Talzenna (talazoparib) and Xtandi (enzalutamide) next option

Talzenna It is actually a PARP inhibitor that includes Xtandi. Hopefully, he has a genetic problem like BRCA, which can be treated by a PARP inhibitor.

They are very hard on the body and can cause about about 50% of the people taking that drug to be anemic and need blood transfusions. Definitely would like to know if your husband has a genetic problem, Since those with BRCA or ATM usually do better on Pluvicto.

Some information about 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.

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

Here’s more info on that combination (enzalutamide (Xtandi) with talazoparib (Talzenna)) that was FDA-approved in 2023 for some with metastatic castration-resistant prostate cancer —> https://www.cancer.gov/news-events/cancer-currents-blog/2023/fda-talazoparib-enzalutamide-prostate-cancer

There are other combinations that have shown promise:
> https://www.onclive.com/view/novel-combination-regimens-are-expanding-the-prostate-cancer-treatment-paradigm

> https://zerocancer.org/stages-and-treatment/systemic-therapies/immunotherapy

> https://amp.cancer.org/cancer/types/prostate-cancer/treating/vaccine-treatment.html

None of these treatments are certain to work, and when one doesn’t, you just have to move on to the next one (& hope and pray that it does work).

> https://www.everydayhealth.com/prostate-cancer/prostate-cancer-treatment-what-to-do-when-it-stops-working/

Thanks Jeff...Because Pluvicto didn't work, I'm not sure about the gene BRCA..I don't think he has that...

I guess we'll wait and see..

@cal77, I'm sorry that side effects continue to challenge your husband as the doctors look for a treatment that is effective. This must be so hard for him, but also for you as you care for him and try to ease the suffering.

Has he started Talzenna (talazoparib) and Xtandi (enzalutamide) yet? How are YOU doing?

I don't know if this article applies, but it does mention talazoparib and new combo treatments FDA just approved. It may not be relevant, I am not up on these treatments, but since I seen this drug mentioned and had recently received article, thought I would pass along.
https://www.medscape.com/viewarticle/fda-expands-talazoparib-combo-indication-prostate-cancer-2026a10014gv

@diverjer
Unfortunately, PARP inhibitors really don’t work well unless you have BRCA1 or BRCA2. Here are the issues mentioned in that article you gave a link to. As you can see, it is partially beneficial for some other genetic issues.

Strongest PARPi benefit:
BRCA2 (then BRCA1) in mCRPC
BRCA1/2: marked rPFS, OS gains; consistent across trials
PALB2, CDK12: possible benefit, less robust; wide CIs
ATM, CHEK2: little/no demonstrated benefit in pooled analyses
Gene‑specific responses support biomarker‑ and gene‑level selection

Yes I did notice that and that was a one reason I thought about not posting it but then I thought it might be interesting for some that had the BRAC1 AND 2 issues.

Here is another study I received about Darolutamide Improves Metastasis-Free Survival in Prostate Cancer. If I shouldn't post me, let me know, won't hurt my feelings:)
https://www.medscape.com/viewarticle/darolutamide-improves-metastasis-free-survival-prostate-2026a10014uh