metastic bone cancer Cabazitaxel

[Barry&Bren]

Hi, Brenda here. My dad Barry has a difficult decision to make. He is 77 years old and had prostate cancer about 18 yrs ago. Two years ago it came back in the form of bone cancer. He has had a lot of Docetaxel but it doesn't seem to have worked and now oncology would like him to have Cabazitaxel. The trouble is, he is feeling better than he has in the last two years and is loathe to want to make himself sick with chemo again.

He has pretty great mobility and walks without the need of a walker and although energy is limited he even walked 100 yards to the neighbours place and back yesterday with no dramas. He wants to know if the new chemo will make all his hair fall out again and just how bad the other side effects might be?

I am glad it isn't my decision to make. I was diagnosed with breast cancer (could there be a genetic link between breast and prostate cancer) two years ago and am now a survivor, hopefully mine won't be back.

Dad and I have an interesting life story as I only tracked him down and we reunited nearly two years ago after we were separated when I was two. I am now 55 and I want him for as long as possible in my life.

[Barree]

Hi Brenda,

Aside from Cabazitaxel, there is a new trial starting in Brisbane just after Christmas where the investigators are comparing Cabazitaxel with a new treatment called Lutetium 177 which appears to be as good or better than Cabazitaxel.

If you go to the Search box at the top of this site and type the words  Lutetium Trial  you will see a whole lot of recent posts about this new treatment and the trial. I suggest you check this out. 

After you have checked out the postings if you wish to find out more - just get back to me.

Cheers ,

Barree

[whatmeworry1941]

Hi Brenda,

 

I am assuming his already has been on things like Zoladex and bicalutamide (And Similar?)

 

As Jim said, look out for the Lutetium 177 trial.

 

http://www.australiancancertrials.gov.au/search-clinical-trials/search-results/clinical-trials-details.aspx?TrialID=373983&ds=1

 

Also their is a new therapy called radium-223, which is about to be approved on the PBS. In February the Federal Cabinet will probably approve it then.

 

Of course discuss this with his Oncologist(s) as we can only advise of the treatments out there,  but if you do enough research, you and your father can make an informed decision.

[Charles (Chuck) Maack]

Regarding Jevtana/cabazitaxel side effects:

A most recent approval here in the U.S. by the FDA (reported in September 2017)  is the prescribing of Jevtana/cabazitaxel at a lower dose than in the past for men having failed docetaxel/Taxotere:

See: https://tinyurl.com/y7p2dnna

Here is some older stuff I resurrected from my files from patients regarding side effects of Jevtana/cabazitaxel:

 Regarding Jevtana: Cabazitaxel (Jevtana – Sanofi Aventis) and Mitoxantrone are currently prescribed when docetaxel/Taxotere, the usual first line medication prescribed for hormone refractory prostate cancer, is failing.  Cabazitaxel, an intravenous infusion, has been found to extend life for an average 15.1 months, 2.6 months longer than that of Mitoxantrone at 12.7 months, as well as have less side effects than both Taxotere and Mitoxantrone.

 According to Medical Oncologist Charles E. Myers, a renowned specialist in the treatment of recurrent and advanced/high grade prostate cancer reporting to subscribers to his weekly video, he and others are excited by Cabazitaxel because of its much less toxic side effects, extended time of survival over Mitoxantrone, better quality of life, but also the consideration if used as the first line of treatment to replace docetaxel/Taxotere, may provide survival much longer than that of Taxotere. 

 Dr. Myers made note that Dr. A. Oliver Sartor, currently at the University of Tulane Medical School in New Orleans, well known for his expertise in research and clinical application of drugs, was the lead investigator regarding Cabazitaxel. 

See:

 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3063116/

 http://www.prnewswire.com/news-releases/cabazitaxel-increased-survival-for-patients-with-advanced-hormone-refractory-prostate-cancer-86278037.html

 And there are many other reports on the internet.

 Another patient reported: “The side effects from the Jevtana included diarrhea requiring treatment with IV fluids and loperamide (Immodium); fatigue, treated with methylphenidate (Ritalin); and nausea and vomiting, treated with prochlorperazine (Compazine). The diarrhea was the worst, but after a couple of cycles I learned how to control it so that it never got bad. The odd thing was that the timing of diarrhea attacks seemed random. I couldn't say that I would get it x-number of days after treatment. Sometimes it struck over two weeks after treatment.

 

The way to control the diarrhea is to stop it before it starts. Begin treatment at the onset of increased frequency of movements. Do not wait until it progresses. Then take another dose after EVERY movement, until it stops. I never had to take more than three doses in a row. An ER physician told me that it was safe to take up to 10 pills (5 doses) per day if needed. Then if that doesn't fix it, head for the ER. I also used "ume-kuzu" tea with success. That's a teaspoon each of umeboshi paste, kuzu root starch, and tamari in a cup of water.

