Prostatepedia

Conversations With Prostate Cancer Experts


Leave a comment

Managing Chemotherapy Side Effects

Dr. Cy Stein is a medical oncologist at California’s City of Hope hospital. He routinely advises his fellow doctors to, “Never think about yourself. It’s only about the patient.”

Prostatepedia spoke with him about dealing with the side effects of chemotherapy for prostate cancer. Why did you become a doctor? What was it about medicine that drew you in? What keeps you there?

Not a member? Join us.

What are the most common chemotherapy drugs that men with prostate cancer are likely to encounter today?

Dr. Cy Stein: It all depends on what your definition of chemo is, but I take a very narrow definition that I think most of the community would take. There are two chemotherapy drugs that exist for prostate cancer. One of them is called Taxotere (docetaxel). The other is Jevtana (cabazitaxel). I don’t consider drugs like Lupron (leuprolide) to be chemotherapeutic agents. We consider them to be hormonal agents because they act directly on testosterone. Testosterone, as I’m sure everybody knows, is the male sex hormone. In order to get responses in prostate cancer, physicians have to lower the patient’s level of testosterone in their blood. That’s not a chemotherapeutic way of doing it; that’s a hormonal way of doing it.

Similarly, the newer drugs that have come out recently are not chemotherapeutic agents either. I’m referring to Zytiga (abiraterone) and Xtandi (enzalutamide). We call them oral hormonals. Provenge (sipuleucel-T) is a kind of tumor vaccine, so it’s really immunologic oncology. Xofigo (radium 223) is also not a chemotherapeutic agent, so we’re down to two.

What are the differences between the two. When would Taxotere (docetaxel) be used over Jevtana (cabazitaxel)?

Dr. Stein: Taxotere (docetaxel) was first developed in 1995-1996 and has been on the market for a long time. It was originally used in breast cancer and lung cancer as well. Then it was introduced for use in prostate cancer.

There is significant amount of toxicity with Taxotere (docetaxel), although it is a very good drug. It is different from Jevtana (cabazitaxel), even though both of the drugs are formed to the same general class of molecule, which we call taxanes. They both come from, ultimately, the needles of the Pacific Yew tree. Even though the names sound similar, these are different drugs with different toxicity profiles.

The important thing for a patient to remember is that, even though these drugs have side effects, at times we see spectacular responses from both of them. The side effects are manageable and definitely worth the effort for the patient because of the potential for the response that you can get. Taxotere (docetaxel) has more side effects than Jevtana (cabazitaxel). Taxotere (docetaxel) seems to have more toxicity, and most important, the toxicity seems to get worse as patients age. Therefore, I find it extremely difficult, if not impossible, to give Taxotere (docetaxel) to men who are over 80.

What toxicities are we talking about?

Dr. Stein: For Taxotere (docetaxel), the major dose-liming toxicity is fatigue. People are not going to feel anything on the day that they get the Taxotere (docetaxel). The day after, they’re going to feel pretty tired, and most men will want to just stay in bed. Their partners don’t particularly like that, but it’s probably best to leave them in bed because they’re not going to be very functional for a day or more on Taxotere (docetaxel).

It’s not uncommon for a man to say, “For three days after I get this drug, I’m very wiped out.” I’ve even heard them say, “Five to seven days after I get this drug, I feel very wiped out.” Then the men will get better, and eventually they will come back for their next cycle, and we’ll do it all over again. It doesn’t happen quite so much with Jevtana (cabazitaxel) because it is a little easier on the fatigue.

In terms of other side effects, one of the side effects that Taxotere (docetaxel) has, only in about 10% of cases, is febrile neutropenia. That is the white blood cell count goes down seven to nine days after getting the chemotherapeutic drugs and leads to an infection. The patient will have a fever of 100.4 or greater, and the febrile neutropenia requires antibiotics. With Jevtana (cabazitaxel), the incidence of febrile neutropenia is much, much higher. What I do is I make sure that all of my patients have Neulasta (pegfilgrastim) applied before they get the chemotherapy, to prevent their white count from going down.

