17 years with metastatic prostate cancer – hope disappearing down the Lu

[HighCadence]

No long story this time round. I’m going to cut straight to the chase. The Lu-177 treatment has stopped working. My PSA has been on a steady increase for the last three months (see the chart above). My last PSMA scan showed the large mets in my spine have stabilised, but not improved. Smaller mets in my spine, clavicle and scapula have improved slightly, as has activity in a lymph node. 

I had a chat with my Doctor yesterday after the 5th infusion, and he told me a sixth cycle was unlikely to resolve/significantly reduce the mets in my spine. When I asked him if I should pay for a sixth cycle or spend the money on a family holiday, he said “That’s a very difficult question to answer”. 

So, it looks like I’m going to have to try to get myself on an immunotherapy trial. I’m germ line BRAC2 and my tumours exhibit micro-statellite- instability, so there is at least some chance immunotherapy will work. I’ve decided against Cabazitaxel, as I don’t want to feel sick for months for no real gain. 

So, my fellow warriors, if you have any advice for future treatment, please let me know. I’m open to pretty much anything. Any advice will be gratefully received. 

Aside from that, I’d like to wish you all happy holidays and good/better health for 2020.

David.

[Canook]

Hi David,

Have you tried Olaparib (AZD-2281, MK-7339 trade name Lynparza is an FDA-approved targeted therapy for cancer)?? 

It is a PARP inhibitor, inhibiting poly ADP ribose polymerase (PARP), an enzyme involved in DNA repair.

It acts against cancers in people with hereditary BRCA1 or BRCA2 mutations, which include some ovarian, breast, and prostate cancers.

Canook

[HighCadence]

Hi Canook,

I have. The oncologist had great hopes because of my gene mutation but it didn’t work.

Thanks for the reply. 
David. 

[Canook]

Well that's disappointing to hear HC.

 

Hoping your last Lu treatment kicks in late and you make a miraculous turnaround while you wait to get into an immunotherapy trial!

 

(My grandfather directed one of the world's first international immunotherapy research units at Queens University in the 1930's and lean to this as our best hope for new, revolutionary genetically-tailored treatments.)

[HighCadence]

Thank you Canook. 

[alanbarlee]

Hi HC,

 

Just to take the PARP possibility a bit further, I saw a recent reference to a current phase 3 trial in Oz and elsewhere, ('Keylink 010'), combining an immunotherapy drug (pembrolizumab) with a  PARP inhibitor (olaparib), based on very promising phase 2 trials.

 

Another trial to consider might be a new PARP inhibitor, pamiparib (BGB 290), which is the subject of a current phase 2 trial.

 

Best wishes,

 

Alan

 

 

[Patrick Turner]

The problem with Lu177 is that a patient may initially have PsMa-Ga68 scans which show Lu177 should work well, but then there is mild reduction of Psa and a Pca progression. The docs at Theranostics Australia said that if my Psa bounced back up early after going down that Brca2 test should be done and PARP inhibitors used. But for me, it looks like I got a good response with Lu177, see my Psa graph at

http://www.turneraudio.com.au/Patrick-other-concerns.html

I bet I am Brca2 positive because my father's mother died of Oa, my father died of melanoma, a sister died of Oa, and other sister got Brca but is alive and well at 75, 10 years later. 

I watched a friend die earlier this year from mutant forms of Pca that sprang up in his liver, even though previous chemo had removed kidney lesions. He had very poor short response to RP, salvation RT, ADT, and Cosadex added to ADT boosted Psa from 7 to 40. He lasted less than 3 years after diagnosis at 57.

I was told that taking Enzalutamide during and after Lu177 would make Lu177 more effective, so I am still taking Enzalutamide after beginning it right after No 3 shot of Lu177. Docs said previous chemo (which failed ) would have re-sensitized my Pca to drugs such as Abiraterone or Enzalutamide where they had failed before chemo.

I cannot be sure what is working now, but my Psa graph indicates a good result. Nobody has said I have mutant Pca, so all I can say is that I'm lucky.

Patrick Turner.  

[HighCadence]

Thanks Alan - that’s one of three things on my list. Will let you all know what I go with and how the PCa respond. Happy Xmas. David. 

[HighCadence]

Hi Patrick,

i have a call with the oncologist this morning, and retesting is one of the things on the agenda. Will let you know what he says. Hope you are feeling better. David. 

[Johnno]

HighCadence are you familiar with the cancer forum "Health Unlocked" ?

Put your situation out there and you'll find some very interesting and knowledgeable people are there to help you. https://healthunlocked.com/