrating. Hopefully with more research that will change and this PCA can be moderated like other chronic diseases. Dominic 6/03 - PSA 2.0 6/04 - PSA 2.5 8/05 - PSA 4.2 11/05 - PSA 5.89 BIOPSY 8/16/05 T2A, 3+5 = 8 RP 12/13/05 PATHOLOGY GLEASON 3+5=8 TERTIARY 4, SEMINAL & LYMPH - NEG EXTRACAPSULAR EXTENSION TO MARGIN POSITIVE MARGIN - RIGHT APEX PSA POST RP 1/26/06 = 0.5, 2/1/06 = 0.55 PSA on 3/27/06 = 0.95 START SALVAGE RT ON 3/27/06 FINISHED SRT 5/19/06 6-20-06 - PSA 0.24 7-08-06 - PSA 0.15 9-14-06 - PSA 0.10 12-19-06 - PSA 0.08 2/7/2007 - PSA = 0.09 08-17-07 - PSA = 0.31 10-02-07 - PSA = 0.48 11-06-07- PSA = 0.61 01-25-08 - PSA = 1.12 > On Feb 9, R L wrote: > [quoted text clipped - 19 lines] > Here is the link: http://clinicaltrials.gov/ct2/show/NCT00514917 > ClinicalTrials.gov Identifier: NCT00514917 "Subjects in this group may have no radiographic findings that are suspicious for metastatic disease. " (unfortunately) > In my discussions with med onc's from notable institutions, the jury > is still out on efficacy of Docetaxel for men with early stage PC > hence the study. The feeling is prostate cancer is where breast cancer > was 10 to 15 years ago. Not much has changed in the past 10 - 15 years with breast cancer except: The newer chemos are better tolerated and eek out a few more months, on average, in the metastatic setting, AFAIK. Herceptin aka Trastuzumab has had a "major impact in the treatment of HER2-positive metastatic breast cancer".[5] http://en.wikipedia.org/wiki/Trastuzumab The NCCN gudelines are here http://www.nccn.org/professionals/physician_gls/f_guidelines.asp For prostate cancer (professional version) American guidelines Practice Guidelines in Oncology v.2.2007 http://www.nccn.org/professionals/physician_gls/PDF/prostate.pdf Systemic therapy starts on Page 12 Systemic Chemotherapy starts on Page 25 Systemic chemotherapy should be reserved for patients with castration-recurrent metastatic prostate cancer except when studied in clinical trials. In this group of patients, docetaxel-based regimens have been shown to confer a survival benefit in two phase III studies: SWOG 9916 compared docetaxel plus estramustine to mitoxantrone plus prednisone. Median survival for the docetaxel arm was 18 months vs. 15 months for the mitoxantrone arm (p=.01). TAX 327 compared two docetaxel schedules (weekly and every 3 weeks) to mitoxantrone and prednisone. Median survival for the every 3 week docetaxel arm was 18.9 months vs. 16.5 months for the mitoxantrone arm (p=.009) Docetaxel-based regimens are now the standard of care for first-line treatment in this group of patients. Petrylak DP, Tangen CM, Hussain MH, et al. Docetaxel and estramustine compared with mitoxantrone and prednisone for advanced refractory prostate cancer. N Engl J Med 2004; 351: 1513-1520. Tannock IF, de Wit R, Berry WR, et al. Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer. N Engl J Med 2004; 1502-1512 Note: All recommendations are category 2A unless otherwise indicated. Clinical Trials: NCCN believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged." J > Two posts from you saved in one day. Thanks! > [quoted text clipped - 3 lines] > > rest redacted Glad to be have been of help, Steve. If I had known you were saving, I would have provided sources such as: Re: Small role of chemotherapy, aside from common sense.. http://www.ncbi.nlm.nih.gov/pubmed/15630849?dopt=Abstract RESULTS: The overall contribution of curative and adjuvant cytotoxic chemotherapy to 5-year survival in adults was estimated to be 2.3% in Australia and 2.1% in the USA. CONCLUSION: As the 5-year relative survival rate for cancer in Australia is now over 60%, it is clear that cytotoxic chemotherapy only makes a minor contribution to cancer survival. " The above excluded smaller cancers such as non-melanoma skin cancers and also excluded leukemias. Hence, the general statement, for 22 common cancers, for every 100 