There are some patients who may not need Neulasta (pegfilgrastim), but I prefer to sleep calmly at night. I don’t want to worry about a patient getting febrile neutropenia on Jevtana (cabazitaxel), so I treat every one of my patients with Neulasta (pegfilgrastim).

In terms of other toxicities, many men say that Taxotere (docetaxel) also causes food to taste like cardboard. Their hair will certainly thin, but it probably won’t all fall out. They may get tearing of the eyes. They may get changes in their nails such as brown bands that horizontally cross the nails. These disappear after discontinuation of treatment. They can also, potentially, get a little bit of fluid in their lungs, although in my experience that hasn’t been a clinical problem. They can also, potentially, develop neuropathy.

It sounds rough, and for some men it is, but a lot of men go through it very well. They can have a tremendous response. I’ve seen any number of individuals have responses of 75% and even 90% in their PSA. These are the kind of individuals who live a great deal longer than if they didn’t respond.

Jevtana (cabazitaxel) is a very similar story, except the fatigue is much less. The neuropathy is significantly less, although I have seen patients with neuropathy on Jevtana (cabazitaxel). The nail banding does not happen. The poor taste doesn’t happen. The hair loss is greatly reduced. Fatigue is also significantly reduced, but there is still fatigue in some patients.

Because the toxicity profile is better with Jevtana (cabazitaxel), I don’t hesitate giving this drug to patients who are over 80 years old. In my opinion, they seem to tolerate it better. I had a patient who was 90 years old and of sound mind and body. He didn’t have much of a choice; he had two sons who were doctors. We talked it over and he said, “I want the drug.” He got the drug, and I started him with a much lower dose than the full recommended dose. I titrated him up to tolerability, and he received 13 consecutive cycles of Jevtana (cabazitaxel). All his pain went away, and he lived an extra year.

Jevtana (cabazitaxel) has a lower dosage option that has just been approved. What has been the impact for your prostate cancer patients?

Dr. Stein: I use two doses of Jevtana (cabazitaxel): 25 mg/m. and 20 mg/ m.. The overall survival with both doses is identical, but at 25 mg/m., the PSA is more affected as opposed to the 20 mg/m.. In other words, you have more PSA decline on the 25 mg/m. than you have on the 20 mg/ m.. Of course, you have less toxicity on the 20 mg/m.. For those men who really follow their PSAs very closely, I might, all other things considered, recommend the 25 mg/m.. For most men, I think the 20 mg/m. is just fine. For Taxotere (docetaxel), the full dose is 75 mg/m.. There’s little evidence that you lose much in the way of efficacy if you go to 50 mg/m. to avoid toxicity, and I’ll do that frequently.

Is there anything men can do to prepare themselves for these side effects?

Dr. Stein: Aside from communicating with their doctors and taking Claritin if you’re receiving Neulasta (pegfilgrastim), I’m not sure there is anything you can do.

Is there anything else you’d like patients to know about chemotherapy for prostate cancer?

Dr. Stein: These are very realistic options for patients. Men can tolerate Taxotere (docetaxel) for maybe six to eight cycles. It’s hard for men to get more. With Jevtana (cabazitaxel) it’s unbelievable how much people can get because the toxicity is less. I know of a man who received 55 continuous cycles of Jevtana (cabazitaxel) and did extremely well. My own personal record is 33 cycles. In one of those cases, the patient had a 99% response in his PSA; he lived three extra years. He did extremely well. I had another man who also got 33 cycles. His PSA was roughly 50 to 70 and it stayed that way for 33 cycles before he started to progress. I have seen quite a few remarkable responses.

Join us to read the rest of this month’s conversations about chemotherapy for prostate cancer.


Leave a comment

Clinical Trial: Intravenous Vitamin C + Taxotere (Docetaxel)

Dr. Channing Paller, an Assistant Professor of Oncology at Johns Hopkins University School of Medicine, focuses on translational research and clinical trials of developmental therapeutics in prostate and other solid tumors.

