In your practice, do you use Taxotere or Jevtana more often? And those are like the two main
chemotherapies that are used in prostate cancer.
Alright, so these are the two main chemotherapies and they are very similar. There was a nice
comparative clinical trial performed. Half the people got Taxotere, half got Jevtana,
and they showed equivalent efficacy (anti-cancer effect was the same). They showed a little
less side effects with the Jevtana. So, if I had complete freedom, I would start with
Jevtana in everybody. However, insurance companies like to use Taxotere first because it's less
expensive. So, it may be difficult to get an insurance company to pay for Jevtana as
an initial therapy whereas if patients had previous Taxotere, usually Jevtana would be
covered. So, I don't have always complete freedom due to the way payment schedules are.
These medicines are fairly expensive and if the insurance companies are reluctant to pay
for one, then certainly we would start with the Taxotere.
And, as far as the side effects go, they're pretty much equal? Are they the same side
effects or do you see different side effects between the two?
Very similar. I think the biggest difference between Taxotere and Jevtana is Jevtana seems
to have a little less fatigue, and fatigue is a very prominent component of all chemotherapy
and particularly Taxotere, it can be an issue. There are other ways to circumvent fatigue.
Taxotere is usually given every three weeks, but you can give smaller doses every week
and that can be helpful. But, the reduction in fatigue is a difference and a meaningful
difference. It also seems there may be a little less hair loss with Jevtana. And as far as
the losing hair and side effects and the numbness,
I've noticed when I was in the transfusion room in your office, you had people not only
have, you know, ice caps sometimes but also, like, their fingertips in ice and so that's
to help... Is that a common thing in every other doctor's practice?
I don't know what's happening in other doctor's practices, but the idea of icing the fingertips
is that anything growing in the body is sensitive to chemotherapy, and so fingernails are growing
pretty quickly and by making the tips cold during the treatment, the blood flow is limited
there and therefore the carrying of the chemotherapy through the bloodstream to the fingernail
bed is limited, and so you have less problems with damage to the fingernails. There's also
another issue with Taxotere that seems a little more common compared to Jevtana called peripheral
neuropathy. So people can get the numbness that you talked about. That has to do with
the nerves, not the fingernails. Icing doesn't have anything to do with preventing it, but
it does seem to be a little less likely with Jevtana than with Taxotere.
Okay. And so, those are the only two chemos that you use in your practice or are there
any other types of chemotherapies when you're dealing with a really advanced patient?
Well, there's another medicine that's FDA-approved for lung cancer called Carboplatin and Carboplatin
seems to have genuine benefit in prostate cancer. Usually, if it's given in combination
with Taxotere or Jevtana, as opposed to being used by itself. And it's an infusion that's
given right along with the Taxotere. It has similar side effects. You always have to watch
blood counts and, you know, give medicines to prevent nausea which thankfully is very
effective. But Carboplatin is sometimes overlooked and it certainly is an effective medicine
for prostate cancer patients.
Okay. Well, thank you Dr. Scholz.
So, if you have questions that you would like me to ask Dr. Scholz in the future, you can
go ahead and leave that in the Youtube comments below and we will pick them up from there.
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