Great insight on Cabozantinib (XL 184)

There is a flurry of XL 184 information circulating after last week’s ASCO conference in Chicago. This link to MedPageToday includes a brief video interview with Dr. Maha Hussain, University of Michigan.

http://www.medpagetoday.com/MeetingCoverage/ASCO/26962

On a personal note, this is the drug that we are pursuing for my next treatment. There are currently open Phase I and Phase II trials, though neither are available in Kansas City.

The Phase II trial is recruiting in multiple locations, it looks like Las Vegas might be the best option for me. The Phase I trial is only available in Boston and though it is currently full, they will likely recruit 11 additional patients to expand the trial in late July. My Oncologists’ office is currently helping us determine if I qualify for either trial. Stay tuned!

If this doesn’t pan out, and because I am not responding to the Zytiga, my other option will likely be Taxotere, i.e. chemotherapy. If we do go down this path I will discuss using Taxotere in combination with some other drug in an off label or experimental basis. I'm not sure if there is anything available, or if this even makes sense, but we will be discussing these options with my Oncologist.

I have thought about Provenge but becasue it does not immediatley have an impact on PSA, it is not a path I am ready to pursue. 

Overall my health remains stable. I continue to have a few minor aches and pains from time to time but it is easily alleviated with a few Advil. 

My thoughts and prayers are currently with Terence in Seattle and Brian in New Zealand. I ask that you send your prayers and/or positive thoughts their way as well.

Meet my friend Dex

A few milestones yesterday, one personal, one not.

Yesterday I had my sixth treatment of chemo. Although this will continue until the end of January, I am now half way through! The good news is my PSA was down, though only slightly, down is not up!

PSA: 39.57

Other good news, my INR (marker to measure blood thinner pharmaceuticals) was finally up to 1.8. The doc increased my dosage once again and we are pretty certain that the injections in my stomach will be a thing of the past next Monday!

On the other hand the steroids (Dex) woke me at 2:15am…..I never went back to sleep! I'll be dead tired by 9:00pm or so and am hoping I sleep through the night!

The other milestone was yesterday was the first day of fall. As I've written here before I'm not a big fan of fall. Winter is the worst. Fall, except for the beauty of the trees for a brief period, represents death in my mind.

As I let the dog out this morning I noticed our elm tree had almost completely changed to purple and had even began it's annual dumping of leaves into our backyard. The nights are cooler, the days are shorter and it seems that we went from summer to fall overnight.

Three days and counting until the golf tournament. We still have a lot of loose ends to pull together but I am not concerned that it will all come together and the event will go off without a hitch!

BIG NEWS, GOOD NEWS....BIG GOOD NEWS!

I was going to drag this out, be cute, be creative, etc. but I am tired!

My PSA today was 39.98, a 25% reduction from three weeks ago!!!

WOO-HOO!!!!!!!!!!!!

As I mentioned above, I am beat. We did not sleep well last night, and we had to leave the house at 7:15 this morning to make the 8:00 appointment. I had both my monthly appointment for Lupron and Zometa and my three week chemo treatment all in the same day. We were through at the hospital 12:30ish. In the four and a half hours we were there, I had the following procedures:

- 8:35 blood drawn

> White blood count back up to over 12 !!!!

> Most other markers were back in range, red blood count was still a little low, but no show stopper

- 9:00 Met with Doctor V, the Physicians Assistant and the Clinical Trial Coordinator

Everything seems to be progressing as expected with the blood clot in my leg. The good Doctor did give me the green light to play golf on Wednesday afternoon, so I was happy

- 10:00 Began pre-treatments

- 10:40 Began Taxotere infusion #4

- 11:45 Began Zometa infusion

- 12:20 Received the Lupron shot

Mary and I made our usual stop for lunch at The Blue Koi and were home by 2:00.

I could use a good nap......

It's a day later and I feel completely fine. I did have trouble sleeping last night. I woke at 11:30 and was up until about 12:45. Then a slept for an hour, was awake for 20 or 30 minutes, would sleep for another hour, wake up etc.

I forgot to enclose this yesterday.
Historic Data:
6/9/08 52.02 (Started Chemotherapy)
Day before and day of treatment (12mg Dexamethasone)
Daily (10mg Prednisone)
With Treatment (once every three weeks); Benadryl - 25mg, Dex10mg, Zofran 24mg, Zantac 50mg, Taxotere 151mg
Waiting for trial drug (Atrasentan)/placebo to arrive.
5/19/08 48.87
4/21/08 38.31 (Stopped Nilandorn as required by clinical trial starting on June 9th)
3/24/08 34.7
2/25/08 29.4 (Started taking Nilandron on 2/4/08; Started Selenium 200 mcg on 2/26/08)
1/28/08 36.2 (Stopped taking Ketoconazole and Hydrocortisone in anticipation of next treatment)
12/31/07 30.9
12/3/07 21.9
11/5/07 23.3
10/8/07 19.30
>10/8/07 Changed Lupron from 120 day dose to monthly dose> 9-12-07 Began taking .5mg of Avodart per day. Changed Ketoconazole from 600mg twice per day to 400mg three times per day)
9/4/07 21.80
8/6/07 19.25
8/2/07 16.96
7/02/07 20.30
6/04/07 17.80
4/30/07 16.25
4/2/07 17.68
3/5/07 21.87
2/5/07 20.90
1/8/07 18.90
12/11/06 24.86
11/13/06 43.61
10/16/06 51.48 (Started "High Dose" Ketoconazole and Hydrocortisone, 10/01)[at this point and for a second time we prepared for Taxotere. First my Oncologist wanted to try High Dose Ketoconazole and Hydrocortisone.]
9/11/06 83.97 (started Zometa)
8/23/06 41.77
8/18/06 54.66(no tests in June or July)
5/19/06 11.37 (stopped Casodex)
4/3/06 4.25
3/5/06 1.45 (started Casodex again)
1/27/06 0.46
12/28/05 1.85[at this point we prepared for Taxotere, chemotherapy treatments. First I had a new PSA test and new bone and CT scans, lymph nodes clear, spine clear, ribs, femur and hips stable. The PSA dropped to 1.85 and the scans revealed marked improvement. Chemo was cancelled 72 hours before it was scheduled to begin]
12/15/05 7.18
11/03/05 4.64 (Stopped taking Casodex)
9/22/05 0.8
08/11/05 0.35 [nadir]
6/24/05 0.55
4/17/05 2.51 (taken at MD Anderson, Gleason lowered to 7/7)
4/06/05 3.51 (Six weeks after starting Lupron and Casodex)Original Gleason scores (7/8)
Pre-treatment tests:
2/18/05 Started Lupron
2/11/05 Started Casodex
2/?/05 219
12/?/04 189 (Original test)

