Zytiga variable results – Someta (bone meds) interaction?

Has anyone else taking Zytiga/Abiraterone for metastatic CRPCa noticed a regular rise in PSA after a monthly Someta/Xgeva/Bondromat (bone meds) i/v followed a drop after 14days?

My PSA results have been variable during 10wks on Zytiga. My PSA has risen on 3 occasions after each Someta i/v (bone med) & Firmagon injection(testosterone blocker), then dropped 2wks later. Diane303’s “Zytiga side effects” post about her husband’s serious problems with Zytiga + Xgeva (bone med) prompted me to think that there may be an undiscovered interaction between Zytiga & bone recovery medications

I have been taking Zytiga (aka "AbiTabs") for 10wks. I am "lucky" to be young enough at 55 to withstand any adverse toxicity so far. “Lucky” covers 6yrs with radical prostatectomy, radiotherapy, Decapetyl HT, 2x taxotere and now Firmagon & Zytiga, however my sense of humour is still alive and kicking ;-)

I also wonder if the timing of taking the Zytiga pills each day relative to food intake is even more important than J&J suggest on the pack. The instructions given by our European supplier are very specific about taking the tablets 2hrs before & 1hr after eating (but also curiously - not after 10pm at night??), so this suggests that stomach & intestinal problems might have happened to patients during trials. I have not seen many posts on this or other sites about Zytiga side effects, also I've only ever seen one set of PSA results from an Australian guy taking Zytiga , again on another site.

I'll take my results graph (and theories) to my oncologist next time and see what he thinks.

Report post

19 replies. Join the discussion

To jmcg..more questions than advice..Doc suggests start Zytiga after 2 yrs on Lupron as PSA has risen from 1 to 6 over two months .Age 86 with metastatic C since early '09.. Local cost est at about $6000 month. Do you have a European source that beats this...Can side affects that appear formidable be
tolerated by old man already crippled by arthritis, living alone... I certainly need advice by anyone already on this med.I live in Michigan and Doc has not yet helped with side affect advice. I know that Predisone has to be part of the treatment and liver tests are required....Thanks for anything you can offer.

Report post

To jmcg..more questions than advice..Doc suggests start Zytiga after 2 yrs on Lupron as PSA has risen from 1 to 6 over two months .Age 86 with metastatic C since early '09.. Local cost est at about $6000 month. Do you have a European source that beats this...Can side affects that appear formidable be
tolerated by old man already crippled by arthritis, living alone... I certainly need advice by anyone already on this med.I live in Michigan and Doc has not yet helped with side affect advice. I know that Predisone has to be part of the treatment and liver tests are required....Thanks for anything you can offer.

Report post

redney84, always willing to share my experience/opinion. PSA doubling in less than 6mths like yours is classified as high. I had a similar fast rise with PSA doubling every 4mth after 4yrs on Decapetyl (similar injection to Lupron). Zytiga wasn't available then, so I had to have 2 lots of 7mth Taxotere chemo sessions in 2yrs, which worked well - until the end of each treatment. Latest PSA rate before starting Zytiga was worse, doubling every month. As I said in my previous post, my PSA since then is variable but it hasn't increased either, which is great!

Can't tell you a price as Zytiga is not freely available in Europe yet, it's only given on a trial basis from J&J through research hospitals. First global Euro approval has been given very recently but have heard it won't be available on prescription for at least 6mths, as individual Euro countries will have to negotiate price and then their health authorities decide if they will give it to their patients. That's what the UK calls "the postcode lottery"

I can't really advise you about side effects as I am lucky that I have not had any noticable change in side effects since I started Zytiga 3mths ago. Aged 55 and reasonably fit, my oncologist was inpressed that my side effects with taxotere weren't too bad, so maybe age & fitness help with Zytiga. I have to take 5mg Prednisone 2x day but then I had to take it 1x day before during chemo. I gained about 5-6% weight with that. However, I did have severe pain in my knee & elbow joints when I stopped the Prednisone and a rheumatologist told me that was possible patients need to "come off" courtisoids gradually. Perhaps that might help your arthritis.

Unfortunately I don't know anyone else taking Zytiga, so I can't compare notes regarding side effects but if you look at the prescribing info on the Zytiga website http://www.zytiga.com/pdf/prescribing_information.pdf
you can see all the side effects (and percentages) that were experienced on the pre-approval trials by the 791 men taking Zytiga/Prednisone and the 394 men taking placebo/Prednisone.

