...copied from one of the hundreds of posts I have been reading all evening regarding chemo tx with Carboplatin and Paclitaxel...

WHY is Carboplatin often substituted for Cisplatin? Tks......Lois

For many it is easier to tolerate and doesn't effect hearing loss. Cisplatin is still considered the gold standard - I honestly don't know why except it has been around for a long while and it's efficacy has been proven. Carboplatin was developed as a less toxic alternative.

That's a very good question Lois, since the article states that Cisplatin is more effective for head & neck cancers (but also has more toxic side effects). So once again we are back to the risk vs. benefit dilemma.

This article is probably already on the site but here is a link anyway: http://annonc.oxfordjournals.org/cgi/content/abstract/9/1/13

Cisplatin is an ancient compound that was FDA approved in the 70s for certain cancers. It is a simple drug PtCl2(NH3)2 that acts by damaging DNA. It does have a number of side effects that make it for some people problematic. Ringing and hearing probles are among these problems.
Carboplating is a newer drug that very similar to cisplatin. It was introduced in the late 80s. It has less side effects than cisplatin. It is also less reactive but can be given in higher concentrations. It does cause amongst other things a drop in the white blood cells. This is (or should be monitored) when you are on this drug.
From what I have seen MOs generally use cisplatin because it has been around longer, there is more data and it is though to be more potent that carboplatin (that may however depend on the type of cancer). Quite often people start out with cisplatin and then get switched to carboplatin .... as happened in my case.

Markus

For what it's worth, our oncologist at Hopkins felt that *in general* results with carboplatin seem to be equivalent to that for cisplatin. She emphasized that radiation is the "workhorse" of the treatment and that adding chemo improves efficacy by about 10-15%. Even if cisplatin were somewhat more effective, the difference is some percent of a relatively small percent. Individual variation between patients, as well as varying treatment protocols (even at same hospital), makes it hard to "tease out" if difference in result is due to the chemo drug and what is due to other factors.

I have not looked at the trials in the paper Gary cites but it would be very important that the patients enrolled were equivalent in all aspects BUT the chemo drug they received, and that includes whether they were HPV+ or HPV- since this factor alone impacts response to treatment.

Certainly many people are given carboplatin and do very well, and it is certainly far less toxic (although certainly not risk-free). It works in much the same way as cisplatin, forming platinoid bonds within the DNA of cells and preventing cellular repair.

Carbo is usually substituted for cisplatin when the latter is contra-indicated, which includes things like existing hearing loss, kidney issues, and so forth.

Gail

Thanks, all of you! I now understand more clearly...and Gail, I believe that your statement regarding existing hearing loss is the very reason Buzz has been prescribed the carboplatin, instead of the cisplatin.

Poor guy has had a problem for years, finally got a hearing aide this Spring, but almost immediately lost it at the golf course!

With his diagnosis concerns, replacement of the hearing aide is somewhere near the bottom of our 'list of things to do'...

Tomorrow, we go for eye exam and replacement of glasses. Tuesday to Radiation Oncologist, Thursday back to Baptist Hospital and Friday to Salisbury VA for Rehab consult.

I figure rehab will be placed on the back burner because of the immediate need for rad/chemo...

Thanks again for your earnest responses!

Lois,

Bill has significant hearing loss in his right ear (left works OK.) We were also faced with the decision whether to use Cisplatin or Carboplatin. I researched and asked and mulled and queried the docs and bottom line, we decided to go with Cisplatin (weekly, so not as toxic) and risk the hearing issues. Believe me, it was a tough decision, but both ENT and Primary Care docs told us that they would take the aggessive approach and worry with the side effects later, if they occurred. So, we had a choice and I do understand your worries.

All your appts this week sound so familiar. I have had to develop a notebook to keep up with business cards, receipts, notes, reports, etc. Not only are you a caregiver, you are a secretary!

Good luck with your treatment decision and the next week of appointments!

Deb

Altho someone[s] will strongly disagree with this statement, I have to say that the Docs who told us that they would deal with John's side effects "later" never had experienced one of them. Amy in the Ozarks

The side-effect risk is real and I think it is quite meaningful that at Hopkins they consider existing hearing loss as a contraindication for cisplatin use. It is not as if carbo desn't work, either, that's all my husband had as a chemo drug and he has come through very well from locally advanced cancer, tonsil, BOT and 2 nodes. At least two patients going through same time as he was were switched to carbo from cis- due to severe side effects and now, two years later, they are also doing well. In fact one only got through 24 radiation treatments, as she got so sick, and still is cancer-free.

If there is a hearing loss due to cisplatin, it is usually not reversible so cannot really be "dealt with later" as Amy says. Not everyone has hearing loss but the average percent affected is about 33% (range 2-60%) -- how often the drug is administered and a number of other factors seem to contribute to this wide range.

However, I'll bet many doctors would be hard-pressed to show a really significant difference from one drug to the other within their own practice. I think it is really a matter of "doing what they have been doing."

Also with a tonsil/base of tongue, has Bill been tested for human papilloma virus? It has been shown that even smokers can get HPV cancers, which are biologically different from those caused by smoking and respond more effectively to treatment. A recent paper showed that, surprisingly, the two factors (HPV and smoking) were not synergistic -- that is, smoking did not increase one's risk for the viral cancer. 72% of tonsil/base of tongue patients in this study were found to be HPV+

Gail

Gail,
Are you saying they are also testing smokers for HPV? If so, that is good because everything else I've read indicated they are only testing non-smokers. Seems to me, us smoker/drinker types are more likely to be infected as a group because of lifestyle thus it would be nice to know which caused it rather than assuming.