She is keenly interested in the rigorous evaluation of natural products in cancer treatment.

Prostatepedia spoke to her about her Prostate Cancer Foundation instigated and Marcus Foundation funded clinical trial on combining intravenous Vitamin C with Taxotere (docetaxel).

Paller-20537-111ret

Dr. Channing Paller: One of my interests is studying natural products that people take as dietary supplements. We don’t know whether they work or whether they cause harm, so I test them. Several of my clinical trials study these compounds rigorously in a placebo-controlled fashion, as we would with any cancer treatment.

I knew about a recent randomized study of high dose intravenous ascorbic acid (vitamin C) in ovarian cancer patients, which showed that ascorbic acid treatment combined with standard chemotherapy reduced toxicities from the chemotherapy and also trended towards improved overall survival. Vitamin C enabled the patients to receive more cycles of chemotherapy, and that was associated with longer overall survival.

In response to the findings in ovarian cancer, the Prostate Cancer Foundation sent out a request for proposals for early stage research on vitamin C’s role in treating prostate cancer. We decided to initiate a large (60 patient) placebo-controlled trial with co-primary endpoints of quality of life and cancer response to the combination of intravenous (IV) vitamin C and chemotherapy. We are extremely grateful to the Marcus Foundation for supporting the trial.

We chose Taxotere (docetaxel) because it was first line and an easy place to start to answer the question. Jevtana (cabazitaxel) would have worked just as well.

What can patients expect to happen during the trial?

Dr. Paller: We are conducting a randomized placebo-controlled Phase II trial of standard-of-care Taxotere (docetaxel) for metastatic castrate resistant prostate cancer with either ascorbic acid or placebo, which is electrolytes and hydration, given twice a week in between the cycles of chemotherapy every three weeks. Some people say that this is too big a commitment, so they get to take breaks if needed. They can miss a session or two here or there. They can even take two weeks’ break, if needed. We’re trying to help people live better, not chain them to the clinic.

Join us to read more about Dr. Paller’s trial.


Leave a comment

Dr. Ken Pienta: Chemo For Prostate Cancer

Dr. Kenneth J. Pienta, of the Johns Hopkins University School of Medicine, is an international expert in the development of novel chemotherapeutic agents for prostate cancer. He was the recipient of the first annual American Association for Cancer Research Team Science Award and is the author of more than 300 peer-reviewed articles. He frames this month’s conversations about chemotherapy for us.

Pienta_lab_Background

Not a member? Join us.

In 2018, chemotherapy for prostate cancer continues to be one of the many options we have to lengthen the lives of patients suffering from metastatic prostate cancer. There are still multiple other therapies that we don’t consider chemotherapy. Second-generation anti-androgen therapies like Zytiga (abiraterone), Erleada (apalutamide), and Xtandi (enzalutamide) are all now standards of care in castrate-resistant prostate cancer. We also have Xofigo (radium-223) as an option for patients with bony metastases.

There are two chemotherapies that have been approved for prostate cancer: Taxotere (docetaxel) and Jevtana (cabazitaxel). Now, the real challenge for patients and providers is when to use those chemotherapies.

Multiple studies have demonstrated that, when you’re newly diagnosed with metastatic prostate cancer, it may be beneficial to receive a limited number of doses of Taxotere (docetaxel) at the start of hormone therapy. That’s especially true if you have multiple places where the cancer has spread. That’s not correct for all people, but for some patients, it is a good option. More and more physicians are prescribing Taxotere (docetaxel) with a luteinizing hormone-releasing hormone (LHRH) antagonist at the start of therapy.

However, that doesn’t mean you cannot use Taxotere (docetaxel) after other things have failed. If you failed second-line hormone therapy or have failed radium therapy, Taxotere (docetaxel) is still a good option that helps people live longer.

Jevtana (cabazitaxel) continues to be a good chemotherapy option if patients have failed Taxotere (docetaxel).

