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klo Offline
"OCF Down Under"
"Above & Beyond" Member (500+ posts)
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"OCF Down Under"
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Posts: 638
Whilst the article Charm refers to in his quote and that DavidCPA provides a link to is talking about HPV and oropharyngeal SCC, nowhere does Posner make any statements, either positive or negative, about cetuximab and its effects on HPV caused SCC.

The quote that Charm has shared refers to Dr Posner's comments in relation to the RTOG 0522 trial where he says it is important to wait for meaningful results and whilst 3 year results may be interesting, the 5 year data will be the most important.

He cautions that drawing conclusions based on interim results are premature. This is what he is referring to when he says "a number of trials with drugs like cetuximab have not shown positive results early on". He is saying that a number drugs do not show good results in the first 12 months of trials and he goes on to give reasons why. The reasons he gives have nothing to do with the treatments. I guess this is why we measure success based on 3 and 5 year data.

He also says that when the results are final, analysis should include stratification by HPV status as HPV +ve cancer is biologically quite different and is known to be more responsive.

Unfortunately, the link DavidCPA provides took me to the first page of the article but allowed no access to pages 2-5 (for me anyway). I found it by logging on to Medscape and then searching within the site for Posner. The article titled Management of Oropharyngeal HPV positive Cancer should pop up first


Karen
Love of Life to Alex T4N2M0 SCC Tonsil, BOT, R lymph nodes
Dx March 2010 51yrs. Unresectable. HPV+ve
Tx Chemo x 3+1 cycles(cisplatin,docetaxel,5FU)- complete May 31
Chemoradiation (IMRTx35 + weekly cisplatin)
Finish Aug 27
Return to work 2 years on
3 years out Aug 27 2013 NED smile
Still underweight
Joined: Mar 2008
Posts: 3,082
Patient Advocate (old timer, 2000 posts)
OP Offline
Patient Advocate (old timer, 2000 posts)

Joined: Mar 2008
Posts: 3,082
Registered Medcape members can read the Posner seminar in its entirety as a Continuing Medical Education with pop up quizes to make sure you are getting it right (and they are graded). I got them all right and nice printed certificate at the end; In the CME Posner does make many statements about cetuximab and HPV and TX.
But again, different people draw different conclusions from the same articles and studies. No denying that Klo's post is what she understands. but it's becoming standard that she and I read things differently.
OCF members can go with my judgements as one who has had Erbitux and discussed it his doctor who no longer prescribe Erbitux for HPV or go with Klo's cheerleading for a drug that her patient never had,( and if he had, may not have done so well as he has and could be facing a recurrence like many many Eribux users.) My advice remains to choose the drug(s)such as platinum based ones that worked for Klo's patient instead of Erbitux which may have left Alex with a recurrence.
Charm

Last edited by Charm2017; 10-13-2012 08:34 AM. Reason: toned it down

65 yr Old Frack
Stage IV BOT T3N2M0 HPV 16+
2007:72GY IMRT(40) 8 ERBITUX No PEG
2008:CANCER BACK Salvage Surgery
25GY-CyberKnife(5) 3 Carboplatin
Apaghia /G button
2012: CANCER BACK -left tonsilar fossa
40GY-CyberKnife(5) 3 Carboplatin

Passed away 4-29-13
Joined: Oct 2011
Posts: 805
KP5 Offline
"Above & Beyond" Member (500+ posts)
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Posts: 805
I'm with Charm here. Why would anyone NOT hit this with the best stuff that has been PROVEN successful?
I have to say it is a bit concerning that maybe new members are getting completely confused with all the different OPINIONS though. Perhaps just the links to the subjects should be given and then people can discuss them with their own doc? We have to remember that while we are all quite familiar with these subjects, others are not and are here seeking info, not arguments. That just adds to their confusion.
Peace,
Kathy


