Provenge? Anyone scheduled for this treatment?

mrspjd

VascodaGama said:

Genetics replacing PSA in diagnosing PCa
My above post was confusing and I am sorry for doing so. Here is my other “Half”.

I believe in genomics as the way to identify the “fundamental causes” of prostate cancer (pointed out by Kongo). And in doing so, genomics can guide researchers in the development of a new treatment (most probably eradicating PCa for good).

This genomic idea began in 1993 with the discovery of the PCA3 gene in the urine which was associated to the prostate cancer by molecular biologist Marion Bussemakers. The urine test (PCA3) makes part of the group of tests used in the diagnosis of prostate cancer, and it is said to be more accurate than our “friendly” PSA which can give false alarms from enlarged benign hyperplasia.

Genetics also play a role in the risk factors for prostate cancer as it is associated to cases of Pca running in members of the same family or in ethnic groups like Western Europeans, Asians and African Americans. Studies based on genetic principles have identified several genetic variants which are contributors to the risk of developing prostate cancer.
I read that “…There are twenty-five genetic variants that are known to increase the risk of developing prostate cancer: seven on chromosome 8 (five of those in the 8q24 region), two on each of the following chromosomes: 2, 3, 7, 11, 17 and 19 and one on each of the following chromosomes: 4, 5, 6, 10, 22 and X".
This means that if those variants are identified in one’s DNA, most probably that person is prone to develop Pca.

Genetic testing for prostate cancer already exits but companies running the “business” are few and the test is very expensive ($500) when compared to the cost of a PSA. (http://www.eyeondna.com/2008/02/12/decode-launches-prca-prostate-cancer-dna-test/)

Logically, very few are doing this test and very few studies exist to produce Tarhoosier’s Eureka pill (the Silver Bullet). The announcement by BBC about a “low cost DNA test” to determine a person’s chances of developing certain inherited diseases, is the light for a hope that we may see Genetics replacing PSA which would be the impulse to studies with sound principles, and therefore, manufacture of directional drugs, identify diets and behaviors.

Benlysta is a drug resulting from a study that identified genetic variants linked to the systemic lupus disease. The cause was the biological activity of B-lymphocyte stimulators that contribute to the production of autoantibodies (antibodies that attack the body’s own healthy tissues).
Drugs to “kill” prostate cancer could be produced on the same principle, as well as it could identify the foods that most contribute in the combat of those risk variants, addressing the problem at earlier stages.

All this genomic identification are based in molecular biology regarding the formation, structure, and function of DNA, RNA and proteins, as well as their roles in the transmission of genetic information. In the “Human Genome System” we know that the genetic “information” encoded in a sequence of the DNA strand, passes to molecules of RNA through a process called transcription. RNA acts as a messenger (mRNA) to pass the information to proteins through a process called translation. The message transcribed from the gene is therefore translated into a protein product that is specialized for a particular function based on the instruction stored in the gene. (lovely study)

Knowing the function of each gene becomes essential to the development of molecular markers and treatments for diseases, such as prostate cancer. More billions should be spent in this line of researches which in my view are in the right direction.
National Cancer Institute has representative videos showing how genetic information is passed and how cancer may develop;
http://www.cancer.gov/newscenter/benchmarks-vol1-issue1/Video ).

I dedicate a toast with red wine to the future of the Genomic affair.

The best to all.
VGama

The Human Genome Project
For anyone interested in reading more about this facinating research, general info on The Human Genome Project can be found at http://www.ornl.gov/sci/techresources/Human_Genome/home.shtml

I'll raise a glass of red to toast w/Vasco & others in hopes that The Genome Project will lead to answers and ultimately, to discoveries, in finding cures for insidious diseases such as PCa.

gottalottodo

VascodaGama said:

Expect Doctors to use these new drugs in parallel with others
Mrs
The partner of Dr. “Bob” Leibowitz is/was Dr. Stephen Tucker (now practicing in Singapore). These doctors have long years of experience in treating PCa patients with a variety of drugs “cocktails”.
Tucker, Leibowitz, Roundy, Myers, Labrie, Scholz, Strum, Lam and colleagues are a “collection” of oncologists, etc. who have given hope successfully to high risk patients in advanced cases as must as in low risk cases. They know well, through years of real facts in the use of many drugs (hormonal, chemo, immune, etc), about drugs side effects, dosages, their inter-reactions and risks.
The cocktails are “fixed” according to principles in balancing interactions/reactions with the enzymes of our systems, and still do the “kill” effectively. Some drugs cause lower count of white blood cells (leukocytes) attacking the immune system functionality, others deprive enzymes from metabolizing still other drugs in the cocktail. Etc, etc, etc.

