Hi,

When did they introduce Cisplatin to H&N rad treatment? (don't see anything when I Google).

Any reports or stats on:
how well it works; it's advantages; are there less re-occurances; etc ??

Thank you.

LisaB, I have no idea when it was introduced, but I can tell you it was not new 5 years ago when I had it. I only had two influsions because my hearing got really strange so I was switched to carboplatin and one of the tax* drugs and can hear just fine today. I am also here today without recurrence, so as far as I am concerned, it is a good drug.

I just remembered one of the chemo docs telling me, as he took me off it, that he had used it 25 years previously and his patient went totally deaf. I do not know if that was a head and neck patient, but that indicates the drug has been around for a long time.

Lisa, They did a big Phase III clinical trial using cisplatin with radiation the results of which were published in the New England Jounral of Medicine in 2004. Obviously it was being used before that, but with less certitude about how much benefit it added. That study in 04, as well as another done in Europe that came out at the same time, showed a reduction in recurrences by as much as 16% over people (with Stage III and IV cancers) who were just given radiation treatment alone.

Joanna's right cisplatin has been around for a long time. The nurse-practitioner in my MO's office has been an oncology nurse for over 25 years and rememebrs the early days of cisplatin, when there were no anti-emitics that could come close to controlling the nausea it produces. Thank goodness I wasn't treated then!

Nelie

http://www.chemheritage.org/EducationalServices/pharm/chemo/readings/cisplat.htm

Try "Cisplatin history" when you Google search

I have read that it can add an additional 13% or so, to the 5 year survival when combined with RT.

It is the firstline adjunctive ct (combined with RT) in the NCCN oncology practice guidelines.

Some have had recurrences in spite of all possible measures being taken. I have not seen data on this subject - maybe Brian has.

We have had many discussions about Cisplatin (AKA Platinol) Try searching the forum in "treatment & medications" topic there are 5 pages of hits on Cisplatin.

Gary, you post the most interesting links! Thanks for that one on cisplatinum. I guess I'm just a science geek sometimes, but I think the history of how things are discovered, especially when it's by accident, is fascinating stuff!

Nelie

Just to "muddy" these waters some- when we had our first appointment[this past summer] with John's chemo Doc, we talked about his existing palsey and hearing difficulties. The Doc said, "O.K., we'll use Carboplatin instead of Cisplatin- they are virtually the same results wise." Since I had been following Gail and Barry's tx, I felt O.K. with this. Amy

Amy is right, the results for carboplatin (as a radiosensitizer) seem to be essentially the same as for cisplatin (as Gary says, chemo appears to add 10-15% effectiveness to radiation). Our MO - who has done extensive research on chemoradiation for HNC -- felt that there was good reason to use carbo for Barry, as he has existing high-end hearing loss from infections as a kid and also has some benign familial tremor, a hereditary condition which could be exacerbated by the peripheral neuropathy associated with use of cisplatin as well as taxanes such as Taxol.
Her exact words were "the radiation is the workhorse in this treatment and the chemotherapy simply enhances its effectiveness" The platinoid drugs inhibit the ability of a cancer cell to repair itself by forming platinum bonds within the cell's DNA.

The seven weekly carbo treatments were, in Barry's words, a "non-event" re side effects during treatment (of course he was given powerful antinausea drugs, Anzemet and/or Zofran) and afterwards. A hearing test after treatment showed no hearing loss compared to before-treatment test, and no problems with neuropathy.

Gail

I am a CPA, not a medical doc and especially not a cancer expert and I frankly hope never to become an expert on cancer. My MO, from Moffitt Cancer Institute, told me that concurrent use of Cisplatin and rad would enhance the effects of rad by 30%. He also told me that I may experience some hearing side effects from Cisplatin which may or may not become permanent. He also never mentioned Carboplatin until I told him I was experiencing some hearing difficulties at the very end of my treatment. As I posted a few days back, I have been told that I have permanent high end freq hearing loss.

Funny, we can't all get the same information with which to base the very important decisions they hit us with when we are most venerable.

Although it seems logical that carboplatinum would work exactly the same way, since it is such a close cousin, to my knowlwedge no one hs done the kind of large scale clinical trials clearly documenting its effectiveness on oral cancer that that have been done with cisplatinum. I think what that means for those of us who aren't docs, is some docs are way more cautious than others about being willing to say that it is equally as effective.