Kathy wife/caregiver to:
Kevin age:53
Dx 7/15/11
HPV16+ SCC Stage IV BOT/R
Non smoker, casual drinker
7/27/11 Cistplatin, taxotere,5FU 2/3week sessions, followed by IMRT 125cgy x 60 (2x daily) w/Erbitux weekly. Last rad 10/26/11. Last Erbitux 10/27/11
PEG placed 9/1/11 Removed 11/8/11
Clear PET 10/12 and 10/13 and ct in 6/14
Joined: Mar 2008
Posts: 3,082
Patient Advocate (old timer, 2000 posts)
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Joined: Mar 2008
Posts: 3,082
Actually several OCF readers and posters are much more familiar with some of the subtle nuances of these subjects than many doctors treating oral cancer patients. The "confusion" comes when the doctor has not had the time to keep up on the latest results on HPV or radiation more than once, In many places, an oncologist treats many different types of cancer besides oral cancer. they do their best but....
To me, getting out the message that Erbitux as a single agent chemo for HPV is not a proven succesful drug treatment is personal, not academic. When my RO decided to quit prescribing Eribitux for HPV because he saw first hand the increased numbers of recurrences in HPV patients, starting with myself five years ago, he risked angering some powerful people above him whose reputations and fame were based on those early Erbitux studies. All I'm risking is some nasty posts, some nasty PMs while I stand to benefit from keeping some poster from having a recurrence. So in the risk balance equation, I'll risk approbation if it means I can keep even one OCF reader out of the recurrence club.
When things are highly personal to me and my doctors back up the medical evidence behind my positions, the only confusion here would be to think that I could be dissuaded from posting these warnings and similar ones.
I agree wholeheartedly that there should be discussions with your doctor. But that discussions should be two way, such as asking why do you say no more radiation when CCC are doing it 3 times? Or why are you scheduling a Petscan this early when it usually gives a false positive this early?
Or why don't you have my exact TSH blood level number before TX ? And in this case, Why are you giving me a drug that has not been clinically proven in any trial to work all by itself on HPV+ patients? And know enough that if the Doctor says oh it has in Bonner or Extreme that is not correct . They would not be bad doctors, nor bad people for falling for the Eribitux Kool Aide. My MO is wonderful and he believed with his whole heart 5 years ago that those glowing studies (which did not track HPV) meant this was the best possible treatment for me. Heck, I read the studies and even more reports and they were fantastic.
But the real world has intervened in the last 5 years and that academic glow has diminished with each and every recurrence. Better to be a little confused and not join the recurrence club
Charm

Last edited by Charm2017; 10-14-2012 06:58 AM. Reason: toned it down

65 yr Old Frack
Stage IV BOT T3N2M0 HPV 16+
2007:72GY IMRT(40) 8 ERBITUX No PEG
2008:CANCER BACK Salvage Surgery
25GY-CyberKnife(5) 3 Carboplatin
Apaghia /G button
2012: CANCER BACK -left tonsilar fossa
40GY-CyberKnife(5) 3 Carboplatin

Passed away 4-29-13
Joined: Oct 2011
Posts: 805
KP5 Offline
"Above & Beyond" Member (500+ posts)
Offline
"Above & Beyond" Member (500+ posts)

Joined: Oct 2011
Posts: 805
I agree Charm. I KNOW you are posting from personal experience. That would be all it would take for me NOT to do Erbitux alone, and I think your case makes it pretty clear to surfers also. I sure hope you don't think I was saying to stop saying it to you...NO WAY!! You have the goods to back up your opinion!
Kathy


Kathy wife/caregiver to:
Kevin age:53
Dx 7/15/11
HPV16+ SCC Stage IV BOT/R
Non smoker, casual drinker
7/27/11 Cistplatin, taxotere,5FU 2/3week sessions, followed by IMRT 125cgy x 60 (2x daily) w/Erbitux weekly. Last rad 10/26/11. Last Erbitux 10/27/11
PEG placed 9/1/11 Removed 11/8/11
Clear PET 10/12 and 10/13 and ct in 6/14
Joined: Jul 2012
Posts: 61
Supporting Member (50+ posts)
Offline
Supporting Member (50+ posts)

Joined: Jul 2012
Posts: 61
Do the negatives regarding Erbitux usage apply if HPV is not involved and radiation is used in conjunction with Ebbitux?



2010 sore throat
Jan 2011 ENT no prob
Jun CAT no prob
July PET
July biop pos
July PEG

HPI (1-3) T2N1 squamous cell carcinoma right tongue base treatment chemo/XRT end Oct 2011.
Jan 2012 PET neg
June PET-18mm mass right tongue base pos to 7.2 SUV no nodes pos
July MRI.
July bio pos
Joined: Dec 2010
Posts: 5,264
Likes: 5
"OCF Canuck"
Patient Advocate (old timer, 2000 posts)
Offline
"OCF Canuck"
Patient Advocate (old timer, 2000 posts)

Joined: Dec 2010
Posts: 5,264
Likes: 5
As far as I gather Erbitux is better when used to treat non HPV related cancer however - cisplatin is the standard and proven- why risk your health ?


Cheryl : Irritation - 2004 BX: 6/2008 : Inflam. BX: 12/10, DX: 12/10 : SCC - LS tongue well dif. T2N1M0. 2/11 hemigloss + recon. : PND - 40 nodes - 39 clear. 3/11 - 5/11 IMRT 33 + cis x2, PEG 3/28/11 - 5/19/11 3 head, 2 chest scans - clear(fingers crossed) HPV-, No smoke, drink, or drugs, Vegan
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