Thank goodness we’ve seen over the last several years an increase in the number of drugs available to treat metastatic prostate cancer in addition to chemotherapy. Chemotherapy has been around for quite a while now, but there is still a role for it.

Again, the challenge for all of us is: when do we slot them in for you? The chemotherapy we use for prostate cancer is really a single agent chemotherapy, either Taxotere (docetaxel) or Jevtana (cabazitaxel). This is not the multi-agent therapy we use for other cancers, so the idea of major side effects is a bit overblown. For example, nobody vomits from chemotherapy for prostate cancer. The drugs we use to prevent that are too good.

We also have gotten much smarter about limiting the number of doses we use. We don’t necessarily give chemotherapy until it doesn’t work anymore. Often, we just give several doses and then take a break. If you get more than a couple doses of chemotherapy, you will still lose your hair temporarily.

Chemotherapy can make you feel more tired when it lowers your blood count, and it can make you more susceptible to infections, but people are very rarely hospitalized now for an infection from chemotherapy. It’s virtually unheard of that somebody would die as a side effect of chemotherapy.

The major side effect of Jevtana (cabazitaxel) tends to be diarrhea, but again, as we’ve learned about the dosing of that drug, that has become more manageable.

Another side effect of both drugs can be peripheral neuropathy, which is tingling in the fingers and toes. But we watch for that too. If you start to develop that, we tend to stop the drug. These are very tolerable medicines.

The word chemotherapy always evokes images of horror, but chemotherapy in 2018 is a lot different than it was even five years ago. We just know how to give chemotherapy much better. When I started in the field 30 years ago, if you had metastatic castrate resistant prostate cancer, survival was 6 months. Now, with the advent of all these newer therapies, we’ve gotten much better. The landscape of how to treat prostate cancer has changed completely in the last five years. It will change completely again in the next five years. The challenge is in what order are we going to use all these powerfully good drugs rather than having only one drug to give or none at all.

For us as physicians, it’s an exciting time to take care of men with prostate cancer.

Join us to read this month’s conversations about chemotherapy for prostate cancer.


Leave a comment

Us TOO: Mark Slaughter’s Prostate Cancer Story

Mark and Denise Slaughter talk about their experience with chemotherapy for prostate cancer.

DSCN7750 (ed) Denise & Mark

Not a member? Join us.

The C word. No one can imagine beforehand the horror of being told you have cancer.

My problems began with urinary troubles: middle of the night urges, frequency, and the inability to go, start, or finish a urine stream. My primary care physician recommended a urologist.

My urologist was awesome and earned my confidence and trust with his approach. He explained he was trying to see a picture rather like a jigsaw puzzle, but in order to see the picture clearly, he needed more pieces of the puzzle. He convinced me to let him do a digital rectal exam (DRE).

The result was not good. On a 0-10 scale, 0-5 would indicate no problems and 5-10 would range from concern to panic. He said mine was about a 7 or 8. Very smooth everywhere, no evil nodules or lumps, but way too hard. Unlike the softer part of your thumb near the palm of your hand (like it should be), it felt like the harder area of your thumb where the bone is located. It was definitely a reason for concern.

Next, he talked me into a PSA test. I was one of the men who, about seven or eight years ago, read the controversial studies about PSA tests and unreliable results, and I took them to heart. Many organizations were saying PSA was overrated and shouldn’t even be used. So, I had stopped letting doctors test mine. My PSA was tested and came back very bad. It was 259. To see more of the picture, my doctor needed to do a biopsy. He respectfully listened to all of my logical arguments.

No number of needle probes will show you enough of the prostate. Too many and you can damage a fragile little organ. Besides, you would access a sterile body part by going in through a sewer. He held his ground and said he really needed this important piece of the puzzle. My wife and I thought about it overnight and agreed to let him do the biopsy.

My biopsy procedure was a piece of cake. I was given an antibiotic before the procedure. An ultrasound device accurately guided the doctor, and he was able to get 12 samples: 6 from each side of the prostate. Of the 12, I was really only hurt by one of them. Each felt like someone quickly poked me with a pencil. I heard the device click. I required no pain medication and passed a little blood during urination for a few days afterwards.

