Would like to hear some of you weigh in on a tough decision we have to make regarding chemo. Husband has significant hearing loss in his right ear from what was finally characterized as some sort of "vascular incident" in the auditory artery. In other words a small stroke that cut off blood supply. Gave him terrible vertigo temporarily and loss of hearing permanently. This occurred 6 years ago. No other health problems since. Till now.

With his recent DX, we are looking at rad and chemo....cisplatin being the top choice but the docs are leary because its well known side effects. Carboplatin w/ taxol is what is being touted by the local MO but RO at our CCC (went there for 2nd opinion--only saw an RO and surgeon) concerned that he needs more "aggressive" treatment. It is a hard call.

Can anyone direct me to studies comparing the two and the outcomes. At our first consult with the local MO, carboplatin was presented as a great alternative but I am worried now that it is not as effective and that we are choosing hearing over life expectancy. We talk to both docs next week to begin the tx's but I would like to hear what you guys have to say.

Thanks, Deb

Deb,

That's a tough call and only one that you, your husband and your medical team can make.

With that said, I'll tell you what happened to us...Our MO told us the chance of my husband's hearing being impacted by Cisplatin was very slim...and, we were bummed when he started to notice a problem within a week of his first of 3 planned treatments.

Initially, our MO was weighing out the pros and cons of Erbitux/Certuximab vs. Cisplatin. It appears that Cisplatin is the gold standard, so we went with it knowing the risks.

When the ringing and hearing issues developed we then weighed out Carbo and Erbitux with his MO. We went with Erbitux. What we were told is that it has been an effective option for tonsil and base of tongue cancers. However, it's a newer treatment option so there aren't long term studies on it.

We were told that with the one dose of Cisplatin that my husband got at least 60% of the benefit of the drug...and, they were happy when he chose the Erbitux.

We had toyed with the idea of participating in a study that would have used both drugs. But, we opted out of it knowing we wouldn't stay on the study if the Cisplatin impacted his hearing. So, in a way, they are happy he got both drugs.

We were told, that if the hearing thing became an issue they would switch him...which they did. So, the actual hearing loss is small, but we were told it would have been greater if we continued.

So, that's our experience.

But, I don't consider ourselves experts and I rely very heavily on my medical team when it comes to big decisions like this. I wish you luck in making your decision.

You are in the tough part. Treatment sucks, but at least you can start to count down the days. I did not enjoy the consultative, planning phase...I found it overwhelming. I wish you both luck and strength!

Best,

Tks Margaret,

Yep, this part sucks for me as I am a control freak and have to have my hands on what the next step is. Hubby seems in a state of shock, kind of burying his head in work, and, I think would rather have me make this and other decisions for him...NO WAY! When he asks, "What do you think?," I always say, "Before I say anything you have to give me your thoughts."

It drives me crazy that there does not seem to be a good answer yet on these chemo drugs and the best combination for good results. When the question of Erbitux came up at Moffitt CC, they would not consider it with Carboplatin because no studies have apparently shed light on that combo. It just makes your head spin because you feel that your decision has so much riding on it!

Thanks for your thoughts and your good wishes...we all need it.

ANYONE ELSE CARE TO COMMENT??

This is a hard one because there is good data on the effectiveness of cisplatin and not such good data on the effectiveness of other drugs such as carboplatin, and there seems to be a big difference in whether docs are willing to go beyond the cisplatin data. There are several people here, though, who have been treated with carbo instead. Chemically, it is a very close relative to cisplatin so in a logical sense it makes sense that it would work similarly.

I can't comment on the Erbitux and how it stacks up in place of cisplatin since I don't think there is any good data on that (and it is not at all similar and works using a different mechanism).

Hard decisions. Sorry to be so not-helpful.

Nelie