newbie - 1258153

Not sure where the rare staining comes in, but they all fall in with adenocarcinoma. I just wanted to let you know there is a support group on a site called Inspire under Lung Cancer Survivors. There we share all kinds of info. This site is for specific medical questions answered by Lung Cancer Specialists. I come here often for my medical questions and have always loved this site and all the staff ever since I've joined. Where are you being treated? Is this a lung cancer specialist? I only ask because the general chemo now for adeno would be either of the platin drugs-carbo or cisp with alimta (pemetrexed). It's started at a lower dose if you're doing radiation at the same time and then increased after chemo. The two your talking about can be a rough doublet, especially the cisplatin. I can go on and on, but don't want this to end up being a book. Join Inspire and we can talk more.I'm sure someone here will chime in and give you links to first line treatment, etc. Wishing you the best. Take care, Judy

Hi Sandy,

Welcome to GRACE. I'm sorry to hear of your diagnosis, but glad to hear that your surgery went well and that you are feeling great. That should make your treatment easier to tolerate. As you say, everyone reacts to it differently and I hope you are one of those for whom it doesn't cause significant side effects.

With regard to cisplatin, Dr. Weiss has previously stated:

"Here are the preventatives that I believe in with cisplatin:

Renal prophylaxis- IV fluid before and after chemotherapy. Mannitol with chemotherapy. IV fluids days 2 and 5 for patients with pre-existing kidney problems, trouble keeping up with fluids during chemo or creatinine bump during chemo.

Electrolytes- Magnesium. Regular monitoring of other electrolytes, especially potassium. Prophylactic potassium reasonable as long as potassium is not elevated to start.

Nausea prophylaxis- Steroids and 5HT-3 antagnosist (ideally aloxi, if not zofran) with chemo. Emend if possible. Steroid taper following chemotherapy for patients who still have trouble with nausea in the few days after chemo or severe fatigue believed to be due to abrupt withdrawel of higher doses of steroids.

Hearing prophylaxis- The question, "How's your hearing?" Audiogram pre-chemo if answer is anything other than, "normal," or "great." - http://cancergrace.org/forums/index.php?topic=7718.msg56834#msg56834

Good luck with your treatment.

JimC
Forum moderator

Sandy,

Dr. Gadgeel described the side effects of similar treatment:

"Common side-effects of this treatment

Nausea/Vomiting – Usually can be well controlled with appropriate anti-nausea medications

Fatigue – A general sense of tiredness is experienced by many patients about 1 or 2 days after the chemotherapy. The extent of the tiredness varies from patient to patient. This symptom generally lasts for 2-4 days with the intensity of the tiredness reducing with every passing day. It is possible that the extent of the tiredness may be worse with each subsequent round of chemotherapy

Lowering of blood counts, particularly whiteblood cell count – The lowering of white blood count is usually for only few days, which is less worrisome than a situation in which the white blood cell count is very low for a week or longer, as is typical in treating leukemia or some other cancers. However during this typically brief time of low blood cell counts, the patient is at higher risk for getting an infection. If a patient during this period gets an infection, then the infection could spread in the body very rapidly, since the number of white blood cells is not adequate to fight it, so intravenous antibiotics are needed. It is therefore very important that a patient on chemotherapy go to the emergency room right away if they get a fever of 101°F or more at anytime during the treatment period. The probability of this happening is very low, less than 5%.

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Esophagitis (inflammation and swelling of the esophagus) – The esophagus connects the mouth to the stomach. It runs at the back of the middle of the chest. Even though radiation doctors have become very good at targeting the radiation only to the cancer, there is some extension of the radiation treatment to the surrounding structures, including the esophagus. This can cause inflammation and swelling in the esophagus, which makes swallowing food painful. Usually this starts about 2-3 weeks into treatment. In most patients this can be managed readily with proper instructions on food intake, hydration with fluids and medications. However, in < 10% of the patients, it may be severe enough that the patient has a difficult time swallowing food or water and may need to be admitted to the hospital for intravenous fluids and other support.

Pneumonitis (inflammation and swelling of the lung) – Some patients may develop inflammation in the lungs, usually in the area of radiation. This can cause coughing, shortness of breath, and fever. This usually happens about 2-6 months after radiation and is felt to be a reaction in the lung to the treatment. In about 10% of the patients, it could be severe enough to require admission to the hospital. Though it can resolve on its own with time, it is severe enough, treatment with steroids may be needed, with oxygen support also sometimes added as well. Most patients recover from this condition significantly or even completely.

Since this side effect may occur even several months after completion of treatment, it is important for the patient to inform their doctors if they develop new cough or shortness of breath and not assume it is an unrelated minor issue such as a cold."

JImC
Forum moderator

I'd just add that, while challenging, the treatment plan you're describing is one that experts would consider completely appropriate. There is no "best" one here -- the patient population is too heterogeneous, and there are too many options to consider -- but what you've outlined sounds like one that any lung cancer expert would nod in agreement to, as long as the person being treated is young, fit, and motivated. I think it's a regimen that would be associated with the best chance of a good long-term outcome that we could provide.

Good luck.

-Dr. West

Just curious, I know it's an older combo, but how many still use it for adeno instead of pemetrexed?
Take care, Judy

Judy, I believe this combo has the best proven cure track record. Though we should wait for the experts to comment, I sometimes get the wrong info filed into my memory if it doesn't expressly pertain to D.

Janine's exactly right. Cisplatin/etoposide remains the best studied chemo combined with radiation for stage III NSCLC, and it is a very appropriate treatment. Cisplatin or carboplatin with Alimta (pemetrexed) is a very reasonable alternative, but a recent trial called PROCLAIM that tested cisplatin/etoposide vs. cisplatin/Alimta was stopped for "futility", meaning that early results showed that there was no way that the Alimta-containing arm would emerge as superior. It may be comparably effective, but we can at least conclude from what little we know now that it isn't significantly better than cisplatin/etoposide with chest radiation for unresectable stage III NSCLC.

-Dr. West

Thank you both for the clarification. It's always a good thing to have more info than less. As we're all different, I was offered cisp/alimta and never offered the cisp/etop. I chose to switch to carbo because of my hearing issues.Take care, Judy