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Vasco perhaps you can help here?

moonlitnight
Posts: 58
Joined: May 2013

Hi there Vasco and all. My husband is now on Zytiga with prednisone. We don't like the prednisone part - immune suppression is just ridiculous when someone has cancer. Also bone loss. We wanted Xtandi but the cancer centre doc couldn't get authorization for it. However, we have since learned that my husband's insurer will cover it.

Is there an alternative to prednisone when used with Zytiga? What if we halved the dose even? I realize it is supposed to reduce side effects.

VascodaGama's picture
VascodaGama
Posts: 1707
Joined: Nov 2010

MLN

At the time of your last thread (http://csn.cancer.org/node/272931) the PSA was high at 7.0 and Lam recommended you to try getting it down to 0.05. I know from your other forum that the PSA was higher at 8.9 just before starting Zytiga.
I wonder if the Zytiga has been Lam’s choice for the achievement.

Prednisone seems to be irreplaceable in the combo with Zytiga. The fact is that Zytiga, though being excellent, is “delicate” in the pathways it uses to be effective. Any interference from other drugs would alter its “behaviour-ship”, and prednisone just assures that the body would not “over react” when Zytiga is in action. Prednisone suppresses the immune system to help control conditions in which our immune mistakenly attacks our own tissues. Taking Zytiga may cause severe low blood pressure leading to stressful status causing death to which prednisone work to avoid.
Zytiga is extraordinary but it is so delicate that it may
even react with common food or with the body’s chemistry induced by food intake. These constrain the timing for having a meal vz for taking the drug.
Even a simple statins can interfere with Zytiga if it uses the same pathway for acting.

Dr Myers explains it well in his conferences and videos. He is not a “simple” medical oncologist. He was a researcher along his medical career and seems to recommend “cocktails” based on the actual facts and “chemistry” of that particular patient or case. He does not follow just guide lines. He looks for interactions between drugs and administers or avoids any one that would prejudice the effect of another, just like an “artist”. This is behind his success in the treatment of difficult cases in advanced PCa patients.

In this old conference video you can listen to discussions about the sequentials in taking your present choice of Zytiga and Xtandi medications. They are different and act differently. In fact they probably may be taken in combination but it needs to be “Supervised” for any interaction. Enzalutamide (marketed as Xtandi and formerly known as MDV3100) is an androgen receptor antagonist drug (similar but more refined than Casodex). Abiraterone (Zytiga) is a 17Alpha-hydroxylase (CYP17) inhibitor, used for men whose prostate cancer has spread to other parts of the body (advanced cases) and that become HT refractory. A similar inhibitor is the drug Ketoconazole which is much cheaper and has been in use for more than a decade. The CYP17 enzyme is found in the testicles, adrenal glands and prostate cancer cells. Most hormonal therapies either stop the production of testosterone in the testicles or block it from connecting with the cancer cells. Zytiga works by blocking CYP17 so that testosterone can’t be produced anywhere. The participants, all famous doctors (Slovin was my oncologist in 2000 at MSKCC before these drugs were “invented”), also talk about prednisone to be avoided in diabetic patients;

http://www.researchtopractice.com/PCUTT112/Video/7#

 

Here you can listen to some of Myers’s videos exactly in regards to the interaction of medicines with Zytiga, etc;

http://askdrmyers.wordpress.com/2012/10/17/combining-pca-drugs/

http://askdrmyers.wordpress.com/2013/06/05/using-new-pca-drugs/

http://askdrmyers.wordpress.com/2014/02/13/high-cholesterol-zytiga/

http://askdrmyers.wordpress.com/2013/08/07/statins-pca-2/

 

About Zytiga (Abiraterone);

http://www.zytigahcp.com/mechanism-of-action?utm_source=N6246.905338.UROTODAY.COM!&utm_medium=Banner&utm_content=728x90&utm_campaign=ABI206

 

Best wishes and luck in his (and yours) journey.

VGama

 

moonlitnight
Posts: 58
Joined: May 2013

Hi Vasco and thank you. Don's PSA today is 6.9, down from 8.9 in May and 7.9 in June. I will watch those Zytiga videos. We see Dr. Myers October 2. Such a long wait...

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