Answers From The Community
I am also a caregiver to my husband of 49 years. He also has stage IV prostate cancer diagnosed 2 years ago. He is getting Lupron shots every 3 months and Xgevia monthly. In April they started him on Zytiga. He took it for 3 months with no side effects. He stopped because he needed radiation for a tumor on his spine. The radiation worked, he is pain free but has not resumed the Zytiga. We are now discussing chemo options.
Prostate Cancer Drug Zytiga May Extend Life
Study Shows Zytiga Adds 4 Months of Life to Patients With Advanced Prostate Cancer
May 25, 2011 — The newly approved prostate cancer pill Zytiga may extend life by up to four months in men with spreading cancer who have already been treated with , a study shows.
This survival gain “means quite a bit,” says study researcher Howard I. Scher, MD, chief of the genitourinary oncology service at Memorial Sloan-Kettering Center in New York City. “These are a group of patients for whom there is no standard of care and it is particularly gratifying to see these results, to say the least.”
The new study is published in the New England Journal of Medicine.
Prostate cancer is the most common diagnosed in men besides skin cancer, according to the American Cancer Society. One out of every six men will be diagnosed with prostate cancer during his lifetime.
The new drug, which was approved by the FDA in April, inhibits a protein that helps form male hormones. The findings may help reshape the way doctors view and treat advanced prostate cancer.
The new study included 1,195 men with metastatic cancer whose disease had progressed after chemotherapy. Those men who received steroid therapy along with the new pill survived for 14.8 months, on average, compared with 10.9 months seen among those who received a along with steroids. This translated into a 34% reduction in risk of dying, the study shows.
Neoadjuvant Zytiga Plus Hormonal Therapy Can Eliminate Tumor In Some Men With High
Six months of neoadjuvant treatment with the targeted agent Zytiga® plus hormonal therapy eliminated or nearly eliminated tumors in one-third of men with localized high-risk prostate cancer, according to the results of a study presented at the annual meeting of the American Society of Clinical Oncology . The current study marks the first time that the drug has been investigated in earlier stages of prostate cancer and in the neoadjuvant setting.
Drug Forms And Administration
Zytiga and Xtandi are both given as pills. You take them once a day.
Zytiga comes as a 250-mg tablet and a 500-mg tablet. The usual dosage is 1,000 mg once a day. You should take Zytiga without food . You take Zytiga along with prednisone, a corticosteroid that helps reduce certain side effects.
Xtandi comes as a 40-mg capsule. The usual dosage is 160 mg once a day. You can take it with or without food.
What To Do In Case Of Overdose
If you think youve taken too much of this drug, call your doctor. You can also call the American Association of Poison Control Centers at 800-222-1222 or use their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.
When you get Zytiga from the pharmacy, the pharmacist will add an expiration date to the label on the bottle. This date is typically one year from the date they dispensed the medication.
The expiration date helps guarantee the effectiveness of the medication during this time. The of the Food and Drug Administration is to avoid using expired medications. If you have unused medication that has gone past the expiration date, talk with your pharmacist about whether you might still be able to use it.
Standards Of Care In Hormone Therapy
Most doctors agree that hormone therapy is the most effective treatment available for patients with advanced prostate cancer. However, there is disagreement on exactly how and when hormone therapy should be used. Here are a few issues regarding standards of care:
Timing of Cancer Treatment
The disagreement is due to conflicting beliefs. One is that hormone therapy should begin only after symptoms from the metastases, like bone pain, occur. The counter belief is that hormone therapy should start before symptoms occur. Earlier treatment of prostate cancer is associated with a lower incidence of spinal cord compression, obstructive urinary problems, and skeletal fractures. However, survival is not different whether treatment is started early, or deferred.
The only exception to the above, is in lymph node-positive, post-prostatectomy patients, given androgen deprivation as an adjuvant immediately after surgery. In this situation, immediate therapy resulted in a significant improvement in progression free survival, prostate cancer specific survival, and overall survival.