Take care,
Eileen

Gail,

Please re read my post regarding the hearing loss. Believe me, we understand the risks and are not negating them but we have weighed the issue and made a decision. Please don't make a blanket statement by saying that hearing loss can't be dealt with...it can be in a number of ways and that is what we and our doctors (RO, MO, PCP and ENT) have decided to do.

I appreciate your insight on a number of issues on this board, but when you second guess a well informed decision made by one of us, it doesn't help.

We have not had the HPV workup (been just a little busy) but I intend to push it at the right time. Thanks for the suggestion.

Deb

Sorry Deb, I was answering the original question and I don't want to seem to second-guess you -- however I am not making that blanket statement, here's what is written on cisplatin drug effects:

"Another dose-dependent effect of cisplatin is ototoxicity. Again, it is a cumulative and irreversible side effect, that becomes more significant with irradiation therapy. The ototoxicity of cisplatin also appears to be most significant in children who may experience loss of balance along with hearing difficulties due to greater sensitivity to the drug. Initial symptoms include tinnitus (ringing in the ears), or some hearing loss or both. These effects usually decrease when the treatment ends, however, many patients experience irreversible hearing loss in the high frequency range (>4kHz). Therefore, audiograms are recommended every two or three cycles to monitor the condition of the inner ear."

Because my husband had existing high-end hearing loss (>4,000Hz) from ear infections as a child, neither his MO, RO or ENT wanted him to take cisplatin. They all said that their experience found carboplatin to do as well as cis- as a "radiosensitizer" which is what it is -- it is not the primary treatment, but an adjunct and enhancer of the primary treatment, the radiation.

As my husband said, why risk a permanent quality-of-life issue whe there is a suitable option?

I should add that Hopkins gave him a audiology test before and after treatment and there were no changes.

Gail

Gail, once again, you did not understand what I was saying. The blanket statement referenced "dealing" with hearing loss issues. I am fully aware of the side effects (read my posts...I did a lot of research.) Yes, hearing loss is a quality of life issue...we have been dealing with it for ten years now...but we know that one can compensate with it in many ways. My husband also lost sight in his left eye 30 years ago in an industrial accident (so no left eye, no right ear) but he has passed his FAA exams (private pilot) with flying (no pun intended) colors...examiner was very complimentary of his techniques. So, in other words...he has dealt with his disabilities like a lot of other people deal with theirs...and go on with their lives.

We did have the audiometrics done prior to treatment so we have a baseline. We don't feel that we have come to our treatment decision in an irresponsible manner and we are staying positive that the outcome is good.

Happy that your hubby is doing well and that his treatment at Johns Hopkins was seemingly successful. I do sense that you have a little bias that treatment decisions made anywhere else are inferior. I hope that is not the case...not all of us can arrange for treatment at J H.

Sorry, if I sound a little short, but I want to make sure that you and other readers understand what I wrote. I was not arguing the risks..we are a intelligent, well educated, well informed couple that decided to take the most aggressive approach to this cancer possible. If we have problems along the way, we will have do as we always have...deal with them.

Deb

I think that this is getting a bit out of hand.
This thread stared with emmylou1951 asking about cisplatin ve carboplatin. Looking at the genesis of this, this is what Gail responded to.
Most of us only have a personal experience to relate which makes for a poor statistic. This also means that they can only relate their experience of the particular place they were treated.... whether that is at Hopkins or elsewhere. That much should be obvious. The function of this board is, in my opinion, also to get into contact with people with different views and experiences. You learn from what is useful and leave the rest.
Deb, it is good that you are happy with your treatment plan. This is as it should be. Realize however that plans can change. You are just at the beginning of the treatment. Quite a few of us have started out on cisplatin and then had to change.... regardless of our education, research abilities or plans.
In MO speak worring about side effect also means to switch to carboplatin IF there are side effects. If not the point is obvioulsy moot, maybe you are lucky, many of us were not. The ringing I had after just two low concentration cisplating infusions was quite bad and severely impacted conversations. I sincerely hope that this works out for you. Not all people are prepared to put up with potential and later on REAL side effects the same way as you.
It is always easier to avoid damage, if possible, than try to fix or compensate for it later.

I wish you the Best for your treatment!

Markus

Markus,

I don't feel that anything is getting "out of hand." I think all viewpoints are needed...I would have appreciated a thread like this when we were trying to make our decision. I also don't expect that everyone would make the same decision...I just wanted to clarify our position.

I think we all feel that "it is easier to avoid damage, if possible, than to try to fix or compensate for it later." But in response to a life or death decision, easier isn't always better.

Please note that we did not go against our physicians recommendations to do this course of treatment; it was presented as an option and it was a joint decision. We are prepared to make a change if any noticable hearing problems arise as they did in your case. Hopefully we will have some warning. So far, everything is OK.

Thank you for your viewpoint and good luck in your recovery.

Deb

I have been following this thread from the beginning.
I wasn't given a choice, mine is carbo regimen (palliative) but a week ago, I had
'ringing/throbbing' in my left ear.

I looked up side effects of carb and nowhere was it mentioned, although I had read about hearing problems being a side-effect of cisplatin on this site.

Fortunately, the 'symptoms' now seem to have subsided, but I still don't feel I hear as well as I did.

I also had an eye-exam today as my eyesight has definitely deteriotated--both my long and short vision. I currently have tests every 4 months anyway and RX has stayed the same for a good number of years, so am wondering if this change is a result of the cancer, chemo, or just 'natural progression due to age (58)' Any thoughts anyone??

Brenda