Unusual Triple therapy sequence, Nubeqa and Fatigue

Posted by dpfbanks @dpfbanks, Jun 25 7:35pm

HX in profile, and update to unusual application of triple therapy.

Lung only Mets 17 yrs post RARP and no treatment, so he was treatment naive on discovery of lung Mets- PSA only 0.37, so some suspicion as to aggressive cancer type, but not enough tumor tissue from lung needle biopsy to test for subtypes. Give heterogenous nature of tumors, we did get confirmation of no lung cancer (Nk1.3) and confirmed ‘adenocarcinoma of prostate origin’. COE urologist recommended triple therapy + Carboplatin. Local GUOncologist preferred start with ADT + Chemo (docetaxel+carboplatin) and add the ARPI ( Abiraterone or Nubeqa) after 6 rounds chemo. So, we are halfway through that. Revisited COE for scans and labs and showed 1-2 mm reduction in tumors along with undetectable PSA (< 0.01) since the first 3 wks of treatment. Due to Round 3 being pretty heavy and low RBCs/Hbg, round 4 will reduce Carboplatin by 25%.
We have now started the Nubeqa so it will be on board for at least 2 days before round 4 (tomorrow). Well, 3 doses of Nubeqa and he is experiencing really big fatigue.

All that to ask, does Daralutamide have big fatigue as side effect? Do you get used to it? Might the fatigue be greater coming later in the systemic treatment? Might it get better after chemo is done?

We are also considering stopping the Carboplatin after round 4 for a couple of reasons- we have nothing to confirm and aggressive subtype, the myelosuppression is real, the combo hasn’t been studied enough to know if 6 rounds of added Carbo is better than 4, and now that we finally started the Nubeqa, it may now carry the load. I am not asking for medical advice here, just discussing an unusual presentation and repurposed treatment. But we do welcome any thoughts and experience. Thank you

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jeff Marchi | @jeffmarc | Jun 25 9:37pm

I have heard from two people that had fatigue from Darolutamide. I know over a dozen or more people, including myself, that have reported no fatigue at all.

Many people have fatigue from ADT while some people have terrible fatigue, I know people that have had to stop using it because of the fatigue.

Chemo causes severe fatigue for a lot of people. Most people say that for the first three days after they have to really take it easy because of the fatigue.

My RBC was 3.84, pretty low, but I’ve had no fatigue, My hemoglobin is also low at 11.7. I think these are a couple of low numbers since I have started Darolutamide. Neither of those has caused me fatigue. The PARP Inhibitor is expected to do that when I start it, because it causes anemia in so many people.

mjp0512 | @mjp0512 | Jun 26 6:52am

Very recently diagnosed but, FWIW, I have been on ADT and Darolutamide for 2+, almost 3, weeks. No fatigue so far. Just very minor joint stiffness (knees). Although I am anxiously waiting for the side effect dump, it's been pretty uneventful, but I know it's still early. Sorry, no experience with chemo in combination. (not yet anyway)