Length of Cancer Treatment
The disagreement in this situation is between continuous androgen deprivation and intermittent androgen deprivation.
Combination vs. Single-Drug Therapy
When To Contact Your Team
Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:
- you have severe side effects
- your side effects arent getting any better
- your side effects are getting worse
Early treatment can help manage side effects better.
Theres More Hope All The Time
Metastatic prostate cancer can turn on a dime. For too long, a sudden shift in the disease has meant bad news. But now, more and more men are seeing a sudden turn in the right direction. Jeff Finerman is one of them.
In a very short time, Jeff has gone from being nearly bedridden after weeks of debilitating bone pain to feeling great. He feels so good, in fact, that hes planning on joining his family on a long-awaited trip to Asia a trip he thought he would probably have to miss. Two months ago, I wasnt going to be part of that, he says. My wife and I knew I probably wouldnt be going.
In September of 2017, Jeff was in such pain that I was soaking in the bathtub two to three hours a day. He had just changed doctors to UCLA medical and PCF Young Investigator John K. Lee, M.D., Ph.D. Dr. Lee was ready to write me a prescription for some heavy pain medicine; meanwhile, I was loading up with Advil. Then, I started Zytiga with prednisone ; along with Xgeva, a drug that specifically targets and strengthens cancer-riddled areas in the bone; and Lupron, a form of deprivation therapy that helps control cancer by lowering testosterone. His quality of life was pretty bad, agrees Lee, and he was not able to do much physically. He was writhing in pain.
Jeffs doctor at UC Davis suggested starting a clinical trial, in addition to androgen deprivation therapy and radiation.
Guide To Managing Side Effects Of Chemotherapy
Follow these simple rules to manage your side effects:
Pay attention. Be aware of all expected and unexpected reactions to the drugs.
Be proactive. Make a list of your medications. Talk with your health care providers about what signs to look for and when to call them.
Relax and get well. Chemotherapy drugs are powerful and can take a toll on the body. Focus on getting well by finding ways to alleviate stress. These may include listening to music, doing yoga or stretching exercises, taking walks or watching TV.
Keep a journal. Write down any physical and emotional changes you experience while taking the medications. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your health care team to manage your side effects.
Consult your doctor. Talk with your health care providers about any side effects you experience. There are several drugs designed to help ward off or treat different side effects.
Anyone Taking Zytiga To Treat Stage Iv Prostate Cancer
Asked by on Sunday, August 4, 2013
Anyone taking Zytiga to treat stage IV prostate cancer?
I’m the caregiver for my husband of 52 years. The chemo treatments stopped working and his PSA started rising dramatically. He started taking the drug Zytiga ten days ago and I’m wondering if anyone can compare side effects they’ve experienced that may be related to Zytiga. He was extremely fatigued before starting it and two days after starting he had to have two units of blood transfused. A couple days after that he had very low blood pressure and needed fluids infused. This may not be from the Zytiga but I want to know if anyone else has experienced anything similar. Yesterday was his best day in a month but today the fatigue is back.
Any feedback would be greatly appreciated! Thanks,Ginny
Cancer That Is Thought To Still Be In Or Around The Prostate
If the cancer is still thought to be just in the area of the prostate, a second attempt to cure it might be possible.
After surgery: If youve had a radical prostatectomy, radiation therapy might be an option, sometimes along with hormone therapy.
After radiation therapy: If your first treatment was radiation, treatment options might include or radical prostatectomy, but when these treatments are done after radiation, they carry a higher risk for side effects such as . Having radiation therapy again is usually not an option because of the increased potential for serious side effects, although in some cases may be an option as a second treatment after external radiation.
Sometimes it might not be clear exactly where the remaining cancer is in the body. If the only sign of cancer recurrence is a rising PSA level , another option for some men might be active surveillance instead of active treatment. Prostate cancer often grows slowly, so even if it does come back, it might not cause problems for many years, at which time further treatment could then be considered.