cancers cured, surgery cures about 50, radiotherapy about 40 and chemotherapy at best 10. ----------------------------------------------------------------------------------------------------------- Re: Chemotherapy resistance; there's a number of very good sources for such, on search. Here's one http://www.bccrc.ca/at/focus_multidrugresistance.html Nearly 50 per cent of human cancers are either completely resistant to chemotherapy or respond only transiently, after which they are no longer affected by commonly used anticancer drugs. This phenomenon is referred to as multidrug resistance (MDR) and is inherently expressed by some tumour types while others acquire MDR after exposure to chemotherapy treatment. ----------------------------------------------------------------------------------------------------------- http://www.bccancer.bc.ca/HPI/CancerManagementGuidelines/Genitourinary/Prostate/ Management/SystemicManagementofProstateCancer/Chemotherapy.htm Chemotherapy Updated: 9 November 2004 Because of the difficulty of treating many patients in this population and also evaluating the response, cytotoxic chemotherapy is only recommended in suitable selected patients with active drugs with low subjective toxicity. The combination of Mitoxantrone and Prednisone (GUPMX) has demonstrated clinical palliative benefit in patients with painful bone metastases without improvement in overall survival. More recently, in randomized studies, Docetaxel given every three weeks in conjunction with prednisone (GUPDOC) has been shown to improve overall survival and provide superior pain relief and improvement in quality of life parameters, as compared to mitoxantrone. Palliative benefit is most likely to accrue to patients where general condition and marrow function is adequately preserved. Suitable criteria: * Early recognition of hormonal resistance and disease progression e.g., rising PSA despite castrate levels of testosterone and failure of trial of secondary nonsteroidal antiandrogen therapy. * Minimal prior radiotherapy (less than 25% of bone marrow). * At least partially ambulatory. * A parameter measurable for response (palpable tumour mass, rising serum PSA, or symptoms that can be evaluated). Refer suitable patients early to the medical oncology service for consideration of chemotherapy, after recognition of development of hormone resistant disease. Chemotherapy may be delayed in asymptomatic patients without visceral disease. Patients in severe and/or uncontrolled pain should be first managed with radiotherapy and analgesics as appropriate. Details of current protocols are available on request. References: 1. Tannock IF. de Wit R. Berry WR. Horti J. Pluzanska A. Chi KN. Oudard S. Theodore C. James ND. Turesson I. Rosenthal MA. Eisenberger MA. TAX 327 Investigators. Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer. New England Journal of Medicine. 351(15):1502-12, 2004 Oct 7. 2. Tannock IF. Osoba D. Stockler MR. Ernst DS. Neville AJ. Moore MJ. Armitage GR. Wilson JJ. Venner PM. Coppin CM. Murphy KC. Chemotherapy with mitoxantrone plus prednisone or prednisone alone for symptomatic hormone-resistant prostate cancer: a Canadian randomized trial with palliative end points. Journal of Clinical Oncology. 14(6):1756-64, 1996 Jun. which is the chemotherapy section of BC Cancer Agency >> Health Professionals Info >> Cancer Management Guidelines >> Genitourinary >> Prostate >> 5. Management http://www.bccancer.bc.ca/HPI/CancerManagementGuidelines/Genitourinary/Prostate/ Management/default.htm ----------------------------------------------------------------------------------------------------------- The comon cancers are listed here (along with data, and more information, on each) http://www.nci.nih.gov/cancertopics/commoncancers Bladder Cancer Melanoma Breast Cancer Non-Hodgkin Lymphoma Colon and Rectal Cancer Pancreatic Cancer Endometrial Cancer Prostate Cancer Kidney (Renal