 There's another side effect that deserves mention, but it's not from the Jevtana. It's from the daily prednisone. Severe muscle loss in the large muscles of the arms and legs. I looked at my legs one morning and they were gone. Like I needed something else to reduce my muscle mass. So put me down as warning others to ask some pointed questions about the risks vs. benefits of prednisone. My oncologist told me going in that he wasn't really sure if it did anything helpful or not. Knowing what I know now, I would not accept it without some better evidence. Of course, I can't say now whether or not it had any positive effect. I can, however, say with certainty that it had some highly negative effects.”

 Now here is an interesting and unexpected good side effect experienced by one patient – apparently extremely rare:

 Information below sent to Sanofi Aventis in March 22, 2013:

 “Patient on Jevtana/cabazitaxel as an almost last chance medication after having been through ADT, chemo, and other medications, called this evening to ask if I had ever heard of someone with his status and on this medication ever having an almost surreal experience of tumescence of the penis that even extended to the feeling of near orgasm.  The tumescence only developed to a real firmness not having been experienced in years, but not to what one would consider an erection suitable for intercourse.  This came on unexpectedly and the patient was amazed and found it difficult to imagine considering his history with medications that include continued use of an LHRH agonist.

 

A consideration could be that with the prostate gland having never been removed nor radiated, and despite continued LHRH agonist, the pathway of mind to neurovascular bundles to penis still exists which would give one pause to wonder if in some way, the Jevtana/cabazitaxel can cause such an unexpected reaction.   Have you learned of such an experience from other patients prescribed Jevtana?”

 Sanofi telephoned on March 25, 2013 reporting that they checked all their records and this is the first they have heard of this unusual effect the patient had never experienced prior to beginning Jevtana.

 They will keep note of this occurrence in case anyone in the future also brings up such an unexpected experience.

 They asked that if anyone else has such an experience, to be sure to report this to Sanofi as well as to the physician prescribing the Jevtana.

 Hope this helps with what might occur – not necessarily will

 

 

 

 

 

 

 

 

 

[Guest Ian]

 

.

.Hi Brenda,

I had 66 treatments of cabazitaxel before I gave it a miss. It was still working but gave it up because of severe side effects. I was in ICU with clots in the bladder, and urosepsis. The Onc told me I had had a 50% chance of dying. I had chronic bronchitis and was hospitalised 5 days. Had infection in greater toes which went to the bones of greater toes which resulted in partial amputation. Had atrial flutter and atrial fibulation  with blackouts. had an oblation to fix problem.  Had some nausia but not too bad. I haven't had any treatment for 12 months apart from hormone  and Denusomab for bone strengthening. Recent scans were good but PSA now doubling every 3 months I'm 69 and was diagnosed 15 years ago Gleeson 9. will try xtandi when PSAs get too high. I have no regrets about having cabazitaxel. All the very best for your Dad's outcome. Speak to his onc tor expert advice.

Regards,

Ian

[Guest Imp]

Hello Brenda, I’m 70, diagnosed 5 years ago, Gleason 10, PSA 150, metastasised to bones, I am on cabazitaxel now, I’ve had  docetaxel previously and also bouts of radiation etc, I did have side effects from the docetaxel which I was able to cope with but I certainly wasn’t looking forward to the cabitaxel, however in my case, so far, after three sessions of it, I’ve had no side effects at all, this is the best I’ve felt for ages, the first infusion (cabitaxel) I was pushed into the hospital in a wheelchair, that has now been put away for a while, I can only say how I feel at the moment and how it has affected me, but of course we’re all different and we can react differently to the treatments, it’s good to hear that you are a survivor as well, Imp

 

[Barry&Bren]

Thank you very much for your input. Dad is thinking at this stage to go ahead and give the Cabazitaxel a go. He can always opt out if its not working or if its too tough. I will mention the Lutetium 177 trial to his oncology dept in Hervey Bay. It is nice to know there may be other options coming up in the future. Merry Christmas all. <3

[Barree]

Hi Brenda,

As is the case with all trials, before one can get on a trial - you need to  meet the eligibility criteria.

The following is in part of the question and answers sheet provided to patients  thinking about the Lutetium177 trial.

What stage of prostate cancer patients are you looking for?
This trial is suitable for men in whom the prostate cancer has spread to other parts of the body, has grown despite previous hormone treatment and docetaxel chemotherapy, and where the next step would normally be to consider further chemotherapy with cabazitaxel.

I have had previous docetaxel (also referred to as Taxotere) chemotherapy, am I still eligible for this study?
Yes, you must have received treatment with docetaxel chemotherapy to be eligible for this study.

I have previously had Cabazitaxel chemotherapy, am I still eligible for this study?
No, if you have previously been treated with cabazitaxel you are not eligible for this trial.

Something to ask about when discussing your Dads on going treatment with his oncologist.

Your Dad will only be eligible for the Lutetium177 - if he has not had Cabazitaxel.

Cheers,

Barree

[Guest Ian]

Hi Brenda,

If your dad can afford lutetium 177 privately it is available even if he has had cabazitaxel. The cost I believe is upwards of $10.000 per treatment and 6 treatments may be required. I intend to try a couple when the time comes.

Kind regards,

Ian