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3rd Round of Cisplatin

iluvbeagles
Posts: 8
Joined: Jun 2013

My husband is being treated for Stage 4a tonsil cancer (HPV - SCC) with 30 rounds of radiation and 3 rounds of Cisplatin (at the beginning, middle and end of the RAD treatments). He finished his last RAD on Wednesday 6/12 and was to have his 3rd round of Cisplatin on Tuesday 6/11 but lab report showed low white cell, red cell and other counts. Tested again yesterday and his counts were even lower. Is there a window of time during which he must receive the 3rd chemo infusion? I am hoping he improves over the weekend, but can't get an answer as to whether or not they will do blood work on Monday to see if is counts are high enough to allow them to do the 3rd round then. His chemo oncologist is away on vacation and we are being told that alot of patients miss the third round of chemo with little or no impact on the outcome. My husband doesn't want to give up. The third treatment is important to my husband. We feel that it must be important since it is in his treatment plan.  I am concerned that there is no discussion about other options.  I inquired about a "booster" shot to help his counts recover, but was told that since he had radiation they can't administer any "booster" due to heart/cardiac risks. 

Is there a window of time during which he must receive the 3rd chemo infusion?

Has this happened to anyone here, and where you provided with any options? 

Does it make since for me to ask if there are other chemo drugs that could be given instead of the Cisplatin, or other treatment options to address my husband's concern about not getting the 3rd infusion of Cisplatin?

 

Many thanks,

Mary

KTeacher
Posts: 993
Joined: Jan 2011

but, this is what happened during my treatment.  I developed a sinus abcess a few weeks into chemo and rads, had to stop and go to Stanford, ended up in the hospital for a few days--surgery and IV antiobotics.  Returned home.  Continued with rads and chemo when my blood counts were ok.  I missed a few chemo treatments but did finish.  In the end I needed to get hydrated and 2 units of blood.  I faught the blood but it really helped.  I know that others have had a shot to perk up the white count.  Is your husband having cardiac issues?

I had cisplatin once a week and radiation daily for 6 weeks (with a little vaca in the middle due to infection).

iluvbeagles
Posts: 8
Joined: Jun 2013

Hi KTeacher.  Thanks so much for your reply.  No, my husband doesn't have cardiac issues so I don't understand why he couldn't get a shot to perk up the white count.  But maybe there is about his situation that I am not aware of that precluded him from receiving that type of treatment.  I will have to see when his chemo oncologist returns to the office next week.  He was away and the "fill-in" doctor wouldn't make any decisions or discuss this with us. It just isn't right that my husband had no access to a chemo oncologist for an entire week at a critical point during his treatment plan, but that is something we will also discuss with his doctor during our next visit.  I just wanted to see if other people whose treatment plan included chemo and radiation received treatment of any sort to help with the white count.  Again maybe there is something to my husband's situation that I am not yet aware of.  We shall see what the doctor says next week.

I hope you are doing well, too!  And thank you again for sharing.  You all are so helpful.

Mary

Skiffin16's picture
Skiffin16
Posts: 8104
Joined: Sep 2009

I was STGIII Tonsils and HPV+ also..., January 2009...

Had three rounds of Cisplatin, Taxotere and 5FU (TPF), then seven weeks of concurrent weekly Carboplatin and daily rads (35)...

It probably won't matter as for a lesser or alternative chemo if his blood counts are down..., they won't give him any.

But, have you asked, or they offered a Neulasta Injection...? Neulasta was given to me a few days after each of the doses of TPF.. It boosts the blood cell counts in the bone marrow... Something to ask about or consider...

Again, welcome...

Best,

John

iluvbeagles
Posts: 8
Joined: Jun 2013

Hi John.  Thanks so much for your reply.  I kinda figured they wouldn't administer another form of chemo while his counts were low...just wishful thinking that there was something they could do.  I will definately ask about a Neulasta Injection.  I honestly didn't know exactly what to ask for by name, but I did ask if they could give him some type booster shot or other type of treatment to help his counts recover and they said no. 

Thank you very much for welcoming me to the board and for the above information. I hope that you are doing well. It is so nice of you and all of the other wonderful people on this forum are here to offer support, information and suggestions.  It is so helpful to hear what others who went through this have to offer.

 

Thanks again,

Mary

donfoo's picture
donfoo
Posts: 1329
Joined: Dec 2012

I've not the personal details for treatment plans that change but I have seen it numerous time. In the case of patient just too ill to keep going, actually I was scheduled for up to 4 rounds of chemo. The last one nearly "killed" me so I think everyone agreed this sorry sucker got enough chemicals, don't want him too weak for teh follow on chemo-radiation.

Sometimes if you are on Cisplatin they will swich to carboplatin(both patimum) or Erbitux. Many patitens survive fine and are not mpacted in any major shortfall in efficay of treatment therapy due to some "slight" variation; how much I have not a clue.

