Bilogical medicines

janenz00

Hi,

 

I have another post here - http://csn.cancer.org/node/251404 - which explains all these questions are on behalf of my father. This is a quick one - Has anyone here treated with Biological medicines along with Chemo?

My father's docs gave him three options:

 

1) Radio + Chemo 6 weeks but will  be tougher for the patient

2) Chemo 6 weeks after 7 weeks radio (Will have normal side effects)

3) Chemo + Biological Medicines for 6 weeks. Then 7 weeks Radio (Lower side effect and recurrence)chance.

 

Any suggestion would be welcome.

 

Thanks in advance,

Jane

longtermsurvivor

Hi Jane

the term "biological medicine" is not restrictive enough to respond to.  If you would please elaborate on exactly what medicines you are referring to, that would be most helpful.  Thanks, and welcome to the board.

 

Pat

janenz00

longtermsurvivor said:

Hi Jane

the term "biological medicine" is not restrictive enough to respond to.  If you would please elaborate on exactly what medicines you are referring to, that would be most helpful.  Thanks, and welcome to the board.

 

Pat

Hi Pat,
 
Thank you. The

Hi Pat,

 

Thank you. The other people I contacted said the same thing. I have asked for more details. Will post as soon as I get it.

 

Thanks,

Jane

corleone

My comment is based on your 3

My comment is based on your 3 options.

Statistically the concurrent chemo (cisplatin) and radiation (IMRT 70 Gy over 35 sessions) therapy is the most effective, if the intent is to “cure”. Besides that, the statistics is not clear if induction (chemo before Rx) or adjuvant (chemo post Rx) is more effective. Also, the targeted therapy (e.g. Erbitux) is somewhat in uncharted territories, and it is more or less experimental. Each medical center has different experience and they would proceed accordingly.

My personal opinion - I would go with #1 (if general health allows, because it has the most side effects, unfortunately). I had that too, plus 3 chemo sessions (carboplatin + 5FU) post concurrent chemo + Rx (but that depends on the stage (mine was T2N2)).

 

Skiffin16

Welcome Jane...

I was STGIII Tonsils and a Lymhnode...

Tx was nine weeks of Cisplatin, Taxotere and 5FU (three week cycles), then concurrent seven weekly doses of Carboplatin and 35 dailys rads...

It's rough, but very doable..

Dx in January 2009, Tx ended mid June 2009, all clear since..

It's always a hard call, I'd go with what your MD's recommend and they have had the mose success with.

Best ~ John

 

blackswampboy

corleone said:

My comment is based on your 3

My comment is based on your 3 options.

Statistically the concurrent chemo (cisplatin) and radiation (IMRT 70 Gy over 35 sessions) therapy is the most effective, if the intent is to “cure”. Besides that, the statistics is not clear if induction (chemo before Rx) or adjuvant (chemo post Rx) is more effective. Also, the targeted therapy (e.g. Erbitux) is somewhat in uncharted territories, and it is more or less experimental. Each medical center has different experience and they would proceed accordingly.

My personal opinion - I would go with #1 (if general health allows, because it has the most side effects, unfortunately). I had that too, plus 3 chemo sessions (carboplatin + 5FU) post concurrent chemo + Rx (but that depends on the stage (mine was T2N2)).

 

we aren't statistics

because our cases vary widely, going "statistically" just isn't very useful.

cisplatin has certainly been in use a lot longer, but to call erbitux 'experimental' is more or less inaccurate...

I was given a choice between cisplatin and erbitux, and grilled my onc for his opinion about efficacy of both. he wouldn't say that one would be more effective than the other for my case. at any rate, in my case the heavy lifting was done by rads, enhanced by chemo.

btw, there has been at least one indirect comparison (research published in 2011) of the efficacy of erbitux and cisplatin in SCC of the head and neck.

"RESULTS: There was little evidence of superiority of either platinum-based radiotherapy or cetuximab-based radiotherapy. All estimated hazard ratios were near 1.0 (equivalence), all confidence intervals spanned the null value (1.0), and no consistent pattern was observed regarding the direction of the effect. The results remained robust in sensitivity analysis.

CONCLUSION:

This is the first quantitative analysis allowing formal comparison between cetuximab and radiotherapy versus cisplatin and radiotherapy. Based on state-of-the-art methodology for indirect comparisons, it was not possible to identify either treatment regimen as superior in prolonging either locoregional control or overall survival. Until the publication of more studies, and particularly a head-to-head comparison, the two treatments may be considered equally efficacious when given alongside radiotherapy. The choice of treatment may focus on the toxicity profile of the medications."

your mileage may vary. so forget the statistics, and go with your doc's recommendation.

ToBeGolden

For What Its Worth

A year after initial radiation (only), I had a totoal laryngectomy, removal of vocal cords. This was followed by more radiation given with both erbitux and cisplatin. 8 months later a PET and biopsy showed the cancer has metastasized to the lungs. So some cancers are impossible to beat. On the up side, I had little trouble with the second ratiation + erbitux + cisplatin. Maybe, if I had more trouble with the sideeffects, the treatment would be more effective.