Many of these drugs have not been approved for a particular type of treatment. Probably the most typical is the ADT3 “cocktail” of drugs (your husband’s protocol), which includes a 5-ARI (finasteride/dutasterine) not approved by FDA for use in prostate cancer but benign cases (recently it has been included in the NCCN Guidelines for the treatment of prostate cancer). Another famous drug in advanced PCa treatment is Ketokanazole which is in fact a drug to treat a variety of skin and fungal infections such as dandruff (Nizoral is its shampoo form).

Both Provenge (immunotherapy) and Abiraterone, are drugs included in the “arsenal” of the above doctors to fight cancer. Expect them to use these new drugs in parallel with Taxotere, Emcyt, Carboplatinum, Leukine, Celebrex, Cytoxan, Revlimid, etc., before, during or after any particular protocol, independently of intermediate or advanced status and their progress.

I have been following studies on Abiraterone which I believe will replace traditional antiandrogens such as Casodex in my close future ADT protocol. Some abstracts by Dr. Oliver Sartor, HT oncologist, and from the research team at the University of Tokyo, comment about still other drugs in the “pipeline”, which will give hope for the many that have failed radical treatments or are confronted with the question similar to the one posted above by Beverlyann (IS THAT THE LAST TREATMENT?).

Many doctors are reluctant in prescribing non approved drugs such as Avodart for PCa cases. They would do it under the "off-label" approach because it makes it easier for them in not assuming the usual load of responsibility
The terminologies used by the various doctors and institutions in fact have the same basic meaning on the status of a patient where HT has failed. Call it; castrate resistant (CRPC). androgen independent (AIPC) or hormone refractory prostate cancer (HRPC), etc.

Hope this helps in your researches.
The best to spj.
VGama

Note; I am not a medical doctor. I have been an avid student researching and studying prostate cancer as a survivor and continuing patient since 2000. (CM)

Provenge's place in line
i am an MD, not that it helps much as i was a surgeon and critical care specialist, neither of which prepared me at all. i had stage 4 gleason 7 PC diagnosed 7.5 yrs ago. for the first 6, PSA was undetectable. but then it slowly rose to 3.8 at which point Casodex was prescribed. it slowed the rise for 6 months. when Provenge was released, i was considered a candidate as i had asymptomatic metastatic disease. i just completed the 3 infusions [May 13]. i had fatigue, headache and aches and pains. By the 4th or 5th day, i was fine . when PSA reached 16 on Casodex [Apr 20], it was stopped and we waited for the Casodex withdrawal. Not happening - one month later it was 22. Next in line is DES + coumadin to offset the risk of blood clots. I think that it is just something to do until 3 months from the end of Provenge so I can start docetaxel, which must be taken with prednisone, which might interfere with Provenge. As i understand it abiratarone is only FDA approved for use after docetaxel.

I can't say for sure but i am thinking that an individual doctor's decisions are no longer that relevant. between the FDA and the insurance companies, doctors are no longer able to prescribe - - and have insurance companies - - pay for any medication for any use. Of course, you can pay out of pocket! For instance, my wife has MS and has been taking Provigil for 7 years. Two years ago, CVS Caremark who has the contract for medications for the State of CT Insureds decided NOT to pay. we appealed 5 levels including the Attorney General's office. There was not Level 1 or 2 evidence, so their decision was upheld. we buy it in Canada now.
this is my first post, so if i do it wrong, i'd be happy if someone corrected me by e-mail. thanks

VascodaGama

mrspjd said:

The Human Genome Project
For anyone interested in reading more about this facinating research, general info on The Human Genome Project can be found at http://www.ornl.gov/sci/techresources/Human_Genome/home.shtml

I'll raise a glass of red to toast w/Vasco & others in hopes that The Genome Project will lead to answers and ultimately, to discoveries, in finding cures for insidious diseases such as PCa.

Gottalottodo; Hopeful for your experience as a MD in this forum
Gottalottodo

Thanks for sharing with us above your experience with Provenge.
Interaction/reaction between drugs or treatments is really “scaring” as it could lead to drastic consequences. This is where specialists in the treatment of cancer have their “margin” of acknowledge over other doctors. I believe that stage IV cases, no matter in which Gleason pattern the tumour is classified, should be handled with “TARGETED” medications/treatments that by themselves will always require a “balanced” approach. The rate of success is dependent on the experience gained through its application in many cases. Those are the guys that one should trust and give in.