I do know one of the key reasons for administering cisplatin with radiation is the chemical acts as a radiosynthesizer, meaning the radiation can beat your butt extra hard with the platimum. The chemo here is not for killing cancer.

fishmanpa's picture
fishmanpa
Posts: 1134
Joined: Jan 2013

While the chemo (Cisplatin & Carboplatin) is a radio sensitizer to assist the radiation, it also is used there to eradicate any stray cancer cells that may have survived and gotten away from the initial infection or tumor site. The way it was explained to me is the chemo drugs attack the cancer essentially freezing them in an open and vulnerable position during reproduction. Then the rads come along and fry 'em! Any cells the chemo attacks in the body away from the rads get frozen in that vulnerable position and die.

"T"

donfoo's picture
donfoo
Posts: 1329
Joined: Dec 2012

"T"

I think this a multi-answer. We agree and everything I have read states chemo administered concurrent with radiation serves this radiosenstizer function. Beyond that it does get less clear because different drugs are called into service. Cisplatin and Carboplatin are platinum based which I understand serves the radiosynthesizer role. Other chemo like Erbitux, even taxols are mixed in so without them you do not have the radiosensitizer funcrtion at all or only partially?

I know in my case, having 7 weeks of induction TPF, preceding the concurrent CRT, the goal of the drugs was to halt, shrink, and even eliminate cancers, both the primary and small cells. By the time chemo was done, all visible swelling of the tumors was gone. Going into CRT at tat point with chemo was purely to serve as a radiosynthesizer, so said the MO. The dosage was pretty low as well carbo 150, so it was too low for it to do duty for killing loose cancers.

Just these simple examples show to me it is sort of ill defined or at least I could not make a logical case for this part of the treatment pie.

Skiffin16's picture
Skiffin16
Posts: 8104
Joined: Sep 2009

My understanding is that the chemo acts to interupt how the cells multiply and replicate, their timing. That's part of why the chemo is given in stages or cycles...

It hits the cancer in various states of trying to replicate and reproduce, so eventually it kills the cycle and the bad screwed up cancer cells die and can't reproduce, but the good cells still can and do regenerate.

JG

fishmanpa's picture
fishmanpa
Posts: 1134
Joined: Jan 2013

JG and Foo...

Same effect, different words... the chemo interupts the cell division... like it's left with it's legs open and the rads come in and kick 'em in the nads!

Because of my heart issues, I was unable to get the induction chemo like many have gotten. Thus the surgery first. The team's logic was 'if we can get 99% out of you then that means less treatment..thus 6 weeks, lesser dose rads... chemo was medium dose 200mg I think..... (didn't matter... still kicked my arse!)

Those left in the spead eagle position eventually die because they can't divide... Hopefully, enough chemo was given in the treatment to catch any and all the rouge cells.... 

That's my biggest concern. My 1st PET was done in Dec 2012. It showed uptake in my neck and a slight uptake right tonsil. I had my those tonsils out in Dec. 2012 and they showed neg for cancer and HPV. Then sel. neck dissection and lingual tonsils removed. No cancer or HPV... the tumors tested pos for HPV. Then treatmet started in March... a full three months from the initial scan. The tumors were extracapsulated. They told me the chemo/rad was to get whatever might be left over in my neck and elsewhere. I won't know until August if it worked for sure.

"T"

buster10
Posts: 2
Joined: Jul 2012

I had the same treatment as your husband...and my counts were too low for the third. It is true that alot of people don't always have the third one and I was told that it was almost just an "extra shot" As it happened I ended up having it a week later...at my request. I just figured what the hell,,if I lose any more hearing (which I did) at least I'll be here to use my ears. Don't worry if he didn't end up getting the last one...if his counts were low, then it's working!

In the end your body decides what treatment you sometimes have and you just have to go along with that.

denistd's picture
denistd
Posts: 517
Joined: Apr 2009

I had a minor wait of 4 days after rads to get the last high dose cisplatin as my blood count was really low and my kidney creatinine levels were higher that the doc would have liked. Had a transfusion roughly 5 weeks into chemo and rads. When I got my last dose of chemo they kept me in the hospital overnight to monitor those levels. The kidney function did become impaired and creatinine levels remain elevated, so there were some lifetime repercussions with the kidneys, but that was four years ago and today my creatinine levels have become stable. Low white cell blood counts, I was told, showed that the treatment was working. Denis

iluvbeagles
Posts: 8
Joined: Jun 2013

Hello All~

 

Thank you so much for taking time to respond to my post.  I appreciate it so much.  You all are both very informative and, in some instances, entertaining.  It’s heartwarming to “meet” so many people who are willing to share their knowledge and experience.  Hope I’m not too mushy for ya!

 

Your comments are very helpful.  If my husband’s counts recover by next week, he is going to request the 3rd round of Cisplatin (or another chemo drug if something else would be more appropriate).  And as you all indicate, if his counts don’t recover it’s just not meant to be.  Though tough to accept.

 

Thanks again.  Your comments are much appreciated.

Mary

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