Only you can say how strong or sensitive your body is but my personal experience is that Zytiga is much better than 7mths of chemo.

hope that helps, good luck

Report post

I’m a very worried young woman from Germany. My dad started with a PSA of 186 in September 2009. First he got a hormone therapy and radiation for his bone metastases. The first month were pretty good and his PSA dropped by. After a while we figured out, that the hormone doesn’t work any longer and he got a chemo therapy starting in fall/winter 2010. The chemo worked well after each treatment, but after finishing the chemo his PSA rised again to 247. His oncologist decided to propose for abiraterone and my dad’s insurance approved the treatment. He also gets the zometa/someta during he takes his Zytiga drugs. He started by the end of July. After two weeks his PSA dropped by to 144 and we all were very happy.
But from that moment his PSA rises and rises again. Yesterday we got his new results: PSA 250.
He says that his whole body is hurting, sometimes the legs, sometimes his hips and his back. It seems that these side effects are more intensive after he got his someta.

His oncologist told him, that it could be usual, that the PSA rises after a few weeks, cause the drug needs some time to work out. But my dad, we all, are very frustrated about the results. The oncologists here in Germany don’t have enough experience, cause the drug is too new.

@Jmcg: Do you have any new information from your oncologist? Or have you heard about some other patients who make those experiences?

I appreciate your help and wish you all the best. I hope, that Zytiga works out for you very good.

Conny, from Germany

Report post

@usagirl, unfortunately I haven't seen my oncologist yet but I don't expect an immediate answer, as he'd probably have to refer back to the drug company & specialists. I haven't seen anything else in other forums either. If I find something useful, I will post it.

you said "It seems that these side effects are more intensive after he got his someta" Can you see a direct correlation between Zometa dates and PSA rise? Ask for 14 or even 7 day PSA checks to help decide. I have plotted my 14day PSA results on a chart to watch trends carefully, my PSA has risen after each Zometa i/v, so it could be influencing the results but that's only my opinion. I get Zometa again next wk, so can see if the same happens 14days later, if so, I'll ask for a break from Zometa. This is not a decision to take lightly as I have metastases in my spine/ribs and the Zometa strengthens the damaged areas.

You didn't mention if your father is taking Prednisone, I assume that he must be, as 2x 5mg/day Prednisone is a condition of the trial.

Zytiga is a new drug and there isn't enough information about it. It is always difficult to get information during trial programmes. Zytiga won't be available in pharmacies for some months yet. However, it has been approved in the USA since end Apr, so we have to hope that posts such as our can stimulate feedback in forums.

Good luck, be strong for your father (and yourself !!)

Report post

@jmcg,
Have you ever considered direct radiation on those bone mets?

Report post

@davydorite, haven't considered ext RT yet, fortunately excessive spread to critical areas and pain have not been an issue so far for me.

However, thanks for raising the point, I'll remember it in case it need it in the future.

Report post

At 59, my husband was diagnosed with prostate cancer and bone metastasis in many areas. 18 months ago he was an avid hiker and exercise ethusiast with annual physicals. His PSA reading were around.8. Last May, he was having a persistent back ache and went it for a cortisone shot. After completing an MRI, we were told he had bone cancer. His PSA was 13.9. After a biopsy, we found out his gleason score was 10. Reality is the cancer was probably there long before but the PSA gave a false read. He has been on hormone therapy, chemotherapy and continues with Lupron and XGEVA. He started Zytiga 4 weeks ago and his PSA dropped 50%. He has been experiencing off and on days of severe fatigue in additional to other mild side effects. During this time, he was given the wrong doseage of prednisone..they dropped from 5 mg / 2x a day to 5 mg / 1x a day. When we realized the oversight and he went back on 5 mg /2x he felt better for a few days but again today has extreme fatigue. He did have his XGEVA, Lupron and start the ZYtiga all the same day so am wondering if between that and the problem with the prednisone, it is simply taking time for his body to equalize. He is due for XGEVA in 2 weeks but considering some of the comments on this site, it may be worthwhile to hold a coupel more weeks until we understand what is causing the fatigue. I don't have a lot of answers right now but hopefully I will soon. I do have one question for ther person who mentioned that Zytiga should not be taken aftr 10pm. My husband takes it between 3am-5am so we make sure we follow the 2hr/1hr instructions. I haven't found anything recommeding after 10pm..would you be able to share where you found the info?

