Alright, Dr. Scholz. So our topic today is chemotherapy. Can you explain what chemotherapy
is and how it works in prostate cancer patients?
Sure. Actually, chemotherapy for prostate cancer is fairly straightforward because there's
not a lot of different agents. In other types of cancers sometimes there maybe half a dozen
or more types of chemotherapy. Chemotherapy just means a medicine to treat cancer. It's
usually infused intravenously, but they have chemotherapy in pills too. It's—think of
it as a sort of a cell poison and chemotherapy medications tend to poison the cells that
are growing quickly. So, the most common chemotherapy for prostate cancer is Taxotere. Probably
the second most utilized is a medicine called Jevtana which is a medicine very similar to
Taxotere. Both of these medicines are infused every three weeks and they have a variety
of different side effects. Generally, not too bad. And both of them are very effective.
Both have been shown to prolong survival. Jevtana has been shown to prolong survival
even after the use of Taxotere. And the third type of chemotherapy that we are using more
and more is a medicine called carboplatin which is FDA-approved for the treatment of
lung cancer, ovarian cancer, and generally is covered for off-label use in prostate cancer.
So, we don't have a lot of agents, but the ones we have are quite good.
So, with carboplatin, what effects are you seeing in comparison to Jevtana and Taxotere?
So, their effects tend to be similar. All types of chemotherapy—practically all of
them—can cause fatigue after each injection that may last for two to five to seven days
and they all—all the ones I mentioned—can cause hair loss in some people (it's not universal)
and all of them have a potential for lowering blood counts. White count which could lead
to infections; red count which can lead to anemia, and platelet counts which if severely
suppressed can lead to bleeding. So, that all needs to be managed and the dosage of
the medicine is adjusted based on how the body weight and the height of the patient
to try and make sure that they get a precise amount that won't lead to those kinds of problems.
And as far as the sequencing goes, is it Taxotere, Jevtana, and then carboplatin as a resort
if Jectana isn't working?
So, the insurance companies generally push for Taxotere first because it's generic and
less expensive. There are some head to head trials between Jectana and Taxotere showing
that the anti-cancer effects are about the same; however, it appears that the Jevtana
is a little bit milder in terms of side effects. So, the policy is mostly dictated by finances
where Taxotere is given and if that stops working or if the side effects seem to be
excessive, then people can switch over to Jevtana. If insurance companies paid for Jevtana
upfront, I'd probably just use that first. Carboplatin is often reserved for people who
have been on these medicines and then they stop working and physicians will then add
some carboplatin to the Jevtana or the Taxotere to try and get the PSA to drop again, but
it's not unreasonable to consider taking the carboplatin plus the Jevtana or plus the Taxotere
right up front because it's probably a somewhat more efficacious combination than using the
medicines by themselves. There is a little bit more incidence of side effects when you
give them in combination, but it's not particularly bad.
Thank you so much for watching! If you would like more information on any of the topics
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