I agree Maria. Well put.

In hindsight I mentioned I could have done a better job of probing ...

Best,

Tim

Hi Charm...

btw ...I like frank and blunt ...so don't change that about your posts...hope you saw my updated post ...still learning to navigate here on the OCF boards.

Thank you,

Tim6003

Tim, I knew you would appreciate Charm's views, and those of this board.

Not a fan of Erbitux myself, but if they are going to administer it then make sure they've done the gene testing on you to see if you're one of the ones that will benefit from it. Article here:
http://www.webmd.com/colorectal-cancer/news/20080602/gene-testing-predicts-response-to-erbitux

They can predict the 2/3's of patients it can possibly benefit. So if we are grading drugs, Erbitux is only going to possibly work on 66% of people, that's a D unless we are grading on a curve

To muddy the waters a bit check the thread below this one - someone new is talking also about Erbitux and it's lack of effect on his mother... Have a good one.

with respect Eric, they are talking about colon cancer in this article. This article cannot be applied to oral cancer as the EGFR expression and possibly the mechanism for mutation is different.

Let us not get confused here. We are talking about using chemicals (whether that be a cytotoxic agent such as cisplatin or a monoclonal antibody such as Erbitux) to sensitise and assist radiation. In terms of treatment, this is NOT chemotherapy, this is chemoradiation.

Chemotherapy is the name given to the use of a combination of two or three chemical agents intended to halt, shrink or destroy tumours and is generally not terribly successful as a curative regimen for oral cancer when used on its own.

Going back to a point that Charm made recently about mutations and resistance, - single agents generally cannot withstand cancer's ability to mutate and render the agent ineffective within a matter of weeks if not days.

We know that Erbitux plus radiotherapy is better than radiotherapy alone. We also know that cisplatin plus radiotherapy is better than radiotherapy alone. When comparing the numbers indirectly across the major trials (which is very unscientific and risky) the magnitude of effect is about the same.

What we don't know is whether Erbitux plus radiation is better than cisplatin plus radiation. This trial has not yet been done and unfortunately only a trial which compares the two directly will give us the answer. The trial that will give us this answer is currently recruiting which means that for now, we do not know the answer and won't until 2015.

Karen
PS this a general clarification post. I didn't mean to post a reply to Charm - I thought I was just adding to the bottom of the thread. Sorry.

With respect Karen a K-ras mutation happens in 40% of colorectal patients so they routinely do the gene testing. K-ras mutations happen in around 5% of SCCHN patients so our wonderful health officials deem it "unnecessary".

I think it would be completely necessary if you are one of those 5% that it's not going to work on...wouldn't you? Now Karen I don't know your background or experience, but I've actually been in a closed meeting at the U.S. National Cancer Institute with Brian and Dr. Maura Gillison as she presented to the National Institute of Health for one of these studies. It's a numbers game to them, not an individual case (and by rights it has to be) but I would want to know.

I would also say that there are few people outside the medical community that has done more research into the treatment protocols and effects of oral cancer treatments then I have, I'm "very" familiar with what these drugs do, but thank you for the refresher. I'll remember this the next time I'm lecturing at the University of Washington, which has the #6 rated cancer care center in the U.S.

PS: I am NOT a Dr! I do have the same size ego generally and I have been known to play a Dr on the Internet and as an adolescent to get members of the opposite sex to remove their clothes for me.


Sorry I forgot my disclaimer

Now we are having fun
As the comments on the NCI page about the Bonner trial make clear, the bottom line remains that Erbitux is a gamble.
[quote]Finally, Posner and Wirth wrote, "oncologists should keep in mind that all studies of platinum-based chemoradiotherapy have shown greater improvement in patients than [this trial] found with cetuximab.... At present, for patients who can tolerate it, chemoradiotherapy with cisplatin remains the standard of care." Dansky Ullmann added that a trial that recently completed accrual is testing whether cetuximab might improve outcome when added to this current standard for these patients[/quote]
It's just speculation that Erbitux may be better.
NCI on Erbitux clinical trial In fairness, the full comments favor Karen's position more than mine on HPV, but it also spells out the fatal flaw in citing Bonner for anything to do with HPV
[quote]The prognostic importance of HPV in head and neck cancer was not known when the study was designed, and the investigators did not test tumor samples for HPV.
[/quote] All the Bonner trial showed was that Erbitux was better than nothing (okay, that Erbitux plus radiation was better than radiation with no chemotherapy at all). Oh and it does support �[quote]it is possible that the acneiform rash is a biomarker of an immunological response that is conducive for optimal outcome.�[/quote]
So Bonner "proves" nothing about Eribitux and HPV.
Charm

Charm wrote:

[quote]So Bonner "proves" nothing about Eribitux and HPV. [/quote]

Correct. The results of the study provide a hypothesis to be tested based on the subgroup retrospective analysis, presented as a forest plot in the five year follow-up. My husband, a scientist, read the Bonner articles and the Lancet commentaries on them prior to starting treatment.