The one, but not the only

I'm in the chair waiting for the multitude drugs to be delivered:
In no particular order....
- Benadryl - 25mg
- Dex (more!!) 10mg
- Zofran 24mg
- Zantac 50mg
- Taxotere 151mg

The first four are given for swelling, nausea, allergic reactions etc.

Brad and Mary are here, my God I love them so much!

My pre-treatment PSA came in at: 52.02
Up a little, not as high as 2006, the last time I almost started chemo.

Just to give you an some insight into today's hospital visit: I've been in the chair since 11:10. Treatment was schedule for 11......It's 11:52 and we have yet to begin. So drag this out for 6 weeks....then make me wait another hour, what ever works for you!!! Sorry, just venting - thank goodness the people are so nice here.

*Live update!!
12:35pm Pre-meds have all been administered and as of three minutes ago....the Tax (chemo) is flowing!

Peace be with you each...

The Inevitable

After 39 months, the inevitable is finally upon us. After meeting with my Oncologist today and receiving my updated PSA number (38.31) we had "the talk".

I am definitely ready to take the next step and use a more aggressive treatment to try to to get the cancer under control. We have been fairly conservative during the past three years. Even so, we have had great results and I have no regrets on any decision we have made to date.

I am eligible for a clinical trial at the University of Kansas Cancer Center. We are researching it and at this point are favoring this protocol. It would be the standard chemotherapy (Docetaxel plus Prednisone) that I would receive, plus an additional oral medication (Atrasentan) that has shown benefit to other patients with advanced hormone refractory prostate cancer. It is a Phase III trial which is randomized, so I would have a 50% chance of receiving the additional medicine versus a placebo. I will receive the chemotherapy intravenously once every three weeks for 12 sessions, which means I'll finish up in early 2009.

From the things I've read about this protocol it is very well tolerated. Most men continue to work or keep up with most of their daily activities. I plan on being no different. Fatigue usually sets in about 4-5 days post treatment which we plan to schedule so it would coincide with the weekend. So in other words, more movies, more couch time!

Crank up the prayer chain people.....I'm going to need a little help here!!

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Historic Data:
4/21/08 38.31
3/24/08 34.7
2/25/08 29.4 (Started taking Nilandron on 2/4/08; Started Selenium 200 mcg on 2/26/08)
1/28/08 36.2 (Stopped taking Ketoconazole and Hydrocortisone in anticipation of next treatment)
12/31/07 30.9
12/3/07 21.9
11/5/07 23.3
10/8/07 19.30
>10/8/07 Changed Lupron from 120 day dose to monthly dose> 9-12-07 Began taking .5mg of Avodart per day. Changed Ketoconazole from 600mg twice per day to 400mg three times per day)
9/4/07 21.80
8/6/07 19.25
8/2/07 16.96
7/02/07 20.30
6/04/07 17.80
4/30/07 16.25
4/2/07 17.68
3/5/07 21.87
2/5/07 20.90
1/8/07 18.90
12/11/06 24.86
11/13/06 43.61
10/16/06 51.48 (Started "High Dose" Ketoconazole and Hydrocortisone, 10/01)[at this point and for a second time we prepared for Taxotere. First my Oncologist wanted to try High Dose Ketoconazole and Hydrocortisone.]
9/11/06 83.97 (started Zometa)
8/23/06 41.77
8/18/06 54.66(no tests in June or July)
5/19/06 11.37 (stopped Casodex)
4/3/06 4.25
3/5/06 1.45 (started Casodex again)
1/27/06 0.46
12/28/05 1.85[at this point we prepared for Taxotere, chemotherapy treatments. First I had a new PSA test and new bone and CT scans, lymph nodes clear, spine clear, ribs, femur and hips stable. The PSA dropped to 1.85 and the scans revealed marked improvement. Chemo was cancelled 72 hours before it was scheduled to begin]
12/15/05 7.18
11/03/05 4.64 (Stopped taking Casodex)
9/22/05 0.8
08/11/05 0.35 [nadir]
6/24/05 0.55
4/17/05 2.51 (taken at MD Anderson, Gleason lowered to 7/7)
4/06/05 3.51 (Six weeks after starting Lupron and Casodex)Original Gleason scores (7/8)
Pre-treatment tests:
2/18/05 Started Lupron
2/11/05 Started Casodex
2/?/05 219
12/?/04 189 (Original test)