Triple therapy

Good Evening Anna (Anna42) 

That's a good question and you have to remember two things here, none of us are medically trained and triplet therapy is a relatively new treatment. Rather than confused I think you are thinking too far in the future.

There are various new "Second Generation" hormone therapies and we have different Community Members on different ones/combinations. At the moment we haven't had any (I don't think) where second generation haven't worked. We have had plenty who have had bad side effects from one or the other and changed to a different one.

During my time on the Community anyone who has become "hormone resistant" to one type of HT has been successfully switched to one of the other HT treatments. 

I hope this helps.

Best wishes - Brian.

Hello Anna42 . That is a good question. The triplet therapy is usually a combination of the hormone injection such as Prostap to initially drop the testosterone and starve the cancer. Within 12 weeks the chemotherapy should be started concurrently with the second generation antiandrogen such as Darolutamide or Enzalutamide - latest research suggests that the second generation antiandrogens should not be started before the chemotherapy but should be started no later than 1 week after starting it. As far as sequencing is concerned it appears that if you have been on Abiraterone then it is possible to follow it with something like Enzalutamide but not the other way round. Most of the second generation antiandrogen work in a similar way and there doesn't seem to be much benefit in trying a different one after initial treatment has failed. The advantage of the Triplet Therapy is that the time to recurrence or progression is pushed further along the line compared to sequential treatment of injection, then chemotherapy, then second generation antiandrogen OR injection, second generation antiandrogen, then chemotherapy.

This Triplet Therapy wasn't available when my husband was diagnosed in July 2020 so he has had Prostap with Bicalutamide from the beginning with EBRT to the whole pelvic area and then sequential treatment with Enzalutamide when recurrence occurred at about 18 months. This was then stopped 18 months later following another progression and chemotherapy was given which got most of it, but not all, so 6 months later it was SBRT. 10 months on and hubby is in the middle of more radiotherapy for a further progression and may have to have more chemotherapy or something else soon.

The problem is that the cancer can find a way round hormone therapy eventually so for some it is possible to have Intermittent treatment and come off it if the PSA drops to undetectable levels for a while, then restart if PSA levels start to rise and scans indicate a progression. Protocols for treating advanced prostate cancer are fluid but we are all hoping that a magic cure will be developed so that we don't have to cope with this rollercoaster of treatment and recurrence/progression.

Hello. Anne42

haveing chemo, radiotherapy and hormone injections is fairly standard, unless he has a different health problem. It as Called the stampede trial I was on it eight and hat years ago.

its meant to hit hard and quickly, it does work.

I had a choice of enzalutamide or Aberaterone, I couldn’t have arberaterone bccsuse I have a heart murmur plus this did not happen I’ll five or six years after chemotherapy.

hope this helps.

Stay Safe

Joe

Thanks that makes total sense. An oncologist made a comment to us that whilst she didn’t want to rule out the triple therapy, she also saw the benefit of keeping options up our sleeve for now, so my husband has more options later on. I guess the nub of is therefore whether having triple therapy at the outset has the consequence of pushing the time to recurrence or progression for my husband further along the line compared to sequential treatment of injection, then chemotherapy, and then the second generation antiandrogen when he needs it - as you say. That now makes sense to me. I’m sure we’ll ultimately go with what the oncologist recommends, but my instinct is to go with triple therapy which seems to be what’s recommended at the moment. But I don’t like the idea of him using lots of his options at the beginning! I agree about a cure - I’m hoping and praying for this desperately and it does feel like there’s a lot of research into immunotherapy with prostate cancer (which I know hasn’t historically worked well) which could give us this? We live in hope. Thank you for taking time to answer my question, all of the support through this forum is really appreciated xxx

Thanks Joe. We’re still at early stages so I think I really need to see another PSA result and see that it is (hopefully) coming down, so that we start to feel better… thanks for taking time to respond 

I am on triple therapy the results from the stampede trial are very encouraging 

www.nejm.org/.../NEJMoa2119115I 

Most ongologists including mine say hit the cancer hard from the onset with triple therapy, there is a great American oncologist who o ly deals with prostate cancer who is on YouTube, dr shalz I think who says hit it with everything from the geko

Here is a recent video on Metastatic prostate cancer by Dr Mark Scholz.

https://pcri.org/news/2023/4/30/metastatic-prostate-cancer-treatment-case-study-mark-scholz-md-alexscholz-pcri

Thanks Linda, he also does a good one on daralutamide and triple therapy 

Must admit...its a concern of mine...but I just remember how upbeat my oncologist was and I stay positive