I'll bet $100 it IS the Ethyol -- our RO (at Johns Hopkins) says that lingering or late-appearing nausea is the chief reason that he has to stop administering this drug to his patients. (In fact he doesn't give it routinely now because of so much toxicity, only if he cannot spare salivary glands through tomo radiation planning). My husband was one of the very few that was able to tolerate this drug all the way through treatment, most (he says) make it 2-3 weeks at most. As it was it made him sick more than once, and they NEVER gave it to him on the days he had his carboplatin chemo (which he too had once a week). Too much! We also found that folks getting cisplatin had even more problems with Ethyol.
What protocol is being used to adminster the Ethyol (amifostine)? The Medimmune guidelines must be followed to the letter (we know because my husband's daughter worked for Medimmune at the time and she told us the "back story" on amifostine and side-effects).
The protocol is:
1) 90 minutes before injection, take a serious antinausea medication -- Zofran or Anzemet. Compazine will NOT work for most patients.
2) 90 minutes before injection, start drinking (or hydrating through PEG) with 20-24 oz. liquid, slowly to avoid nausea and ending just before injection.
3) Patient may also benefit from administration of an antihistamine such as benedryl or a prescription med.
4) immediately prior to injection (which should be no more than 30 minutes before radiation treatment) patients' temperature, blood pressure and other vitals should be taken. If BP is too low (say below 100), no amifsostine. Injection sites from previous days are examined, and if there is a rash, obvious inflammation or other probem, no injection. A generalized rash (usually starting on the back) means that amifostine should probably be stopped completely.
5) Ethyol to be administered by *injection* -- two 250 mg shots (in sterile saline) -- and hydrocortisone cream rubbed over injection sites. This is done 30 minutes before radiation so need good coordination here.
6) Patient must remain quiet for about 15 minutes and then BP taken again. Then he/she can go to treatment.
7) After radiation, stay quiet and sip water or suck ice to reduce chance of nausea. No food for a little while.
Your mother (with her tonsillar/base of tongue) cancer and as a non-smoker is most probably an
HPV+ cancer. Have they tested her for this? If not, insist as this is a biologically different cancer that responds better to treatment and is far less likely to recur. If Sloan doesn't do it (can't imagine they do not, but...) Hopkins does. Do a google for
HPV and head/neck cancer. A paper published May 10, 2007, New England Journal of Medicine, D'Souza et al is very enlightening!
In the meantime, stop the Ethyol and get on top of this nausea problem. Make sure she is getting appropriate antinausea drugs, that is, one of the serotonin drugs such as Zofran, Anzemet or Kytril -- expensive but worth every penny (my husband says!) -- even a short or broken course of Ethyol can help. Our dental oncologist recommends every other day for those who are having problems, he says in his experience it works just as well. (And it does work, studies have shown 15-25% improvement in salivary function BUT this is not worth it if it makes her too sick to have her real treatment. It is the cancer that is the first consideration!)
Gail
