Chemo and Multiple Allergies - 1264733

Hi Barb, Welcome to Grace. I hope you move through this site and your cancer in just the next couple of months. It's true allergic reactions can become more pronounced with more tx. Studies show the benefit from adjuvant to be on the lower side of 4 cycles and specialists are quick to consider fewer cycles if problems arise. I'll ask our pharmacologist to comment.

I wonder if you had a conversation with your oncologist about a different companion drug than paclitaxel or taxanes in general. The doublets you've had are well studied and used often though other combos are used and thought to be effective as well.

There is much debate over cisplatin and carboplatin but it is pretty readily agreed that if cisplatin is not tolerable carbo is easily a close second, many docs even believe they are too close in efficacy to matter even if both are tolerated. Dr. Wakelee is one of our contributing faculty here at Grace and she has written this excellent blog post on the subject of adjuvant therapy. The 4th pp under Chemotherapy Specifics she wrote, "Navelbine is given weekly for 2 weeks in a row with 1 week off, or other strategies are possible. Though many of the studies have used vinorelbine, we know that in patients with metastatic (more advanced) lung cancer, other drugs can work as well as or perhaps better than Navelbine, and these drugs are often substituted. The other drugs that are typically used are Taxotere (docetaxel), Gemzar (gemcitabine), Alimta (pemetrexed), and sometimes others. These choices need to be discussed between each patient and physician to decide which chemotherapy drugs are the right ones for a particular person." Note that Alimta is given to non squamous histology only. http://cancergrace.org/lung/2010/05/17/systemic-therapy-for-resected-ns…

Best hopes to you,
Janine

Thanks for the clarification on "crazy" -- I thought that was a little much.

I'd underscore that we tend to be pretty comfortable with substitutions as needed -- in the stage IV setting, results with many different platinum-based doublets, whether with cisplatin or carboplatin, produce results that are far more similar than different. Several of the carbo-based regimens have actually shown results that are very similar in magnitude of benefit as what we see with cisplatin, but those trials have generally been smaller and underpowered to show significant benefits, but in this case "absence of proof isn't proof of absence". I wrote a post about my conclusion that carboplatin-based regimens are really a fair substitution for many patients:
http://cancergrace.org/lung/2011/08/12/sacrilegious-thoughts-on-adjuvan…

At the same time, there are no trials that say we need to get 4 cycles of chemo into patients. The available evidence actually shows that patients who stop after 2 or 3 cycles do just as well, and I do believe that there is a clear point of diminishing returns, so the benefit is greatest with the first 1-2 cycles and of a lower magnitude with each subsequent cycle. This issue is touched upon in this post I wrote many years ago:

http://cancergrace.org/lung/2007/01/29/adjuvant-chemo-in-older-patients…

I hope that helps.

-Dr. West

Barb,

I will supplement Dr. West's thoughts with a few more comments specific to drugs and genetics...
Paclitaxel reactions are somewhat common and oncologists and infusion nurses know how to handle them. Without any premedications, about 30-40 % of people will have an allergic reaction to paclitaxel, but with steroids and antihistamines (like dexamethasone and Benadryl) this decreases to about 4%. The majority of these are on the first dose and it decreases with each subsequent dose (with most drugs like paclitaxel) as the body gets sensitized to the drug.

For many chemotherapy drugs, people who have environmental allergies or drug allergies (like to penicillin) may have a higher rate of reactions, though this is not always consistent across trials. We definitely know that not all people break down or respond to drugs the same and there are many examples of known genetic changes that can explain some of these differences, including people who develop hearing changes or nerve damage to drugs like cisplatin. It sounds like your doctor is taking good precautions to prevent allergic reactions and you may just be "more sensitive" to drugs because of your genetics. Hopefully, some day, we will be able to genetically profile people before they even get chemotherapy and use these results to tailor drug selection and toxicity management. Unfortunately, we are not there but many places are working on it.

Best wishes on your next cycle,
Dr. Walko

Barb, I'm very sorry you experienced that. I've been told how scary that is.
Here's to hoping that you've had enough treatment and can move past your cancer experience.

Janine