Hormonal treatment is part of that approach, the risks are always there. Treatment needs to be carefully planned, considering other existing health problems and the timely need of additional medications for future arising illnesses or the need of drugs to combat the side effects. This all needs constant vigilance and a methodology previously established.
FDA in fact puts very much “weight” on the matter when deciding on the approval of medications. However, we have seen the reverse to happen, when medications are proved to be efficient in cases to which such approval has not been conceded.

Abiraterone acetate has been on trials in Europe since 2005. Its main principle of action is intertumoral “closing down” the factories of testosterone and avoiding mutations within cells. FDA has approved this drug to be used in refractory prostate cancer but the drug has shown its effectiveness in earlier cases (before mutations take place). I believe that it will become a substitute to anti-agonists in the typical hormonal therapy. Its worse effect is that it interferes with the enzyme CYP450 (c17) which is needed in the metabolism of various drugs.It also interferes with the digestion of food so that it should be taken on an empty stomach.

In the trials of 2007, Abiraterone (CB7630) have shown positive results in patients diagnosed with refractory prostate cancer who have never taken chemotherapy but have taken LHRH analogues and multiple other hormonal therapies, including antiandrogens, diethylstilboestrol and dexamethasone. In the USA Phase II trial results have indicated that the drug benefitted some patients who have used Taxotere (docetaxel) chemotherapy.
This is a drug (Abiraterone) recommended to either before or after chemotherapy.

I wish that you find the best treatment to your advanced case.
Hopefully you will share more of your experience as a MD (surgeon and critical care specialist) in this forum to the wellbeing of all of us in this “boat”.

Thanks.
VGama

bzautry

gottalottodo said:

Provenge's place in line
i am an MD, not that it helps much as i was a surgeon and critical care specialist, neither of which prepared me at all. i had stage 4 gleason 7 PC diagnosed 7.5 yrs ago. for the first 6, PSA was undetectable. but then it slowly rose to 3.8 at which point Casodex was prescribed. it slowed the rise for 6 months. when Provenge was released, i was considered a candidate as i had asymptomatic metastatic disease. i just completed the 3 infusions [May 13]. i had fatigue, headache and aches and pains. By the 4th or 5th day, i was fine . when PSA reached 16 on Casodex [Apr 20], it was stopped and we waited for the Casodex withdrawal. Not happening - one month later it was 22. Next in line is DES + coumadin to offset the risk of blood clots. I think that it is just something to do until 3 months from the end of Provenge so I can start docetaxel, which must be taken with prednisone, which might interfere with Provenge. As i understand it abiratarone is only FDA approved for use after docetaxel.

I can't say for sure but i am thinking that an individual doctor's decisions are no longer that relevant. between the FDA and the insurance companies, doctors are no longer able to prescribe - - and have insurance companies - - pay for any medication for any use. Of course, you can pay out of pocket! For instance, my wife has MS and has been taking Provigil for 7 years. Two years ago, CVS Caremark who has the contract for medications for the State of CT Insureds decided NOT to pay. we appealed 5 levels including the Attorney General's office. There was not Level 1 or 2 evidence, so their decision was upheld. we buy it in Canada now.
this is my first post, so if i do it wrong, i'd be happy if someone corrected me by e-mail. thanks

DES
I would becareful with the DES, as they stopped giving it to women because it causes blood clots.
When I was on it I got a phone call from a friend & I could not say the words I was trying to say.
My wife took me to an emergency clinic & I was admitted & sent to Henry Ford Hospital.Where they ran several tests but couldn`t find any blockage.
the doctor thinks I may have had a blood clot that disolved itself.Although there was no prove of that that may have been caused by the DES.
Woody

gottalottodo

bzautry said:

DES
I would becareful with the DES, as they stopped giving it to women because it causes blood clots.
When I was on it I got a phone call from a friend & I could not say the words I was trying to say.
My wife took me to an emergency clinic & I was admitted & sent to Henry Ford Hospital.Where they ran several tests but couldn`t find any blockage.
the doctor thinks I may have had a blood clot that disolved itself.Although there was no prove of that that may have been caused by the DES.
Woody

DES and blood clots
The prior dose to women was 5 mg per day; now it is 1 mg a day plus 1 mg coumadin to try and interfere with clot formation.

gottalottodo

bzautry said:

DES
I would becareful with the DES, as they stopped giving it to women because it causes blood clots.
When I was on it I got a phone call from a friend & I could not say the words I was trying to say.
My wife took me to an emergency clinic & I was admitted & sent to Henry Ford Hospital.Where they ran several tests but couldn`t find any blockage.
the doctor thinks I may have had a blood clot that disolved itself.Although there was no prove of that that may have been caused by the DES.
Woody

DES and blood clots
The prior dose to women was 5 mg per day; now it is 1 mg a day plus 1 mg coumadin to try and interfere with clot formation.

gottalottodo

VascodaGama said:

Gottalottodo; Hopeful for your experience as a MD in this forum
Gottalottodo

Thanks for sharing with us above your experience with Provenge.
Interaction/reaction between drugs or treatments is really “scaring” as it could lead to drastic consequences. This is where specialists in the treatment of cancer have their “margin” of acknowledge over other doctors. I believe that stage IV cases, no matter in which Gleason pattern the tumour is classified, should be handled with “TARGETED” medications/treatments that by themselves will always require a “balanced” approach. The rate of success is dependent on the experience gained through its application in many cases. Those are the guys that one should trust and give in.

Hormonal treatment is part of that approach, the risks are always there. Treatment needs to be carefully planned, considering other existing health problems and the timely need of additional medications for future arising illnesses or the need of drugs to combat the side effects. This all needs constant vigilance and a methodology previously established.
FDA in fact puts very much “weight” on the matter when deciding on the approval of medications. However, we have seen the reverse to happen, when medications are proved to be efficient in cases to which such approval has not been conceded.

Abiraterone acetate has been on trials in Europe since 2005. Its main principle of action is intertumoral “closing down” the factories of testosterone and avoiding mutations within cells. FDA has approved this drug to be used in refractory prostate cancer but the drug has shown its effectiveness in earlier cases (before mutations take place). I believe that it will become a substitute to anti-agonists in the typical hormonal therapy. Its worse effect is that it interferes with the enzyme CYP450 (c17) which is needed in the metabolism of various drugs.It also interferes with the digestion of food so that it should be taken on an empty stomach.

In the trials of 2007, Abiraterone (CB7630) have shown positive results in patients diagnosed with refractory prostate cancer who have never taken chemotherapy but have taken LHRH analogues and multiple other hormonal therapies, including antiandrogens, diethylstilboestrol and dexamethasone. In the USA Phase II trial results have indicated that the drug benefitted some patients who have used Taxotere (docetaxel) chemotherapy.
This is a drug (Abiraterone) recommended to either before or after chemotherapy.

I wish that you find the best treatment to your advanced case.
Hopefully you will share more of your experience as a MD (surgeon and critical care specialist) in this forum to the wellbeing of all of us in this “boat”.

Thanks.
VGama

Zytiga website
Regarding Zytiga and food interactions, i went to the website and found this:
Food Effect - ZYTIGA must be taken on an empty stomach. Exposure of abiraterone increases up to 10-fold when abiraterone acetate is taken with meals. No food should be eaten for at least two hours before the dose of ZYTIGATM is taken and for at least one hour after the dose of ZYTIGATM is taken.

I also remember reading somewhere else that the absorption of Zytiga depends on the protein, fat and CHO % in the meal. Gee, if they would describe WHAT you should eat, we would be able to take 1/10th as much to get the same amount on board. I wonder why they make us fast and thus have to take [& spend] 10 times as much.

VascodaGama

gottalottodo said:

Zytiga website
Regarding Zytiga and food interactions, i went to the website and found this:
Food Effect - ZYTIGA must be taken on an empty stomach. Exposure of abiraterone increases up to 10-fold when abiraterone acetate is taken with meals. No food should be eaten for at least two hours before the dose of ZYTIGATM is taken and for at least one hour after the dose of ZYTIGATM is taken.

I also remember reading somewhere else that the absorption of Zytiga depends on the protein, fat and CHO % in the meal. Gee, if they would describe WHAT you should eat, we would be able to take 1/10th as much to get the same amount on board. I wonder why they make us fast and thus have to take [& spend] 10 times as much.

The War on the Enzymes
Gottalottodo

I am glad to see another post of yours. I really appreciate your participation in this forum. The majority of survivors in this forum have limited knowledge in medicine and most of our posts are based on own experiences and researches. Our opinions may look like anecdotal to you but we try to share and help each other. We need the expertise of guys like you trained to combat this bandit.