I debated about posting such a negative experience. But on consideration, I think patients need all the information they can get. Rick.

Skiffin16

ToBeGolden said:

For What Its Worth

A year after initial radiation (only), I had a totoal laryngectomy, removal of vocal cords. This was followed by more radiation given with both erbitux and cisplatin. 8 months later a PET and biopsy showed the cancer has metastasized to the lungs. So some cancers are impossible to beat. On the up side, I had little trouble with the second ratiation + erbitux + cisplatin. Maybe, if I had more trouble with the sideeffects, the treatment would be more effective.

I debated about posting such a negative experience. But on consideration, I think patients need all the information they can get. Rick.

All Different...

Unfortunately, and I know you are aware, so not directed toward you, as much as you feeling to explain why you considered a negative reply...

It wasn't, it was a truthful and applicable reply...

We are all different, we all respond differently, an unfortunately, sometimes, we get the crappy end of the stick.

That being said, I hope they can find something to shake the crap off of yours...

Best ~ John

 

 

corleone

blackswampboy said:

we aren't statistics

because our cases vary widely, going "statistically" just isn't very useful.

cisplatin has certainly been in use a lot longer, but to call erbitux 'experimental' is more or less inaccurate...

I was given a choice between cisplatin and erbitux, and grilled my onc for his opinion about efficacy of both. he wouldn't say that one would be more effective than the other for my case. at any rate, in my case the heavy lifting was done by rads, enhanced by chemo.

btw, there has been at least one indirect comparison (research published in 2011) of the efficacy of erbitux and cisplatin in SCC of the head and neck.

"RESULTS: There was little evidence of superiority of either platinum-based radiotherapy or cetuximab-based radiotherapy. All estimated hazard ratios were near 1.0 (equivalence), all confidence intervals spanned the null value (1.0), and no consistent pattern was observed regarding the direction of the effect. The results remained robust in sensitivity analysis.

CONCLUSION:

This is the first quantitative analysis allowing formal comparison between cetuximab and radiotherapy versus cisplatin and radiotherapy. Based on state-of-the-art methodology for indirect comparisons, it was not possible to identify either treatment regimen as superior in prolonging either locoregional control or overall survival. Until the publication of more studies, and particularly a head-to-head comparison, the two treatments may be considered equally efficacious when given alongside radiotherapy. The choice of treatment may focus on the toxicity profile of the medications."

your mileage may vary. so forget the statistics, and go with your doc's recommendation.

@blackswampboy

In general I agree with what you’ve said, except for “forget statistics”. I’ve got your point, but the medical opinion and decision is (regardless of what we want) strongly biased and based on the statistical results (from clinical trials).  The treatment protocols are issued based on those results; the treatment then is tailored based on the specifics. The issue that I have here is that these protocols are not necessarily updated to take into account the most recent results.

janenz00

HI All,My family is picking

HI All,

My family is picking the 3rd option - Chemo ( Docetaxel, Cisplatin and 5-FU) + Biological Medicines for 6 weeks. Then 7 weeks Radio. Has anyone undergone BioMap along with chemo? More specific term would be kinase inhibitors. 

 

Thanks,

Jane

 

blackswampboy

corleone said:

@blackswampboy

In general I agree with what you’ve said, except for “forget statistics”. I’ve got your point, but the medical opinion and decision is (regardless of what we want) strongly biased and based on the statistical results (from clinical trials).  The treatment protocols are issued based on those results; the treatment then is tailored based on the specifics. The issue that I have here is that these protocols are not necessarily updated to take into account the most recent results.

stats

you're right, my "forget stats" was a bit clumsy.

I've no issue with skilled medical pros using current stats to assist judgement for specific cases/circumstances.

but us laypersons digging up five-year-old survival rates off the internet...not so good. 

in the end...we still have to trust our doctors. and even when given bad odds, we owe it to ourselves to believe that we are among the positive exceptions to the stats.

blackswampboy

janenz00 said:

HI All,My family is picking

HI All,

My family is picking the 3rd option - Chemo ( Docetaxel, Cisplatin and 5-FU) + Biological Medicines for 6 weeks. Then 7 weeks Radio. Has anyone undergone BioMap along with chemo? More specific term would be kinase inhibitors. 

 

Thanks,

Jane

 

kinase inhibitors

yes, I believe that the above-mentioned erbitux (cetuximab) is considered a kinase inhibitor (inhibitor of EGFR-associated tyrosine kinase). erbitux is also known as a monoclonal antibody, or targeted therapy. but never heard it called biological medicine, and haven't heard of biomap.

a whole bunch of us have had erbitux, and there are loads of related threads. there are other kinds of targeted therapy drugs too.

best wishes!