My husband is trying to decide which direction to head. He is 52 years old and strong. He is willing to do the 3 bolus but would like to know if there is any data to support the harsher treatment vs. the weekly. If there is anything, please let us know. Thank you, Laurie.

the weekly treatment makes a lot more sense to me. Cisplatin enhances the radiation effects. Since you are getting that every day it makes more sense to me to keep the chemo level more constant (i.e. weekly).
So:
A) more constant drug concentration and less of a spike
B) better chance to intervene if something happens, i.e. oto- or nephrotoxicity
C) The overall amount you get is about the same (more or less)
D) you are more likely to finish the 7 treatments than the 3 big ones. Quite a few people only had 2 treatments.

As with everything you get here discuss with your MO. It seems that the 3 treatments is something the used to do in the past..

M

Hi Markus,

Thank you for your insight. Two docs at Dana Farber in Boston - one says that the 3 are the way to go. The other says that it just isn't necessary for reasons similar to what you laid out for me. Interesting.

Laurie

Hi Laurie

Im not aware of any data available to support the 7 smaller doses vs 3 large ones. It seems the trend is starting to be the 7 doses as its much easier tolerated. Im one of the people who only got 2 out of the 3 doses due to severe side effects of cisplatin. Markus's info is right on target. Best of luck with your husbands treatments and choices.

If I had to do it over again I would go with the weekly. If he does decide to go with the 3 make sure he's on the lookout for ringing in his ears which is damage being done by the Cis. I also would get a pre Tx hearing test to establish a baseline so he can compare it to a post Tx test.

Hi Laurie,
the "disadvantage" is that you need to go 7 vs 3 times. It is also more likely that you end up with a port if you get that many infusions.
I would pay attention to the MD who is more in tune with current treatments. I.e. be careful of the very young and older MDs. (unless the older MD's are current).
so now I have totally confused you!

If it were me I would go for 7 x again. As you can see I started out with cisplatin and had issues (light ringing) even after the very first infusion. So after the second treatment (worse ringing) we had to switch.

M

I don't have a lot of medical info, but I can speak from personal experience. Having a "port" is no big deal. I heardly know it's there. I am doing induction therapy which consists of 3 treatment of Cisplatin, Textara, and 5-fu. I've been told that Cisplatin is very hard on your veins and that is the reason for the port. So whether you do 7day or 3 weeks you may want ask about that aspect of it.

The reason doctor's are giving a 7 lower dosage is to reduce the side effects. Talk to you doctor, but I believe both are equally effective.

From personal experience again. I receive Cisplatin every 3 weeks, however, not concurrent with radiation. I have faired well with this schedule. My experience is that the 1st week is mostly fatigue, lost of appetite, change of taste, and mouth starts to change. 2nd week is when most of the side effect increase. (For me, personally, my pain and discomfort is a 4 on a scale of 1-10) 3rd week, for me, is recovery, everything returns to normal. I really enjoy the reprieve the 3rd week gives me. I just want you to know that not everyone has a terrible experience with chemo. Everyone is different.

Remember also that the chemo continues to weeks after infusion.

One negative aspect is how long you need to spend in the doctor's office to get an infusion. With Chisplatin, you need at least 2 100 mL normal saline which takes 2 hours, an hour for the Cisplatin plus other medications to help with side effects. This is just one aspect of your schedule you may want to discuss.

Another question to ask is how does the weekly Cisplatin affect white blood cells. Possibly a lot less so than the 3 cycles. For me, the Nulasta shot I received after treatment has negative side effects also.

I guess the big question I would ask the doctor is this. Both Cisplatin and radiation have fatigue and especially mouth sores as side effects. What is the combined effect doing Cisplatin weekly. Does it compound the mouth sores and fatigue. My experience with Cisplatin only is that my mouth exploded the first week but recovered by the 3rd. I must perfer I rather take one shot, and not have to suffer every week from the drug.
But as everyone will say many, many times, each person's experience is different.