Report post

I can't answer your questions but maybe I can help with the fatigue...has your husband had a blood test to see what his red blood cells are? Sometimes the guys can have some anemia that can cause the fatigue. wishing the best for you and your husband.

Report post

Thank you..yes, just had labs done this week and there is nothing out of the ordinary. We've experienced the anemia problem..he had a blood transfusion in April and since then his red count has been pretty stable. Thanks for the suggestion

Report post

@jmcg
We can't see a connection between Zometa and the PSA rise, cause they take his blood right before he gets his next Zometa. He gets his Zometa every 4 weeks and he takes his blood every 2 weeks. His PSA rised each two weeks. I just took a look on his chart, he created one as well, cause it's easier to take care of it.
He also takes 2x 5mg/day Prednisone, I forgot to tell you.

If I get more information I will post it as well.

Anyway, thank you for your help!

Report post

@ksemmer, the "not to be taken after 22:00" instruction is on the pill box from Jansen&Jansen in Europe. Although it's very strange I imagine that might have been because some patients in the early phase trials had stomach problems and J&J didn't want long term exposure due to pills being incorrectly digested during the night.

We also have the "2hrs after/1hr before" eating rule. I used to take my AbiTabs in mid-morning as prescribed but then I was looking for clues as to why my PSA was variable and it seemed to coincide with some changes in my eating habits. 2wks ago I decided to try taking them in the early hours of the morning but will not know if this affects the PSA result until my blood test next week.

Why up early in the morning? Wonderfully clear night skies and an opportunity to photograph the stars with my new camera. Hey, there's always a silver lining !!

Report post

Thanks..I just reviewd our pill box and the instructions online and nothing about after 10pm. We happen to choose 3am or so because we both have sleep problems and happen to wake up around that time. We use it our advantage..take the pills, watch world news, and no trying to figure out when is last time he ate or when he will eat again. Regarding PSA and blood tests, we have the labs scheduled for morning and do not take any meds other than Zytiga until after the appointment. Also, fasting 10 hours before..nothing but water which is why we schedule early morning. Our question after 4 weeks on Zytiga..how long should one expect for it to take for side effects to subside? We have many good days and a few awful days in between.

Report post

My dad got an email answer from one of the specialists here in Germany. It's one of the oncologists who works in a clinic which makes the abiraterone trials here in Germany. My dad had two appointments with the doctor during this year and he said, that we shouldn't give up to early, cause of the constant rise of his PSA. The drug needs up to 6 month to obtain constant positive results. So we have new hopes!
We didn't get an answer regarding the Zytiga and Zometa connection. But if we get one, I will post it!

I wish everyone a great weekend so far. He have a pretty bright and warm fall here in Germany :)

Report post

I have been in Zytiga 1000Mg for 8 weeks and it took that long to see the Psa dropping,but in last 2 weeks had leg bone pain up to my butt,and it changes left to right also having difficulties getting up.Advil was not sufficient to control the pain so now started taking a prescription drug for the pain. I am also taking Zometa every 6 Wks.
Anybody with similar situation please respond

Report post

@redney84, we have been fortunate our insurance covers but in doing financial medical planning for 2012 there is a subsidy program put out by zytiga. If you qualify the cost is as low as $20.00/month. Ask your doctor about or go to the zytiga website to sign up.

Report post

Muchfaith//from Redney84...Thanks very much for zytiga info.....I am discussing alternate meds w/Doctor
now and will have a consult w/ VA Docs soon...Age (86) and other med problems involved..

Your advice re; cost assistance is appreciated.....Redney84

Report post

Angelos
My husband has been on Zytiga for 6 weeks and had experienced joint and muscle pain. Lately he has felt leg joint and pain. In the past few days, he has been taking Vicadin generic one time a day which has made a significant difference. We were told not to take any products with ibuprofren. His PSA dropped 50% the first 4 weeks. He also had a Lupron and two XGEVA shots which may explain the side effects during this time. Day 3 of Vicadin generic and he feels much better/more active with the Vicadin generic
Karine

Report post

Thank You Angelos.

Report post

This discussion is closed to replies. We close all discussions after 90 days.

If there's something you'd like to discuss, click below to start a new discussion.

Things you can do

Support Us TOO International

Help Us TOO International Prostate Cancer Education & Support Network reach its goals and support people like yourself by making a donation today.

Donate to  Us TOO International Prostate Cancer Education & Support Network

Discussion topics

Us TOO Education Tools & Resources

Get Involved with Us TOO

Community leaders