Then the results came. Of the 12 needle biopsy locations, nine were found to contain high-grade cancer. Of those nine, eight had a Gleason score of 8, and the last one was scored at 7. The range for cancer is 6 to 10, so we knew this was a bad score. It meant the cancer had spread beyond the prostate gland. My doctor said that the next step was to get CT and bone scans that, together, would show us where the cancer had spread in my body. My next stop was the hospital for the scans. The procedures were simple and easy enough. The results were another story.

February 8, 2018 is a day emblazoned in my memory, a day I will never forget, the day time stopped. That was the day I was told I have the big C word: I have cancer.

My doctor was tactful but did not mince words. The CT scan showed cancer in my lymph nodes, in my groin, and up my back on both sides of my spine. The bone scan showed lesions in four places on my pelvis and six places on my ribs. The tests all showed that I have advanced Stage IV metastatic prostate cancer. There is no cure. But we can manage it with hormone treatments and chemotherapy. With no treatment, I might only have a couple of years to live. With treatments, perhaps three to five years.

Upon hearing this news, my first thought was: I am dead. I had been standing next to my wife Denise, who was seated at her desk as we listened on the speakerphone. I collapsed into a seated position on the floor and reached out to catch Denise as she fell out of her chair. We crumbled to the floor together, sobbing and wailing with wrenching heaves of our chests. Squeezing each other as though life had ended that very moment. We embraced. We cried. We cried. We cried. Time stopped.

We laid together in a heap on the floor for a long time. By the time we climbed to our feet, we could hardly breathe. My face hurt from all the tears. Our eyes were swollen, our faces red below our eyes and otherwise colorless as though life itself had drained from our faces. It was like our lives were over.

My doctor referred us to an oncologist. We couldn’t stand him. He was rude and dismissive as he explained the chemo treatment plan and the poor prognosis for the remainder of my life. It is an understatement to say that he lacked a good bedside manner. Several friends immediately recommended we get a second opinion.

A friend of mine, and my former primary care physician when we lived in Atlanta, told me to forget that guy and get myself to another center. I did just that. I did just that and found an incredible doctor who was instrumental in the CHAARTED study that showed excellent results of early chemotherapy treatment combined with hormone therapy for the treatment of advanced metastatic prostate cancer.

My first appointment with this doctor was an education in prostate cancer. He explained the course of the disease, different methods of treatments, and answered each and every question I had. He described the treatment options as the tools in his toolbox. Whenever one might fail to produce results, he would reach for another one. He explained new drugs, such as hormone therapy, and he explained chemotherapy. Some people prefer chemo because it is six treatments and you are done. Other people would rather take pills for the rest of their lives. No study showed any real difference in the outcome of chemo versus hormone therapy. At first, I was going to go the hormone therapy route. I was terrified of chemo because of my preconceived notions and the horror stories from people I had known who went on chemo and suffered horrendous side effects before dying painful deaths.

But there was a major snag in my getting approval for hormone therapy. Because I am on Medicare and have the Part D drug coverage, I was not eligible for any financial aid from the pharmaceutical companies or from any other charitable organizations for hormone therapy.

Consequently, it was going to cost me in the neighborhood of $5,000 per month for the rest of my life. This was a huge blow to overcome mentally and financially. There was no way I could afford that.

My doctor reassured me again that the results of chemo are as positive as those from hormone therapy. Medicare would pay for the chemo. Because of these two considerations, I chose to take the chemo. Believe me, nothing about taking chemo comes close to the fear and angst of anticipating it.

I am currently undergoing chemo. I am through the fourth of six cycles of Taxotere (docetaxel). The biggest side effect for me has been the infamous cancer fatigue, especially during the first week after chemo. It takes about all the energy I have to walk from my chair to my bed to take a nap.

