Chosing a Chemo drug for a musician Carbo vs Cisplatin

Portal Forums Member Updates Head/Neck Cancer Member Updates Chosing a Chemo drug for a musician Carbo vs Cisplatin

This topic contains 3 replies, has 3 voices, and was last updated by  musiciansdaughter 3 years, 5 months ago.

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June 21, 2014 at 2:53 pm  #1264507    

musiciansdaughter

Thank you for your help!

My dad (non-smoker, age 69, no chronic conditions, otherwise very healthy) has head and neck cancer. They thought they got it all, but his latest scan showed that a few lymph nodes have cancer. The cancer has not spread beyond this, though.

My dad is a professional cellist. This fact is driving many of his treatment decisions.

His docs say that radiation and surgery will be equally effective and, since there is a chance of severing a nerve that controls an arm, they will be opting for radiation and will not be performing surgery.

Both Carboplatin and Cisplatin have a risk of permanent hearing loss, also devastating to a musician. He knows that carboplatin has a slightly lower chance of hearing loss. He wants to keep his hearing if at all possible, but he wants to keep his life more. He is leaning toward carboplatin.

He is very healthy and strong and has no kidney problems (other than occasional kidney stones).

Is it a generally wise choice for a healthy person to opt for carboplatin + 5 FU rather than cisplatin?

June 21, 2014 at 4:24 pm  #1264509    
JimC Forum Moderator
JimC Forum Moderator

Hello,

Welcome to GRACE. I am sorry about your dad’s diagnosis, but it’s good that there is no spread beyond those few lymph nodes. There are various chemo regimens which are used in head and neck cancer, and some of the most recently studied combinations use carboplatin rather than cisplatin. The drug you mention, 5FU, is an older drug which is still used, but carbo is also combined with taxol, docetaxel or abraxane, and cetuximab can also be added as a third drug. You can listen to or read Dr. Weiss’ discussion of these options in this podcast: http://cancergrace.org/hnscc/2013/07/20/weiss-induction-chemo-for-hnscc-pt-1-defining-challenges/

It should also be noted that the frequency of hearing loss and peripheral neuropathy is more than slightly greater with cisplatin than carboplatin. And having a good friend who is an excellent professional cellist, I can understand and sympathize with your dad’s concerns.

Good luck with whichever regimen he chooses.

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

June 21, 2014 at 6:25 pm  #1264513    
Dr West
Dr West

I don’t feel that we could make a recommendation about the right treatment for a person who isn’t our own patient, but Jim is quite right that the difference in toxicity, in terms of both risk of hearing loss and peripheral neuropathy, is far greater with cisplatin compared with carboplatin. Cisplatin would generally be given the nod as being at least slightly more active but carboplatin is simply far less well studied in this setting than cisplatin — hence, it’s definitely going to come down to a judgment call.

Good luck.
-Dr. West

June 22, 2014 at 10:19 am  #1264521    

musiciansdaughter

Thank you both for your help. This is a very scary and confusing time for our family.

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