I wonder if you are on Zytiga, for the comment in your post.
In regards to the administration of this drug, I heard that “starving” is the way to assure a coordinated absorption of the drug. It seems that most of the critical side effects are related to poor metabolizing, and liver enzymes must be shared with other functions and drugs. The "mixture" restricts its administration to a series of precautions’ intake.
I call it “The War on the Enzymes”.
Prednisone (a immunosuppressant) is taken in combi with abiraterone and it requires a “collection” of enzymes for the conversion into prednisolone. This steroid fights any inflammation from the "process" of action of abiraterone, (I suppose) when it inhibits CYP17 (17 α-hydroxylase/C17,20-lyase). Immunosuppressants can leave patient temporarily without “defences”. Could food indirectly affect the all system (????).

In Zytiga website they write about drug Interactions like this;
"ZYTIGA is an inhibitor of the hepatic drug-metabolizing enzyme CYP2D6. Avoid co-administration with CYP2D6 substrates that have a narrow therapeutic index. If an alternative cannot be used, exercise caution and consider a dose reduction of the CYP2D6 substrate. Additionally, abiraterone is a substrate of CYP3A4 in vitro. Strong inhibitors and inducers of CYP3A4 should be avoided or used with caution.” I might be erroneous but it seems that this can indirectly be related to the metabolism of food.

In your position as a MD specialist in critical care cases, I would assume that you have access to detailed pharmacokinetic information from one of your haematologist friend/colleague. Dr. Myers is an extraordinary researcher in this field and uses this kind of “cocktails” in the treatment of advanced prostate cancer. I recall him commenting about the need for constant checks of liver function and other immunologic related conditions (blood), when these type of drugs are “in play”. You could pay him a visit.

Thank you again for sharing your experiences.

Good luck in your journey.

VGama

bzautry

Provenge
Hi
I have started the treatments,I go tomorrow for the 2nd infusion.
I really can`t tell you alot about it except during the first treatment I had severe chills twice,about 1/2 thru & at the end.They gave me demerol & in a few minutes the chills were gone.
My PSA last month was 16.7 & this month 36.4.from what I have read it takes about 6 months before there is any effect of PSA readings.
woody

VascodaGama

bzautry said:

Provenge
Hi
I have started the treatments,I go tomorrow for the 2nd infusion.
I really can`t tell you alot about it except during the first treatment I had severe chills twice,about 1/2 thru & at the end.They gave me demerol & in a few minutes the chills were gone.
My PSA last month was 16.7 & this month 36.4.from what I have read it takes about 6 months before there is any effect of PSA readings.
woody

Woody; Thanks for the info
Woody

You are one of the few patients on provenge still posting here.
http://csn.cancer.org/node/224218
Could you share some light in regards to your doctor's advice on "prohibitions" while on the treatment?

Is there any particular chemo that patients have taken, which is prohibitive for Provenge?
Is there any medicine which could interfere in Provenge treatment?
Is there any proibition in diet or any particular regimen required for/in guys on Provenge?

Thanks for posting.
Hope your PSA get to the levels you are wishing for.

VGama

klinefinancial

bzautry said:

DES
I would becareful with the DES, as they stopped giving it to women because it causes blood clots.
When I was on it I got a phone call from a friend & I could not say the words I was trying to say.
My wife took me to an emergency clinic & I was admitted & sent to Henry Ford Hospital.Where they ran several tests but couldn`t find any blockage.
the doctor thinks I may have had a blood clot that disolved itself.Although there was no prove of that that may have been caused by the DES.
Woody

DES Blood Clot

I had a blood clot on DES ......luckily it was found in my left calf and was able to disolve it with blood thinners......MY wife said it was the worst drug ever as I was most difficult to

get along with.....and emotionally on a roller coaster......lucky for me I had a motorcycle accident and that's how they found the blood clot.

 

ronpilotpi@aol.com

Provenge twice so far, one more to go...

No problems or side effects from first treatment of PROVENGE in late September 2017....but last week, during the second infusion, I had severe chills...nurse gave me some drug which quickly reduced chills...third/last treatment next week...chemo next, not sure when, have mets to lymph nodes and one bone met so far in hip....no pain, just fatigue these days...have already been on CASODEX, XTANDI, ZYTIGA but they all stopped working after a while...been on LUPRON ADT injection for 7 years, and it has kept testosterone low (below 10).....PSA now is at 120......and the whole drama started back in 2008 when a biopsy detected cancer at Gleason 7...had CYBERKNIFE soon afterwards..but a rising PSA indicated that cancer was still in my bloodstream, so all of the other treatments followed from 2010 to now.....

 

Ron - CT