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.