Nubeqa (Darolutamide) versus Zytiga versus Estradiol Patches

@sriddle1
The question comes down to is he castrate resistant! Since he has not been treated yet, he is castrate sensitive, not castrate resistant.

If still castrate sensitive, then it is approved for metastatic disease, which he apparently has. I did say that it was approved for all castrate sensitive people.

@northoftheborder , maybe that’s her issue? Cost, her kickbacks, etc. I am still waiting and seeing how I approach. I’d really like to know why she said, “it’s not approved in this situation.”

What ADT medicine did or do you take? How are/were the side effects now that you’re off Zytiga? Or did they just remove the Prednisone?

Thank you

@sriddle1 I was on steroids to try to bring down the swelling in my spine. I was lucky enough to start on Apalutamide right away in 2021, since the TITAN study had just demonstrated a dramatic benefit from starting ADT and Apalutamide together for my situation (metastatic castrate-sensitive prostate cancer — mCSPC), and my oncologists were tracking the latest research.

For ADT, I started on monthly Firmagon injections, then moved to Orgovyx when it became available in Canada in early 2024 (it's basically the same as Firmagon but in daily pill form — big quality of life improvement over the injections).

I'm pretty sure you can't take Zytiga without Prednisone, but I'm not writing that fron personal experience.

My husband has been on Orgovyx and Nubeqa for 5 months and they are working well so far. His situation sounds very similar to your husband’s. His info. is in my profile if you’re interested. His only side effects of the treatment have been hot flashes and a bit of fatigue, nothing that keeps him from doing normal activities or has affected his health otherwise. We requested the Orgovyx/Nubeqa combo right at the start and had no problems getting either of them. Nubeqa has a co-pay program which requires one payment of $300 and then no more co-pays for a year. Our Blue Shield covers the Orgovyx. My understanding is that both of these drugs are newer and are therefore more expensive but they are much better than the older ones in terms of side effects. Maybe you should ask your doctor for a more detailed explanation of why she won’t prescribe this drug combo. We had no problems getting them through our UCLA oncologist.

One very important point to note about Abiraterone (Zytiga) is that it's an older ARSI that requires the patient to take the steroid Prednisone with it.

While many patients tolerate steroids fine, others experience a whole range of side effects, even if they can tolerate the Abiraterone itself.

Personally, I've experienced steroid-induced diabetes when on steroids to try to take down the swelling in my spine (I had to go on insulin in the hospital until they finally took me off steroids); others experience heart problems, etc.
https://www.mayoclinic.org/drugs-supplements/prednisone-oral-route/description/drg-20075269
Newer ARSIs like Darolutamide and the other -lutamides don't require a steroid, but they cost many thousands of dollars/month, while Abiraterone is out of patent and generics cost as little as U.S. $30/month.

So it's no surprise that U S. insurers push patients towards Abiraterone as a "still good enough" default treatment, and in some cases might force doctors to work hard to justify a more-expensive drug (or penalise them if they prescribe it too often? I'm not sure how things work down there).

@sriddle1
It is approved for Metastatic castration-sensitive prostate cancer (mCSPC).

I don’t suppose you are castrate resistant yet. It is approved for that too.
https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-darolutamide-metastatic-castration-sensitive-prostate-cancer
I have found that when I want my oncologist to give me something different I ask for it. I don’t equivocate. I don’t ask if it’s OK I ask for it.. That’s because I know what the guidelines are and that it will be covered by insurance.

If you can’t get anywhere with this doctor, you might want to try getting a second opinion from a center of excellence.

Is your partner having a real problem with side effects of Zytiga? Like I did.

My hubby is on Nubeqa and Orgovyx for his stage 4 PC. He has very few side effects from this combo. Very occasional hot flashes and some fatigue. Since he previously had a heart attack 8 yrs ago, he does get monthly EKG's to monitor him for Long QT syndrome. He has been on this regimen for 8 months now and after 6 cycles of Docetaxel, he is currently in "remission". I might add we had to fight for the Orgovyx over Lupron. Oncologist said "Insurnace isn't going to pay for that" and I told him we weren't going to go with that answer without checking into it first. Low and behold insurance pays for it. After many issues with that Onco, we now have a new one that listens to us better. But the new one even said "Your my only patient on Orgovyx". I asked why but he didn't have an answer outside of that's how we've always done it.

My husband has been on Orgovyx and Nubeqa for 5 months and they are working well so far. His situation sounds very similar to your husband’s. His info. is in my profile if you’re interested. His only side effects of the treatment have been hot flashes and a bit of fatigue, nothing that keeps him from doing normal activities or has affected his health otherwise. We requested the Orgovyx/Nubeqa combo right at the start and had no problems getting either of them. Nubeqa has a co-pay program which requires one payment of $300 and then no more co-pays for a year. Our Blue Shield covers the Orgovyx. My understanding is that both of these drugs are newer and are therefore more expensive but they are much better than the older ones in terms of side effects. Maybe you should ask your doctor for a more detailed explanation of why she won’t prescribe this drug combo. We had no problems getting them through our UCLA oncologist.