Good morning all.
My mother was diagnosed with Stage 3A Non-Small Cell Lung Cancer. Her upper left lung tumor is potentially resectable There was some discussion back and forth between nivolumab (Opdivo) or chemotherapy as a neoadjuvant therapy. However, oncologists decided on chemotherapy.
On May 11, my mom started her first infusion of cisplatin/docetaxel. Within one day, she began severe ringing in her ears and seems to have lost a bit of hearing. Four days post infusion, she experienced quite a bit of nausea accompanied with vomiting. Also, she is complaining of bone and rib pain throughout her body.
1) Does the ringing in ears subside if we lower dosage?
2) Can the bone pain be a result of the Neulasta injection she received on Friday, 5/13?
3) Do the side effects become more manageable?
4) I'm not one hundred percent sure my mom is a surgical candidate, however, our surgeon feels with therapy, there may be a chance for a left pneumonectomy. Should we switch to a more tolerable chemotherapy in order to keep her body strong for surgery?
Thanks so much!
Reply # - May 16, 2016, 07:48 AM
Hi greekgirl,
Hi greekgirl,
I'm sorry to hear of the side effects your mother is experiencing. Hearing loss and ringing in the ear are common side effects of cisplatin. With regard to dose reduction, Dr. Weiss has said:
"The data on management of cisplatin ototoxicity (ear problems such as hearing and ringing in the ears) is limited and largely based on children. We believe that the effect is dose related, meaning that there is less damage with lower dose. However, even dose-reduced cisplatin can cause hearing loss." - http://cancergrace.org/forums/index.php?topic=9188.msg71690#msg71690
Earlier in that thread, he also said:
"Cisplatin and carboplatin have never been directly compared head to head in adjuvant therapy, but most of us believe that cisplatin has a small edge in efficacy, not a large one. Further, no one has compared the merits of dose-reduced cisplatin vs. full dose carboplatin. However, Cis/Doce is a rough regimen to get through. The goal of good chemo is not only killing cancer cells, but also tolerability. Many oncologists would consider switching to carboplatin a very reasonable option for the patient with bad cisplatin side effects. Carboblatin has much less problems with hearing loss and with neuropathy. Only you and your oncologist can decide on this together, but it may be worth discussing."
Since it's not clear that dose-reduced cisplatin will be as effective as standard-dose carboplatin, it seems reasonable to discuss switching to carboplatin with her oncologist.
Neulasta injections can cause bone pain, and some patients have gotten relief from the pain by taking an antihistamine such as Claritin.
Side effects, in particular nausea and vomiting, tend to improve over time, and it's typical for N&V to start a few days after chemo. Taking anti-nausea meds on a schedule (as opposed to as needed), taking a walk in the fresh air and eating small snacks as opposed to large meals can help.
JimC
Forum moderator
Reply # - May 16, 2016, 07:51 AM
Also, as you say there is
Also, as you say there is value in using a chemo regimen that is tolerable, not only for quality of life and ability to complete the planned treatment (side effects prevent some patients from doing so), but also so that the patient is ready for surgery as soon as possible.
JimC
Forum moderator
Reply # - May 16, 2016, 05:21 PM
Hi Jim!
Hi Jim!
Thanks so much for the link and info. Since lower dosages doesn't seem to lessen the ear pain, hearing, and buzzing in ear side effects, I'll speak to oncologist about this the following week and maybe she can switch to carbo/doc. It seems that my mother has most difficulty with both her ears right now.
Thanks, again.