I am not sure if there have been many large trials which compared cisplatin vs. carboplatin as sole radiosensitizers, but in clinical practice a number of centers now use carbo because they get equivalent results without as many noxious side effects. This article from Moffitt Center, which cites two trials:

Treatment of Locally Advanced Head and Neck Cancer: Historical and Critical Review

Muhyi Al-Sarraf, MD, Cancer Control 9(5):387-399, 2002.

Gail - when you get these in the future, please send the original url to Sheldon Sax so that he can add them to the news section of the web site. We'd like to keep it as current as possible and between the two of us we don't always catch everything, there are so many journals to review.

As an aside- can you address the use of chemo[carboplatin\cistplatin] in recurrances;ie NOT in conjunction with radiation. There are some of us who are experiencing chemotherapy long past radiation therapy. Amy

I guess I'd want to know the sample size for that study before concluding that the no statistical difference they found between cisplatin and carboplat was not just a lack of power.

I was treated at Moffitt and my MO never mentioned Carbo until the end. He made Cisplatin sound like the state of the art chemo. I am meeting with him next Tues and I plan to let him read Gails post. I want his comments and I will share them with the group.

Nelie makes a good point (re sample size) and I tred to find the references in the Moffitt article but they were not listed. The general feeling from all the MOs I've spoken to is that there is little difference in outcome -- several told me cis is used because it has the "longest history" -- there have been some studies on ovarian cancer where a platinoid was the *sole* therapy (no radiation) and cis showed a slight advantage over carbo. One has to wonder, however, if the chemo adds only an estmated 10-15% to the radiation how much difference a slight advantage would be (e.g. 5-10% of 10-15%, is 0.5 to 1.5% added control) in light of the much more significant toxicities associated with cisplatin.

In any case, planty of people getting carboplatin are having complete clinical responses to their therapy so it certainly works.

I too would be interested in Moffitt's response in light of their 2002 article. Perhaps that MO is the only one using carboplatin but if so, why was he asked to write an article espousing it's use. Possibly in the intervening years Moffitt has fond out something we should know about the relative efficacy.

Gail

I met with my MO at Moffitt today and asked him about the 2002 article. He was familiar with the doctor and said he is committed to his preferred treatment but he said that there still has not been a large scale head to head comparison of cis to carb and Moffitt's TX protocol for my type of cancer remains Cisplatin concurrent with IMRT radiation. He also said that if the patient presents a medical history of hearing problems or experiences hearing problems with cis during Tx, they switch to carbo.

Oh well, I'm finished Tx and I just received my first all clear CAT results today so I'm releaved.

Hi David,

For what it's worth, Cisplatin was recommended to us by Sloan Kettering, among others, for Jack. It's their protocol but was also based on how aggressive his cancer was and the extracapsular lymph node invovlement. Sometimes you just have to go with to each his own and realize that opinions in medicine will continue to vary.

The good news is that you've finished your treatments and the CT scan was clear. Everything else is a side effect to be dealt with, being alive is the victory. Congratulations.

May you continue to be well and get good news.
Regards JoAnne

Thanks JoAnne, the docs want to give you their best shot and they go with the most agressive treatment they think you can handle. They can always back off a bit. Their goal, like ours, is to kill all the cancer the first time. Unfortunately sometimes they come close to killing the host!

Now to the next phase, whatever that is.

Hey David great news!

As for cisplatin; when I read thru my notes I see the RO resident dr said that if cisplatin effects the hearing then they will switch to something else. However I recall the chemo dr saying at the time when my Dad told him about his hearing; that there is nothing else to switch to. My Dad; already hard of hearing due to meniers was told most likely his hearing would be effected. And yes the cisplatin did effect his hearing but he did all 3 cisplatin anyhow.

I'm just wondering if there is a study on how effective cisplatin is; are there less re-occurances?

Again congratulations David!

LisaB, I was told that Cisplatin does the best job of assisting the radiation in disrupting the cancer cell. Carboplatin is often used as a switch to chemo when cisplatin proves to rough.

Thanks for your comments.

Yes from what I read alot of people don't get their 3rd chemo; the chemo dr told us that is common. My Dad did all 3 and his bloodwork was acceptable each time. Ya he was sick with each one but he got thru them. He's 69; did pretty good I must say.

We were also told Cisplatin is the 'gold standard' and would help the radiation work better. It wasn't till I read here (after treatment) about the other chemo's.

I'm wondering if there are less re-occurances with the use of chemo with rad and better survival? Any study let me know.

Thanks

Lisa, If you look at my post above about the two large experiments reported in 2004 in the New England Jounral of Medicine I think that answers your question.

Nelie

Thanks Nelie; ooops ha.

Lisa