Cell) Cancer Skin Cancer (Nonmelanoma) Leukemia Thyroid Cancer Lung Cancer ----------------------------------------------------------------------------------------------------------- Chronic cancers. A to Z List of Cancers NCI http://www.nci.nih.gov/cancertopics/alphalist/a-d CLL - Chronic Lymphocytic Leukemia CML - Chronic Myelogenous Leukemia Chronic Myeloproliferative Disorders and Plasma Cell Disorders Including Myeloma but that's getting complicated and way off topic for here. J > Prostate cancer is known for it's late recurrence potential. My sincere apologies for this error. It is renal and breast cancers that are known for their late recurrences. J > After about a year of PSA readings indicating <0.1 I have begun to > develop homorne refractory symptoms. I have nodules in my lungs and [quoted text clipped - 8 lines] > My question: At what point do the doctors usually switch to Taxoterne, > etc.? Ralph, I am sorry to hear of your cancer's progression. I think the next step will be to take you off of Casodex. That seems to be more and more accepted as a next step. For some reason, the PSA often goes down after removal of Casodex. After that, there might the addition of Zolodex (ADT3). Then if/when that fails, chemo. Some doctors start chemo, after all ADT has stopped working, at 2.0 and some 4.0. I don't recall hearing of anything higher, but I could be wrong. > And....what is the current thinking about the best chemo combinations? > I am completely uninformed about any of them. I don't know. I am, like you, completely uninformed about them; choosing to do my research when the time gets closer. It's a matter of laziness, sanity, and wanting up-to-date data.  SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 PSAD .056 years Lupron 07/03 (1 mo) 8/03 and every 4 months there after PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years Casodex added daily 07/06 PSA <0.04, <0.05, <0.04, <0.04 10/11/07 Non Illegitimi Carborundum >> After about a year of PSA readings indicating <0.1 I have begun to >> develop homorne refractory symptoms. I have nodules in my lungs and [quoted text clipped - 25 lines] > do my research when the time gets closer. It's a matter of laziness, > sanity, and wanting up-to-date data. ---------------- This is very helpful information for me Steve-Thanks- Ralph, my thoughts are with you my friend. We are in the same boat. SignaturePSA 19 07/2004 @ 55 12 needle Biopsy 07/2004 G7 T2c RRP 09/2004 @ Johns Hopkins by Dr. Pat Walsh positive margins G8 in most lymph nodes sampled Post Op PSA 19 30 mg Lupron began 12/2004 and every 4 mo after PSA .069 -.079- 1.15-1.35- 2.23-4-7.18-13.70 50 mg Casodex added daily 12/07 PSA 02/07 13.70 @age 58 On February 8, Ralph wrote: (snip) > My question: At what point do the doctors usually switch to > Taxoterne, etc.? > > And....what is the current thinking about the best chemo > combinations? I am completely uninformed about any of them. Here is a website that is directed especially at hormone refractory PCa and its tx: http://www.hrpca.org/index.html And on the site of the Prostate Cancer Research Institute (PCRI) refer to http://prostate-cancer.org/education/education.html and scroll down to "High Risk PC." I believe that the information to be found there is authoritative and reliable. Also on the PCRI site at http://prostate-cancer.org/resource/find-a-physician.html there is a portal to a listing of some of the medics who specialize in PCa. I earnestly recommend consulting a medical oncologist who is well-experienced in PCa tx. Good luck. Regards, Steve J |
Reply to this Message |
 Sign In
 Join
 My Latest Posts My Monitored Threads My Blog My Photo Gallery My Profile My Homepage Start New Thread Enable EMail Alerts Rate this Thread
|
©2008 Advenet LLC Privacy Policy - Terms of Use
This website includes both content owned or controlled by Advenet as well as content owned or controlled by third parties.