Any advice on triplet therapy

Good Evening CCG 

I was just off to bed when I was checking the forum - now I know you had a meeting with your Oncology team on 2 July but unless I have missed it (I don't remember everything) what was the outcome of that meeting?  You say dad''s been prescribed Apalutamide (I think this is a single alternative to triplet therapy). I was doing some research myself into this a coupe of weeks ago (Alwayshope please don't call me a nerd) and I came up with this:

https://www.uhs.nhs.uk/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Prostatecancer/Apalutamide-v1.pdf

I hope this helps - have a great evening and I will catch up with you in the morning.

Best wishes - Brian.

Hey Brian,

Thanks for responding, I hope you have had a nice evening?

Yes, dads appointment went well, the hormone therapy has done its job and in 2 months brought is PSA down from 136 to 0.8. More good news is that the PSMA Pet scan showed extensive bone metastatis but no other spread to lymph nodes or organs. 

Dad has been enrolled on the STAMPEDE 2 trial but unfortunately he is in the arm that doesn’t receive the treatment but at least he will be monitored more closely. 

We were then offered chemo at any time which we said we would consider and dad was prescribed Apalutamide. Which we agreed to. I just find the meetings so overwhelming I forgot to ask about other treatment options and was also banking on the STAMPEDE trial treatment. 

Thank you for that information sheet, where did you find it if you don’t mind me asking. 

Take care

xx

Hello CCG 

I see that my apprentice nerd has already given you an excellent link.

Chief nerd has been doing some digging for you which might give you an insight into triplet therapy and why it is recommended at an earlier stage for people in your father's situation. To clear up one question, chemotherapy can be given at any time but it has been shown to have a better outcome when administered earlier in terms of overall survival and disease free progression in men with a higher disease burden. Like most treatments it does come with some risks but the regular monitoring during treatment means that these can be picked up quickly and then treated. Apalutamide can form one arm of the triplet therapy and the recommendation is to start chemotherapy within 12 weeks if that is the route your dad decides to take.

https://ascopubs.org/doi/10.14694/EdBook_AM.2015.35.e263

This publication is fairly old but the trials that it is based on are still held as valid nowadays. What has changed is that there are more choices of treatment further down the line which is pushing the overall survival figure out further.

Good Morning all. Sorry but just seen this thread, this is very informative and makes so much sense. My oh will be starting  Aluputimide and RT soon. X

Good Morning CCG 

It's the "apprentice nerd" here. Thanks for your reply. Since I became a Community Champion I have been building up my resource bank (I have one from Macmillan) but I add to it as I find further information - I find I have a thirst for knowledge about Prostate Cancer.

The link I sent you was used in a post a few months ago and if I remember correctly it was issued by I think Southampton NHS Trust (anyway somewhere down south!)

Another source I use quite often is NICE (National Institute for Health and Care Excellence) and here's the link for them to Apalutamide

https://www.nice.org.uk/search?q=Apalutamide%20with%20androgen%20deprivation%20therapy%20for%20treating%20hormone%20sensitive%20metastatic%20prostate%20cancer

Your dad's doing well - it's great he's on a trial - as you say more monitoring.

If I can do anything else for you please let me know - please let us know how dad gets on once he starts his new treatment.

Best wishes - Brian.

The NICE guidelines on the use of Apalutamide with Docetaxel are not particularly helpful as they are often cost benefit based. Oncologist are able to prescribe what they consider best for the patient irrespective of the NICE guidelines.

Good Morning Alwayshope 

Yes, thank you for pointing out the cost basis - I know some Consultants also wish to stick to their own tried and tested methods.

I am aware we have two Community members in the last 3 months with the exactly the same diagnosis in two different health authorities. Both members are on very different treatment paths.

It's happened to me personally I was prescribed HT for 3 years and Decapeptyl worked fine - 2 years down the line I collected my prescription and it was for Prostap. My GP had changed it as a cost cutting exercise - i had it changed back!.

Thank you for your help in this.

Best wishes - Brian.

Always Hope and Millibob (Brian), you are both the dream team!!

Thank you so much for all the information and the links too!

I had a call with dad’s team, good news he is a good candidate for triplet therapy and they are happy to give it to him. We have a meeting next week to discuss it further. In the meantime they have said hold off taking Apalutamide. 

Honestly don’t know what I would do without this forum! It’s so supportive. Instagram used to be my ‘thing’ but now I spend most of my free time on here!

Will be spending this weekend researching as much as I can about triplet therapy so I can go in with a list of questions. 

thanks again both xx

Good Afternoon CCG 

It's no problem - that's what we do.

Great news about dad being a candidate for Triplet therapy - it's so new my resources only have this link to it at the moment:

prostatecanceruk.org/.../darolutamide

I hope this helps - You need some "me" time too this weekend!!

Best wishes - Brian.

Thanks Brian, have a nice weekend!

Fingers crossed the sun makes an appearance!