My doctors gave me Compazine (prochlorperazine), which prevents nausea and has worked extremely well for me. I also take Lupron (leuprolide), which has caused some hot flashes, mostly in the late afternoon and evening. Sometimes

I have night sweats. Cramps of my ankles are a bothersome little issue several times a week.

One thing I have not had at all is neuropathy. My wife read about studies done in Canada, the United Kingdom, and France that indicate icing of the fingers and toes during chemo infusions prevents any changes to fingernails and toenails as well as neuropathy. I asked my oncologist and he said although there are no definitive studies in the United States that show results, he didn’t object to my doing it. My wife has faithfully kept my hands and feet iced during treatments. It’s not pleasant, but it’s certainly tolerable and offers a big pay-off. To me, it’s like a kid playing in the snow with no mittens.

Each of my sessions lasts about 1.5-2 hours. Once in a while, when it feels too cold, I take my hands or feet out of the ice for a short break. Overall, my treatments have been far less of an ordeal that the initial fear of treatment.

Another side effect: hair loss. I have had heavy, patchy hair loss on my head that started about 13 days after my first chemo treatment. The afternoon when large patches of hair began falling out into my hands in the shower, I decided to take action. The next morning, slowly, deliberately, I dressed, collected my wallet and keys, walked to the garage, got in the car, drove to the nearest barber and got a buzz cut. I didn’t think about it. I just did it. And it was one of the best decisions I have made. It is far easier to manage quarter inch long hair than patches of messy hair. I would say to any guy, wait and see if your hair begins to fall out, then just accept the fact and manage it.

As for sexual function, I am 66 years old and have suffered from erectile dysfunction for six or seven years. Hormone therapy is medical castration. The result is loss of sexual function. I rarely have any kind of erection, and even the size of my genitals has shrunken somewhat.

But, with a loving partner, these things have not been so hard to accept. I still have the good feelings two people share in intimacy. I would rather be alive than fully-functional, sexually. I do admit my history has made this easier to accept than it might be for some younger men. The key here is perspective. Some choices in life are just hard. You have to decide what matters the most.

The biggest positive about chemo is that you do it and it’s over forever. For me, six cycles of three weeks, then never again. This compared to a lifetime of multiple pills on a daily basis, worrying all the while about how long they might be effective.

On the down side, you have to get your head around walking into a room feeling good and letting them inject you with strong chemicals that will make you feel bad. It’s rather bizarre. I live about 200 miles from my cancer treatment center, so the car trip and hotel stay give me way too much time to let bad thoughts get in the way before each treatment. Again, it’s all about controlling your thoughts and attitude. I know it sounds trite, but holding onto a positive attitude really matters.

The routine at each treatment is: a lab test for blood markers, doctor appointment, and chemo infusion. If my blood looks good, the doctor approves the chemo, then the chemo is prepared and infused. I know it’s working because the blood tests show positive results. My PSA has dropped from 259 to 20, 5, 2, and 1.7 over the first 4 treatments. Similarly, my testosterone has dropped from around 500 to less than 20, which the doctors consider insignificant. They tell me my testosterone level is that of a prepubescent boy, which is good because loss of testosterone starves the cancer.

My oncologist has not even discussed AR-V7 biomarkers with me because, so far, my cancer has been responsive to chemo. We have had some general discussions about castrate-resistant prostate cancer and that there are other options for continued hormone treatments after the Lupron (leuprolide), should it become ineffective.

I have a wonderful support group. First, my loving wife of 46 years is a registered nurse and the best advocate anyone could ever ask for. Second, I live in an active adult community of residents over 55. So many of my neighbors have been supportive and shared their own experiences with cancer. Third, I have a strong faith. My church friends have been amazing with calls, cards, food, gifts, and time for visits. It has been humbling to see how many dear friends I have and how supportive they are in my time of need. I think this is one of the biggest keys in getting through cancer.

I have to mention some of the person-to-person connections I have been provided with through Us TOO have helped greatly in terms of information and support.

My advice to anyone facing chemotherapy is to first go to the nearest national cancer center, get a top-rated oncologist who specializes in your particular cancer, ask questions, listen to suggestions, and make a shared decision with your oncologist and caregiver. Ask your team of doctors and pharmacologists for all information about drugs and their most common side effects.