Factors such as how quickly the PSA is going up and the original Gleason score of the cancer can help predict how soon the cancer might show up in distant parts of the body and cause problems. If the PSA is going up very quickly, some doctors might recommend that you start treatment even before the cancer can be seen on tests or causes .
How Should I Take Zytiga
Zytiga is usually taken once per day while also taking a steroid 1 or 2 times per day. Follow your doctor’s dosing instructions very carefully.
Follow all directions on your prescription label and read all medication guides or instruction sheets. Use the medicine exactly as directed.
Your prednisone or methylprednisolone dosage needs may change if you have surgery, are ill, or are under . Do not change your medication dose or schedule without your doctor’s advice.
Take this medicine with a full glass of water.
Take Zytiga on an empty stomach, at least 1 hour before or 2 hours after a meal.
Swallow the tablet whole and do not crush, chew, or break it.
Your blood pressure will need to be checked often, and you may need frequent blood tests.
You should not stop using Zytiga or or your steroid medicine suddenly. Follow your doctor’s instructions about tapering your prednisone dose.
Store at room temperature away from moisture and heat.
Zytiga Prolongs Time To Pain Progression
The addition of Zytiga® to prednisone also significantly delays patient-reported pain progression and health-related quality-of-life deterioration compared with prednisone alone in chemotherapy-naive men with metastatic castration-resistant prostate cancer, according to the results of a study published in The Lancet Oncology.
In an international, double-blind trial, 1,088 patients with progressive, metastatic castration-resistant prostate cancer were randomly assigned to receive Zytiga plus prednisone or prednisone plus placebo in continuous 4-week cycles. Researchers measured patients pain and health-related quality of life questionnaire). The researchers then analyzed the data to evaluate clinically meaningful pain progression and deterioration in HRQoL.
At a median follow-up of 22.2 months, the median time to progression of mean pain intensity was significantly longer in patients receiving Zytiga/prednisone than in those receiving prednisone/placebo . The median time to progression of pain interference with daily activities was also significantly longer in the Zytiga group10.3 months compared to 7.4 months. Whats more, the median time to progression of worst pain intensity was also longer in the Zytiga/prednisone group compared to the prednisone/placebo group , but the difference was considered non-significant.
The median time to HRQoL deterioration was longer in patients receiving Zytiga/prednisone than in those receiving prednisone/placebo .
Can I Use Zytiga After Using Xtandi
Yes. You can take Zytiga after taking Xtandi.
According to current treatment guidelines, Zytiga is a treatment option for people whose cancer got worse while taking Xtandi or after taking Xtandi.
On the other hand, Xtandi is a treatment option for people whose cancer got worse while taking Zytiga or after taking Zytiga.
Side Effects And Risks
Zytiga and Xtandi work in slightly different ways, so they have some similar and some different side effects. Below are examples of these side effects.
More common side effects
These lists contain examples of more common side effects that can occur with Zytiga, Xtandi, or with both drugs .
- Can occur with Zytiga:
- high blood sugar levels
Dosage For Metastatic High
The usual recommended dose for metastatic high-risk castration-sensitive prostate cancer is 1,000 mg of Zytiga taken once a day. This dosage may also be taken as two 500-mg tablets or four 250-mg tablets.
With your Zytiga dose, you will also take 5 mg of prednisone by mouth once a day. .
If you havent had your testicles surgically removed, youll take an additional medication to lower your hormone levels.
Edema Or Fluid Retention
Zytiga can cause edema .
Before starting Zytiga, tell your doctor about any swelling that you have. They will check to see if the swelling is caused by a disease that should be treated before you start taking Zytiga. If needed, theyll recommend treatment options to help prevent edema before or during your Zytiga treatment.
More Common Side Effects
The more common side effects of Zytiga include:
- joint pain, swelling, or stiffness
- Kidney problems. Symptoms can include:
- having to urinate more often than usual
- needing to urinate often at night
- blood in urine
Your doctor will monitor you for these side effects at regularly scheduled office visits. If you have serious side effects that cant be controlled, your doctor may lower your Zytiga dose or have you stop treatment.
