3 rounds versus 4 rounds of cisplatin/vinerolbine info please - 1263239

jojokie
Posts:6

I've tried to do a search but there just seems to be a lot of info out there! I know one of the the gold standard for adjuvant chemo for stage 2b adenocarcinoma T2N1M0 (local 3 out of 8 lymph nodes involved) is 4 rounds of cisplatin/vinerolbine (2 weeks both followed by 2 weeks just vinerolbine) - at least that has been what has been recommended for me. But, is there any info out there that supports just a 3 cycle round of this treatment? I ask only because it's kicking my butt and I'd like to make an informed decision while still in cycle 3 before heading into cycle 4. I know there is the option to go for a carboplatin based chemo but wondering about cutting this treatment short and possible consequences (I know there there are no crystal balls I just want informed information). THANKS

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Reply # - April 14, 2014, 02:43 PM

catdander
Posts:

Welcome to Grace. I can't imagine the difficulty you must be feeling about now. I've helped my husband go through chemo/radiation after surgery. It was hellish for him. So I can imagine your wish to get through this.

I'll ask a doctor to comment. You should hear back within the day.

I hope you get past this cancer,
Janine

Here is a list of blog post and pod casts on adjuvant treatment. http://cancergrace.org/lung/tag/adjuvant-chemotherapy/

Reply # - April 14, 2014, 04:02 PM

jojokie
Posts: 6

Janine, thank you so much for your response. I've read through a number of adjuvant chemotherapy links on this wonderful site. I guess I was just hoping for some evidence that 3 rounds can be just as effective as 4 rounds of cisplatin/vinerolbine. I know it's probably not the case but there must be some who only have 3 rounds and do okay. Perhaps a bit of wishful thinking. Take care and again thanks for your quick response.

Reply # - April 14, 2014, 05:45 PM

Dr Laskin
Posts: 34

Hi
I'm sorry to say that i know of no clear evidence to say that 3 cycles is just as good as 4; on an individual patient level of course we never know if you even needed it to begin with ! Not something you might want to hear after enduring the first few cycles though overall that is a positive message.

The 4 cycles is mostly based on our experience with the amount of chemo people can tolerate when they have metastatic disease. and in metastatic disease we usually think most of the benefit is seen with the first 2 cycles....but we still recommend 4.

The most important points are:
1. this is your life, if the chemo is horrible you do not need to have it. you've had a lot of it, most of it. that's much much better than nothing.

2. the chemo is being given to increase the chance of being cured. maybe 3 is enough. but - if if if the cancer does come back next year are you going to blame yourself for not taking that last chemo EVEN though you know it's probably not making that difference. it's about minimizing regret.

i hope that helps. sorry i can't just say "yes quit!"

Dr Laskin

Reply # - April 14, 2014, 06:27 PM

Dr West
Posts: 4735

Actually, there is some retrospective data from the NCI-Canada trial, a report ultimately published by Pepe and colleagues (described here: http://cancergrace.org/lung/2007/01/29/adjuvant-chemo-in-older-patients…) that showed that older patients derived a benefit of chemo every bit as good as younger patients (the cutoff being a rather uncharitable 65), but also that the patients who stopped part-way through also did just as well as those who received 4 cycles.

In some trials, the goal is to just get in 3 cycles of platinum-based treatment, as we recognize that this is just an arbitrary goal. Some studies consider it very good if patients get in 3 or 4 cycles. Recognizing that there is very likely a point of diminishing returns around this point and that the benefit of adjuvant chemotherapy is likely quite "front-loaded", I'm OK with my patients stopping after 3 cycles if toxicity is increasing quickly or a patient simply feels a desire or need to stop.

Good luck.

-Dr. West

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