Each person’s cancer is unique and your responses to drugs will also be unique.

The Grim Reaper follows us all. Most of our lives we ignore the inevitable fact that everyone will die. With a chronic, terminal diagnosis, the Grim Reaper comes up closer behind us. The key to survival is to never look back. Focus forward. Look to the light of day. Focus on the here and now. Enjoy life.

In a strange way, having advanced Stage IV metastatic prostate cancer is a gift. It has changed the focus of my life in positive ways. Because now, more than ever before, I live in the present. And life is more intense, fuller, and more complete than I could have imagined.

Join us to read this month’s conversations about chemotherapy for prostate cancer.


Leave a comment

Conversations About Chemo For Prostate Cancer

Pp_Aug_2018_V3_N12_Thumb

There are very few people who don’t immediately panic when they hear that they’ve been diagnosed with cancer. Am I going to die, most wonder, even if they don’t voice that fear to their friends and family. Many patients have a similar reaction when their doctor suggests chemotherapy. But just as cancer itself is not always a death sentence, chemotherapy is not as bad as most think.

Chemotherapy for prostate cancer today is not your grandfather’s chemo. Most side effects are manageable and don’t stop men from going about their daily lives. And studies suggest that using chemotherapy earlier and not waiting until your disease has progressed has tangible benefits.

This month we take a deep dive into chemotherapy today.

Not a member? Join us to read this month’s conversations.

Dr. Ken Pienta frames this month’s discussions and points out that the cultural view of chemotherapy as catastrophic to the patient is largely unfounded.

Dr. Nicholas Vogelzang outlines the history of chemotherapy for prostate cancer and muses about future directions.

Dr. William Oh explains the role chemotherapy plays in a prostate cancer treatment today.

Dr. Cy Stein talks about side effects associated with Taxotere (docetaxel) and Jevtana (cabazitaxel) and how to manage them.

Dr. Oliver Sartor explains the development of Jevtana (cabazitaxel) for prostate cancer.

Dr. Emmanuel Antonarakis talks about the potential impact of switching from Taxotere (docetaxel) to Jevtana (cabazitaxel) midway through treatment and vice versa.

Dr. Channing Paller introduces her clinical trial looking at combining Taxotere (Docetaxel) with intravenous Vitamin C. She’s recruiting patients, so if you think you might be a fit for the trial, be sure to contact her.

Finally, both Mark Slaughter from Us Too! and Bill R. tell us about their experiences with chemotherapy for prostate cancer and their advice for men in similar situations.

The bottom line is that, if you’ve been prescribed either Taxotere (docetaxel) or Jevtana (cabazitaxel) for prostate cancer, there is no need to panic. Both drugs can have a dramatic impact on your survival, and their side effects can be managed with a little forethought and careful monitoring. Talk to your doctor about any concerns you have. Reach out to other men with prostate cancer who’ve had either of these medications. As with anything in life, the more you know going into the experience, the easier of a time you’ll have. Many times we fear the unfamiliar.

And, as always, be sure to share this issue of Prostatepedia with your doctor. Use these conversations as a jumping off point for an honest discussion. She may agree or disagree with some of the points made in the interviews that follow. Talking about why she is taking a certain approach with your disease will help you feel more comfortable with any decision that the two of you agree upon.

There has never been a better time to be a prostate cancer patient, friends. Your doctor has many tools in her wheelhouse to fight your cancer.

Download the issue.


Leave a comment

Chemotherapy For Prostate Cancer

Pp_Aug_2018_V3_N12_Thumb

This month we’re talking about chemotherapy for prostate cancer.

Dr. Snuffy Myers offers his thoughts about this month’s conversations:

Patients are often under the impression that chemotherapy drugs like Taxotere (docetaxel) and Jevtana (carbazitaxel) won’t significantly improve survival and will only dramatically impair quality of life. A patient once said to me, “That sounds like a bad deal.” I hope this issue of Prostapedia changes your view of chemotherapy.