Rare serious side effects
These serious side effects from Zytiga arent common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think youre having a medical emergency.
Serious side effects and their symptoms can include the following:
- Serious allergic reaction. Symptoms can include:
- trouble breathing
- stomach pain
About The Latitude Study
The LATITUDE clinical study evaluated 1199 men with newly diagnosed, high-risk metastatic prostate cancer who had not previously received ADT. All patients had at least two of three risk factors: Gleason score of 8 or more, 3 or more bone metastases, or 3 or more visceral metastases . Individuals were treated with ADT plus Zytiga and prednisone, or ADT alone and directly compared.
After a median follow-up of 51.8 months and a final analysis the overall survival has been confirmed to be significantly longer for patients receiving Zytiga/ADT/prednisone. Zytiga treated patients survived on average 53 months compared to 36.5 months for ADT alone.
The combination of Zytig plus prednisone with can now be considered standard of care in patients with high-risk CSPC.
Metastatic prostate cancer has been treated the same way for over 50 years until Taxotere chemotherapy was shown to improve survival in 2015. Zytiga may be the next advance in treatment with the potential to further improve outcomes by combining it with Taxotere.
Surgery For Prostate Cancer
In some cases of advanced or recurrent prostate cancer, surgeons may remove the entire prostate gland in a surgery known as “salvage” prostatectomy. They usually do not perform the nerve-sparing form of prostatectomy. Often, surgeons will remove the pelvic lymph nodes at the same time.
Cyrosurgery may be used in cases of recurrent prostate cancer if the cancer has not spread beyond the prostate. Cryosurgery is the use of extreme cold to destroy cancer cells.
To reduce testosterone levels in the body, doctors may sometimes recommend removing the testicles, a surgery called orchiectomy. After this surgery, some men choose to get prosthetics that resemble the shape of testicles.
Doctors may also remove part of the prostate gland with one of two procedures, either a transurethral resection of the prostate or a transurethral incision of the prostate . This relieves blockage caused by the prostate tumor, so urine can flow normally. This is a palliative measure, which means it is done to increase the patient’s comfort level, not to treat the prostate cancer itself.
Endocrine Drugs For Prostate Cancer
Drugs work as well as prostate cancer surgery to reduce the level of hormones in the body. Most men opt for drug therapy rather than surgery. The three types of hormone-related drugs approved to treat advanced prostate cancer include luteinizing hormone-releasing hormone analogs, luteinizing hormone-releasing hormone antagonists, and antiandrogens.
Antiandrogens For Prostate Cancer
These prostate cancer drugs work by blocking the effect of testosterone in the body. Antiandrogens are sometimes used in addition to orchiectomy or LHRH analogs.This is due to the fact that the other forms of hormone therapy remove about 90% of testosterone circulating in the body. Antiandrogens may help block the remaining 10% of circulating testosterone. Using antiandrogens with another form of hormone therapy is called combined androgen blockade , or total androgen ablation. Antiandrogens may also be used to combat the symptoms of flare . Some doctors prescribe antiandrogens alone rather than with orchiectomy or LHRH analogs.
Available antiandrogens include abiraterone acetate , ,ÃÂ , ,ÃÂ , , and . Patients take antiandrogens as pills. Diarrhea is the primary side effect when antiandrogens are used as part of combination therapy. Less likely side effects include nausea, liver problems, and fatigue. When antiandrogens are used alone they may cause a reduction in sex drive and impotence.
Zytiga Approved For Prostate Cancer In 2011
The US FDA originally approved Zytiga for the treatment of advanced prostate cancer in 2011 based on a study that enrolled 1,195 men from 13 countries. The study participants had metastatic, hormone-refractory prostate cancer that has progressed after chemotherapy. Patients were treated with either Zytiga plus prednisone or prednisone alone. Zytiga improved overall survival by four months .
Drug May Have Wider Role In Treatment
This group of patients is likely the tip of the iceberg as far as the role that the new drug can play in prostate cancer treatment, Scher says.