Sandy

My husband is doing the weekly Cisplatin. His Oncologist said he felt doing the weekly Cisplatin and every day radiation together would get the best results. Friday is a long.......day. John has radiation at 11am every day. Friday he gets radiation at 11am then goes to receive the Cisplatin at noon. He is being treated at the Cancer Center in the hospital I work at. He generally doesn't get done treatment on Friday until 4pm. It is a long day. John didn't have a port put in. They alternate which arm they are using. He is very nauseous all the time. He is taking both Zofran and Compazine. He hasn't needed any pain meds. Eating is a real chore. He has no appetitie and everything tastes like sh*t. He has a feeding tube but is only using it 3 times a day. He is trying but it is a challenge. Only 3 more chemo treatments and 15 radiation treatments. Wanda

I asked my doctor about this yesterday before the start of my first of the three cisplatin treatments. There is a lot if data that supports efficacy of three infusion vs. weekly. They switch to weekly if a patient can't tolerate the big three or if the patient is older or has other medical conditions that would make it tougher to withstand a bigger dose. We had 2nd opinion from two other CCC and they said the same thing.

The 3 mega dose have been used for a longer time.... so there is more data on it.
If you have any data that directly compare 7 vs 3 applications for H&N cancer together with radiation, then I would be interested to know where that is. The only clinical trial that I found was the European and US studies published in 2004 that used 3x cisplatin in conjunction with radiation.

In many cases the 3 dose option is now not on the table at all, regardless how old and fit you are. Form a pharamacokinetic point of view, especially if you consider the synergism with the daily radiation, the 7 doses make a hell of a lot more sense.

M

Thank you all very much. What a great resource. I'll share it with my husband. God Bless.

I had the 3 doses of Cisplatin. The hearing test indicate some hearing loss at high frequency but I don't notice. I had no other physical problems with it. I did Chemo concurrent with Rad, so the Chemo days were long but I was able to work on the computer, read, walk around while they did the chemo and the other bags. There protocol was to do 3-4 days worth of IV's after Cisplatin. Can't remeber all the stuff..Potasium,etc. Everyone reacts differant but I didn't have much of a problem. I don't know about any weekly vs 3 times comparison studies.

I had induction chemo 6 weeks of taxol Erbitux and carboplatin.
I then had 7 eeks of radiationwith doiuble sessions on fridays
I had Cisplatin during radiation daily mon-fri on weeks 1,4,and 7 when i asked back then my doc said it was the new a withthe best results but ihavent read anyneelse having Cisplatin dailey like that. By the way i had no problems.

Well mine sounds different than the rest. We couldn't start radiation right away due to teeth removal, so I had induction chemo of Cisplatin and Taxotere. Three weeks later I started daily radiation and another Cisplatin. I had two more Cisplatin doses, three weeks apart. With the chemo I had Emend, an anti-nausea drug that worked incredibly well! I had what I called queasiness for a day or so after each treatment. I never got sick from the chemo. I lost my hair due to the Taxotere and I have permanent ringing in the ears and high frequency hearing loss from the Cisplatin. I had these symptoms but recovered from the first three treatments but the fourth caused the permanent damage.

Chuck,

I lost my HF hearing after ONLY 3. Man I don't think I could have handled 4 Cis' and the Emends didn't work for me after Cis #2.

BTW did they test you for HPV?

Did you have a ND?

Haven't checked back for a while. The cancer did come back positive for HPV. What is ND?

ND = neck dissection (removal of lymph nodes in the neck to check for spread).

No ND. It was orginally in the plan, but after treatment they changed their mind.

The three treatment plan with Cisplatin was pretty much the gold standard for many years. I read a report that 2 would work as well. Lately they have been doing smaller and more frequent doses, more than likely due to the nephrotoxicity (kidney damage) aspect. It is also easier to manage the nausea with smaller doses. Cisplatin is some nasty stuff. Be SURE to stay hydrated to protect your kidneys. The drug is also more efficacious when you are properly hydrated.

I had 8 weekly Cisplatin doses and really had very few problems from the chemo. Our CCC (James Cancer Hospital @ Ohio State) was a big proponent of the weekly doses. Worked for me, as I am coming up on 3 years. ;-)

andy did both. 3 rounds cisplatin and weekly doses w/IMRT. the weekly doses were much more tolerable with less side effects.

Moffitt is still sticking with the 3 bags.