The potential benefit of chemotherapy depends on where you are in the natural history of metastatic prostate cancer. If you have just been diagnosed with widespread metastatic prostate cancer, Lupron (leuprolide) plus Taxotere (docetaxel) can have a major benefit in terms of your survival. At this point, you are likely to tolerate chemotherapy better than you would if you had already been through multiple other treatments. However, even in patients who have been extensively treated before chemotherapy, this treatment can often provide significant relief of bone pain that outweighs the drug side effects.

The major alternatives to Taxotere (docetaxel) in this setting are the new androgen blocking agents, such as Zytiga (abiraterone), Xtandi (enzalutamide) or Erleada (apalutimide). Each of these drugs can cause side effects more severe than Taxotere (docetaxel) in some patients. Also, Taxotere (docetaxel) treatment extends for just six treatments done every 3 weeks. In contrast, the androgen blocking agents are typically given continuously until they fail to control your cancer.

In many other cancers, patients benefit greatly when we combine drugs. While the search for effective Taxotere (docetaxel)-based combinations has been going on for decades, no combination has survived rigorous Phase III testing. I, and many others in the field, think that this may be because prostate cancer is a very heterogeneous disease. The path to success requires that we understand at a molecular level the various forms of this disease and the key vulnerabilities of each variation.

One example is the sensitivity of prostate cancers with a BRCA2 mutation to Paraplatin (carboplatin). Another example is the activity of Jevtana (carbazitaxel) + Paraplatin (carboplatin) in anaplastic prostate cancer.

There are several reasons to be optimistic about progress. First, research into the molecular heterogeneity of prostate cancer and the clinical implications thereof is proceeding rapidly. Second, leads that emerge from this research are being tested more rapidly and with greater sophistication than at any time in the past.

Download the issue.


Leave a comment

Dr. Daniel Spratt: On Becoming A Doctor

Dr. Daniel Spratt is a radiation oncologist and the Chair of the Genitourinary Division of Clinical Research at the University of Michigan Health System.

Dr. Spratt talks to Prostatepedia about why he became a doctor.

Not a member? Join us!

Why did you become a doctor?

Dr. Daniel Spratt: There are no physicians or healthcare workers in my family. I took an unconventional path to becoming a doctor. I started working as a personal trainer when I turned 18. I was always involved in fitness and exercise. I took some time off from going to college and worked one-on-one with clients.

At that time, I noticed that I liked being able to help change people’s lives and have that unique interaction. But there are limitations to what a personal trainer can do for a person. That inspired me to go back to college, focus on the research, and go to medical school to become a radiation oncologist.

How did you make your way to radiation oncology versus urology?

Dr. Spratt: In medical school, we rotate through a bunch of different specialties. All along, I thought I was going to be a neurosurgeon; that was my focus and my research. But I started to realize that I love to connect, to have the time and flexibility to discuss how patients are doing. I care more than just about the technical treatment. I enjoy emotionally connecting with patients.

The radiation oncology industry is a unique specialty in that a machine delivers our treatments, and then we get to see the patient. I almost do two things at once. If a surgeon is operating all day, they can’t see anyone other than the one patient in front of them. I get to see and treat dozens of patients a day.

Are you still involved in the exercise world?

Dr. Spratt: Definitely. It is not as strong, but if you spoke to any of my patients, they’d tell you that I prescribe exercise to all of them. The side effect profile for my patients who are inactive versus the ones who are active is like night and day. It’s amazing how patients undergoing prostate cancer treatment, including radiation and especially hormone therapy, are improved by exercise. It doesn’t need to be joining a gym—just being active in some way.

The guys who are active have much fewer side effects during treatment. I jokingly prescribe exercise while

I prescribe radiation to them.

Maybe you shouldn’t joke and really do it!

Dr. Spratt: Exactly. I don’t think a pharmacy can fill that.

Subscribe to read the rest of Dr. Spratt’s comments.