Anyone have experience with triplet therapy?

If you have a number of metastasis that they really can’t use SBRT radiation to eliminate, then chemo or Pluvicto are your best chance of getting clear of the tumors.

Dr. Kwon Can’t do more than you are already doing with drugs, If the option of doing radiation is not possible, because of the location of the mets, leaving the cancer where it is will just allow it to grow and spread.

For most people chemo is not that limiting to their life. If you get cold caps, you can use them on your head to stop from losing your hair. Most people say they were just uncomfortable for a few days after, had to rest to recover. Some do have worse side effects, But most people don’t.

Pluvicto is being used more often to treat people in your situation. While it also has side effects like chemo, they are usually not as intense. You should talk to your doctor about the possibility of using Pluvicto first and reserving chemo to later. Pluvicto Is being used in a lot more situations than it used to be. They used to require that you had chemo first, no longer true, They used to require you be Castrate resistant, Now they are doing it with castrate sensitive people. It’s more often being used early in treatment rather than later.

@jeffmarc Thank you so much, very helpful. I will ask about Pluvicto. I did not know that insurance will cover it if chemo hasn’t already been done.

You say...""I have read quite a bit about success Dr. Eugene Kwon has had using this treatment combination. Your thoughts would be appreciated."

I can relate my experience albeit keep in mind two things, study of one, it's dated...

After surgery, BCR then SRT, my PSA continued to rise. My urologist and one who I sought a 2nd opinion, wanted to put me on ADT monotherapy, Lupron, continuous...

The STAMPEDE and CHAARTED trials were wrapping up. I reviewed those and thought, well, your clinical data isn't an exact fit but given my PSADT and PSAV, it wouldn't be long.

I remember my urologist saying "Kevin, I don't like what your PSA is doing...!" I'm thinking you don't, how do you think I feel!

I digress...I saw sone articles about Kwon, his aggressive approach, so off I went to Rochester. Kwon had the C11 Choline scan done, based on that, my clinical history and current clinical data, he recommended I do triplet therapy;

24 months Lupron
Six cycles Taxotere
WPLN radiation.

He held the ARI in reserve, waiting to see how I responded to the Lupron and Taxotere..

I finished the treatment early, coming off Lupron at 18 months vice 24. We did not add the ARI since my PSA dropped to undetectable in the first three months and stayed there.

How was the chemotherapy...tolerable, usual side effects, fatigue, nails, hair, taste...

The first 24-48 hours after infusion were ok given the drugs that go in before infusion to prevent nausea, don't want to vomit that Taxotere!

The next 3-5 days would be the crash then the next 10-14 would be tolerable and then we'd start the cycle all over again. I worked, would go to the gym, traveled once, went to see a Willie Nelson concert....I did take naps...

As @jeffmarc days, today you more options than I did in January 2017, discuss with your medical team.

My version of triplet therapy brought an almost five year hiatus from treatment.

High risk PCa generally requires more aggressive treatment decisions.

Kevin

@kujhawk1978 Thanks for sharing your story. At first I was disappointed to hear they didn’t want to do any salvage radiation and wanted to go right to chemo. After reading more and hearing from others I’m getting used to the idea of attacking it systemically only. On Orgovyx and Nubequa now and PSA is going down nicely. Doc says better to “hit it hard” the sooner the better. May I ask what happened after your five year hiatus from treatment?

@ucla2025
One thing you need to realize is that everybody is different In their results with prostate cancer,. Some people will have great results after chemo. Some people won’t. There’s no way of knowing where you will fit. The experience of others may not be the experience you have.

In my case salvage radiation gave me 2 1/2 more years before my PSA came back up. The thing is, you don’t do salvage radiation, when there are too many known metastasis. That’s why your doctor wants to do chemo.

You can do Pluvicto which Was not available to @kujhawk1978. Here are some things to consider before doing Pluvicto

Be aware that it works really well for 33% of people OK for 33% of people and not at all for 33% of people. If you have certain genetic issues, either hereditary or somatic, it can affect how well Pluvicto Works. You can ask for a somatic test before doing Pluvicto To find out if you’ve got Genetic changes Due to the cancer, it will also show hereditary issues.

If you have BRCA2 or ATM It seems to work better. If you have RB1, PTEN or TP53 They are Pluvicto resistant.

Hi ucla2025,
I am glad to see you back, but I am sorry to hear that your husband needs chemo. Here is the link for the PC case where patient could not have radiation due to lesion location and had to have triplet treatment. Maybe this info can be of some help :
https://connect.mayoclinic.org/discussion/a-quandry-between-two-medical-recommendations-for-mpca-to-lung-only/
It was posted by @dpfbanks. She is very nice and kind lady and I am sure that she will be willing to help you with any particular question that you might have.

Wishing you and your husband the best of luck with new treatment and 100% success < 3.

@ucla2025
In March 2022, my PSA began a continuous climb over the next 12 months...

.12
.22
.48
.7
.77

That met our first and second decision criteria, three or more PSA tests showing an increase and between .5-1.0.

We imaged, it showed a single lymph node.