“It absolutely will work in untreated patients as well and clearly there are studies ongoing now that are looking at this drug in combination with standard hormone therapies prior to surgery,” he says.
One mainstay treatment for spreading prostate cancer is to deplete or block the action of male hormones known as androgens. This typically works initially, but the cancer eventually progresses even though levels of male hormones are low. Until recently, researchers assumed that tumors became resistant to hormonal therapies.
The opposite may be true. “These tumors may actually be hyper-sensitive to hormone therapies,” Scher says. “Androgen levels are higher in the tumors than in the normal prostate.”
American Cancer Society Chief Medical Officer Otis Brawley, MD, explains it this way: “Hormonally unresponsive prostate cancer is really just incredibly sensitive to hormones. We have even taken away hormones from these guys through medical or surgical castration or androgen blockers and the tumor responds, but then starts growing again.”
“It may be the tumor changes, so it is very sensitive to the small amount of androgen in the man’s body,” Brawley says. The drug interferes with the tumor’s handling of that small level of androgen that was left behind.
Emerging Therapies For Prostate Cancer
Researchers are pursuing several new ways to treat advanced prostate cancer. Vaccines that alter the body’s immune system and use genetically modified viruses show the most promise. One vaccine technique works by manipulating blood cells from the patient’s immune system and causing them to attack the prostate cancer.
Blood is drawn from the patient. From the blood sample, cells that are part of the immune system are exposed to cells that make up prostate cancer. Then the blood cells are placed back in the body, with the hope that they will cause other immune system cells to attack the prostate cancer. In a more traditional type of vaccine, the patient is injected with a virus that contains PSA. When the body is exposed to the virus, it becomes sensitized to cells in the body that contain PSA and their immune system attacks them.
Immune or genetic therapy have the potential to deliver more targeted, less invasive treatments for advanced prostate cancer. This would result in fewer side effects and better control of the prostate cancer.
Types Of Chemotherapy Drugs
The most common chemotherapy drug for prostate cancer is docetaxel , which is usually given with prednisone, a steroid medicine. After starting docetaxel, many men experience the improvements in disease-related symptoms, including pain, fatigue and loss of energy.
If docetaxel does not work or stops working, cabazitaxel may be used.
Zytiga And Other Medications
Below is a list of medications that can interact with Zytiga. This list does not contain all drugs that may interact with Zytiga.
Before taking Zytiga, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.
If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.
Zytiga and Xofigo
Dont take Zytiga with Xofigo, a radioactive medication, unless youre taking them together in a clinical trial. In a clinical study, people who took Zytiga with Xofigo had a greater risk for bone fractures and death. This was compared to people who took Zytiga and a placebo . If you have questions about Xofigo, talk with your doctor.
Zytiga and Provenge
Theres no interaction between Zytiga and Provenge . Provenge is a type of vaccine that makes your immune system more active in fighting prostate cancer.
One clinical study looked at how peoples immune systems responded to Provenge therapy. An immune system response shows that Provenge is working. The results of this study were similar in people who took Zytiga with Provenge and in people who used Zytiga after taking Provenge.
However, current treatment guidelines dont recommend using Zytiga and Provenge together. Instead, the guidelines recommended taking one drug or the other as a possible treatment.
Remission And The Chance Of Recurrence
A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.
A remission can be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. Although there are treatments to help prevent a recurrence, such as hormonal therapy and radiation therapy, it is important to talk with your doctor about the possibility of the cancer returning. There are tools your doctor can use, called nomograms, to estimate someone’s risk of recurrence. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about .
In general, following surgery or radiation therapy, the PSA level in the blood usually drops. If the PSA level starts to rise again, it may be a sign that the cancer has come back. If the cancer returns after the original treatment, it is called recurrent cancer.
When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence, including where the recurrence is located. The cancer may come back in the prostate , in the tissues or lymph nodes near the prostate , or in another part of the body, such as the bones, lungs, or liver . Sometimes the doctor cannot find a tumor even though the PSA level has increased. This is known as a PSA-only or biochemical recurrence.