Xtandi vs chemo vs clinical trial?

Momschooling

My husband has become castrate resistant on Zytiga according to his oncologist. Grateful we got 3 years out of this medicine but now it's time for plan B. The oncologist says Xtandi has a low chance of working but worth it to try. The other possibility is a clinical trial using Xtandi with a phase 2 medication. There is also chemo, but he prefers that to be delayed. Right now, my husband feels good and his lung spots plus a lymph node are growing pretty slowly. I am just concerned that if we do wait it'll be harder to control with chemo. I'd rather my husband go through it while he's strong vs waiting until it's a last resort. I have been through chemo, so I know it's dreadful but I just want what will give him the most time, along with feeling as good as possible.

Old Salt

I suggest your husband gets a second opinion from an NCI-Designated Cancer Center.

NCI-Designated Cancer Centers - NCI

Clevelandguy

Hi,

Just a thought but have they done radiation on the spots on his lung and lymph nodes? When one ADT drug becomes less effective doctors often switch to another class of ADT.

Dave 3+4

RER3877

Just joined CSN and you get my first comment - woo hoo

I did Zytiga for about 14 months and then switched to Xtandi for another 14 months - both seemed to work and didn't really have much of a side effect. Xtandi is probably worth a try but I also agree with the comment about a second opinion.

bdhilton

My two cents after 15 years of surgeries and radiation x2, I would seek out a recognized medical school and request they take over your case. I've worked with department heads at Northwester, UCSF and UC Davis (a Hartmann reversal not cancer) over the last 15 years. Good medical schools are on the bleeding edge of treatments etc. Most Doctors are "just practicing" are doing just that, "just practicing" not research...Granted, you might have to share a hospital room sometimes, at a teaching hospital but I see that as a small price to pay for expertise….Anyway, that’s my two cents..

You are your best advocate....Good luck in your journey

Momschooling

https://csn.cancer.org/discussion/comment/1707208#Comment_1707208

He already did radiation initially, yes ADT sadly no longer working not Zytiga or Xtandi.

RER3877

Just read you notes and it all sound very familiar - I did the same drugs ( 2 years) plus 40 rounds of radiation and was ready to start chemo - I did one chemo session (previously did 3 session for lymphoma) and really didn't want to continue down that path for the long term but it seemed the only option at the time. My Dr. did some genetic testing to look for specific biomarkers. Fortunately, I had the BRAC 1 & 2 deviation (not sure that language is exactly right). And that opened the door for immunotherapy (keytruda). Just completed infusion number 25 and feeling good. Each treatment takes just 30 minutes and so far, no serious effects. Cancer is not gone but it seems to be stabilized and might barely be spreading a bit as of the last scan.

I'm definitely an immunotherapy advocate. Pretty sure I wouldn't be here if that treatment hadn't been available. Good luck with whatever option you consider as the next step.

RER3877

Sorry for the typo in the previous - should read BRCA 1 and 2....

RER3877

Momschooling

https://csn.cancer.org/discussion/comment/1710095#Comment_1710095

Thank you, I will see if we can get him the genetic testing.

Momschooling

https://csn.cancer.org/discussion/comment/1708898#Comment_1708898

We are at the best place in our state and he is in a clinical trial however so far the trial has been a disappointment. He ended up in ER with an AKI the first week, 4 adjustments on bp meds and other miserable side effects only to see that it's not even working. It's xtandi with another drug that's part of the clinical trial.

RER3877

https://csn.cancer.org/discussion/comment/1710124#Comment_1710124

I should also mention that I get Lupron and Xgeva injections every 3 months. Controls testosterone level and slows bone deterioration if the cancer has spread to the bones. Again, I'm not feeling many side effects from these injections except maybe fatigue and that seems to be common for almost every cancer treatment I've had.

Momschooling

https://csn.cancer.org/discussion/comment/1710127#Comment_1710127

My husband still gets Lupron every 3 months as well. He's been on that for almost 4 yrs.

bdhilton

https://csn.cancer.org/discussion/comment/1710075#Comment_1710075

Momschooling, Sorry for the complications.

Clevelandguy

Hi,

Proton treatments can be used even after traditional XRay type treatments. Might be able to use this to mop up his hot spots. Check out the link from the Mayo Clinic.

https://www.mayoclinic.org/tests-procedures/proton-therapy/about/pac-20384758

Dave 3+4