I met with my radiologist and oncologist. My going in position was SBRT to the lone lymph node and six months ADT, Orgovyx, in part based on the SPORT trial.

Radiologist supported that. Oncologist advocated for SBRT but 24 months ADT + ARI, aka, EMBARK trial.

We settled on SBRT, 12 months Orgovyx, hold the ARI, add only if PSA did not drop to undetectable in first three months, revisit our decision at 12 months, decide to come off or continue in three months increments, deciding at that point, continue, come off.

At the 12 month consultation, we agreed to come off treatment. Well, my oncologist supported my request to come off treatment, I know he would have liked me to do the full 24 with the ARI.

\Who was right, me. the oncologist? We'll never know. Like I said, make the best decision, don't look back.

At 20 months since our decision, only thing I know is we made a good decision.

As a side note, this disease has terms and definitions. When you say "salvage radiation" it generally means SRT - Salvage Radiation Therapy, which is radiation after BCR to the prostate bed only vice WPLN - Whole Pelvic Lymph Node or MDT - Metastases Directed Therapy. Given your clinical data, any radiation likely is MDT but only if imaging shows where to target and generally if no more than 3-5 sites.

Kevin

@surftohealth88 Hi! Thank you for the help. Yep, I’ve recovered from the newbie shock I got when first posting. Time to get down to business now. I will check out the link you sent, thanks again.

@kujhawk1978 Thank you again, your help is greatly appreciated.

@ucla2025 There is a lot here to consider and so sorry you are in this boat. The need for chemo prior to Pluvicto changed in June 2025 - and not every case is candidate for it - much depends on your PSMA uptake and other bio markers, co-morbidities, etc. ADT is still required prior.

As for doublet or triplet, this article may help - the phase III clinical trials that support these therapies are good to read, too. This one may be is helpful for your thinking. https://www.urologytimes.com/view/dr-alicia-morgans-details-decision-between-doublets-and-triplets-in-mcspc#:~:text=Dr.-,Alicia%20Morgans%20details%20decision%20between%20doublets%20and%20triplets%20in%20mCSPC,the%202022%20LUGPA%20Annual%20Meeting.

As for triplet therapy, it is SOC for high volume Mets. The definition of high volume doesn’t only refer to the number of ‘spots’, but also location. My hub, whose unusual Mets is lung only (no bone or nodes light up) is considered high volume because it’s in the lungs, even though the SUV on his PSMA PET scan is low. So, there are many factors that make up why each case is unique.

The same seems true with going through triplet therapy. When the lung spots were discovered, our local UG Onc suggested triplet therapy. Because of the rare presentation we went for 2nd opinion at big COE where it was suggested that a 2nd chemo (Carboplatin) be added to the triple (we called it quad therapy). Our local Onc wasn’t crazy about that so, we started with ADT (Firmagon shots) and Docetaxel + Carboplatin 6 rounds every 21 days. Prior to the 4th round we added the Nubeqa after further consulting - so he did get the quad therapy for 3 rounds.

We had some complications toward the last 2 rounds, and after #6. I think it’s updated in my profile/bio (and updating yours would be helpful to others replying to your queries, so we know your details, hint, hint). He finished the chemo mid August and I would say he is still recovering - he had a rare side effect that was likely the contributing factor. Round #6 took his breath away - blood counts were low, but ok, but he had no energy and breathing was more difficult - it turned out he had a chemo induced ‘capillary leak syndrome’ - fluid leaking from blood to tissues, so swollen ankles but for him, the lining of his lungs filled with fluid - it was discovered on the follow up PSMA PET scan and he had 2 thoracenteses in 3 days to remove 1 liter of fluid from each side - no wonder he had a hard time breathing. So, our experience is tainted and unusual.

Overall, I would say that the first rounds of chemo were cumulative but manageable - exhaustion with some expected side effects and then you build back before the next treatment. We are big DIYers and projects kept him going - he built a small yoga deck, cleared some trees, and carried on as much as possible. But it is cumulative and by #5 and #6, he was mostly resting.

We go for follow-up scans in about 5 weeks - it was hard to read the last scans due to the extra fluid, so we will see how the chemo worked. PSA dropped immediately with the Firmagon (was only 0.36 to begin with) and stayed undetectable. He is just on Orgovyx and Nubeqa since chemo.
(Sorry this is so long…).

Chemo is no small endeavor, it’s cumulative and does a number on the bone marrow - and hopefully on the dividing cancer cells too! We did the cryotherapy for hands and feet to prevent neuropathy and it worked…so far. Take the Claritin, listen to the infusion staff, and rest well. It’s intense for awhile and then it’s behind you. If you have metastasis, it’s the standard. Good luck to you and your hub and keep us posted! This road is an odyssey, not a journey, in my book. And it’s helpful to have others to connect with who know the in/outs. Some are very frank here because of many years seeing people going through various treatments and having various results - all here are well intentioned and knowledgeable, so please don’t get discouraged if the message is not touching in a way that works for you. I hope your next decisions come easily. All Best to you and yours.