Carboplatin alone (monotherapy) ?

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daxys
Carboplatin alone (monotherapy) ?

My mum's oncologist decided that the next line of the treatment for my mum will be carboplatin monotherapy. The reason for carboplatin alone and not in combination with paclitaxel are low neutrophils (1.59) and low white blood cell count (3.59).
Does anyone know anything about the efficacy of carboplatin alone?
I am really afraid as we had really rapid progression on single agent pemetrexed in 2nd line. Also reports say that chemotherapy with just a single agent is the worst option after first line afatinib. Time on monotherapy treatment reported in retrospective analysis of LUX-Lung trials was just 2.3 months (which means almost immediate progression).

My mums treatments so far are described here: https://www.inspire.com/daxys/
Thanks in advance!

scohn
Carboplatin

Hi daxys. So sorry to hear about your mum's progression, and hope the carboplatin provides some relief. I can't speak specifically to the mono therapy aspect, but my wife was on Carboplatin/Premetrexed and it worked great for her in terms of getting a 50-60% reduction in the tumor. After several rounds of the Carbo/Prem she went on the Premetrexed maintenance, which did nothing (led to progression fairly quickly). So, I assume the complete lack of Premetrexed effectiveness means the effectiveness of the dual combo was due to almost solely to the Carboplatin. Carbo is certainly the stronger of the two agents. My sense is that Carbo alone can also be harsh on WBCs, so make sure your mum's oncologist takes a good watch on those. After the first couple of treatments my wife had to take neulasta, which did a great job of keeping her WBCs up.

All the best to you and your mum!
Scohn

Wife, non-smoker, dx 4/24/15 adeno NSCLC stage IV. HER2 Exon 20. 6x Carbo/Alimta; effect. 9/15 Alimta maint; ineffect. 11/15 - Opdivo; ineffect. 4/16 - ptK7 trial; effective 1.5 yr. 9/17 Gemzar; effective 16 mo. 8/18 -TAK788 Trial. 10/18 start Abraxane. 7/19 start Kadcyla.

btlaw123
repeat of Carboplatin as single agent.

My wife was put on Carbo/Alimta dual chemo from mid Feb 2018 thru 6/1/18 and her systemic cancer totally gone. She was then put on Alimta maintainance from late June 2018 to Sept 2018. The single agent Alimta was not only non-effective her two lymph nodes (one behind her sternum the other below her supraclavicle) grew rapidly to 3 or 4 cm in three month. The Onc was trying to switch her to immunotherapy Opdevo but was delayed because she had to fight another battle front of her occipital lobe mets. Emergency brain surgery on Oct 17, 2018. She was put on Tagrisso in the interim while dealing with post sugery recovery from late Oct thru Dec. Finally started Opdevo first part of Jan 2019. after two cycle of Opdevo, she got all kinds of problems and signs of bad side effects: low GFR, high AST and possible pneumonitis.

Now its only Feb. Since Carboplatin was so effective in controlling her cancer, is it too soon to repeat Carboplatin as a single agent (last use in June 2018)? or is there another possible alternative treatment?

Jim C Forum Mod...
Jim C Forum Moderator's picture
Repeat of Carboplatin as single agent

Hi btlaw,

I'm sorry to hear of your wife's progression and treatment toxicities. Rechallenging Carboplatin after less than a year does pose the risk of cumulative reduction of bone marrow function, which can limit a patient's ability to tolerate further chemotherapy. The incidence of hypersensitivity reactions to Carboplatin also increases after additional infusions. That subject is discussed here: https://www.hindawi.com/journals/mbd/2010/207084/ in which it is noted that "peak incidence of carboplatin reaction is observed during cycle 2 in the second-line setting". Such reactions can be serious. In addition, although it seems logical to assume that the cancer progressed because carboplatin was stopped, each chemotherapy regimen tends to have a period during which it controls a cancer, followed by progression. In addition, it was discovered many years ago that combination chemotherapy, with platinum and another agent, tended to be more effective due to a synergy between the two agents. So we can't necessarily presume that carboplatin was solely responsible for the period of response/disease control.

 

There are other chemo agents which could be tried. The best-tested in the second- or later-line context is Taxotere (docetaxel), but other options include Taxol (paclitaxel), gemcitabene (Gemzar) and Navelbine (vinorelbine). There is also a less-toxic version of Taxol called Abraxane, which my late wife used, avoiding all the typical side effects of Taxol.

 

Good luck with whichever option is chosen.

 

Jim C Forum Moderator

JimC
Carboplatin alone (monotherapy) ?

Hi daxys,

In the early years of lung cancer chemotherapy, it was discovered that combining a platinum agent with another form of chemotherapy tended to be more effective than monotherapy, due to a synergistic effect. Since many patients begin chemotherapy with such a combination, and since platinum agents such as carboplatin tend to cause significant problems with bone marrow function if continued past 4-6 cycles, later lines of chemo tend to be monotherapy with other agents. But if a patient hasn't previously used a platinum agent, or if it's felt that enough time has elapsed since the original platinum agent was used, then there really is no reason you couldn't try carboplatin alone. On the other hand, if pemetrexed was ineffective, there are other chemo agents that could be added to the platinum therapy.

As a side note, if you would like to establish a signature for your GRACE account, you can go to your dashboard and add it there. You may need to edit it a bit, since there currently is a 255 character limit, something I'm looking into to see if it can be changed.

JimC
Forum moderator
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<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>

daxys
Carboplatin alone (monotherapy) ?

Thanks to both of you for your replies. Scohn, I suppose your wife's great response to carboplatin/paclitaxel was in the 1st line (?). Could I ask what her mutation was/is?

scohn
Carboplatin

Hi daxys. My wife has HER2. HER2 is in the same class of molecules as EGFR. She has the most common HER2 mutation, a mutation in Exon 20, very similar to mutations and insertions on EGFR Exon 20. In fact currently she is on a trial drug that was developed to work on both HER2 and EGFR Exon 20 mutations. Yes, the carbo/premed was 1st line, but she also was on Gemzar alone, which works similarly to Carboplatin but not as strongly, as a 3rd line, which also did (mostly) fine for a while.

Wife, non-smoker, dx 4/24/15 adeno NSCLC stage IV. HER2 Exon 20. 6x Carbo/Alimta; effect. 9/15 Alimta maint; ineffect. 11/15 - Opdivo; ineffect. 4/16 - ptK7 trial; effective 1.5 yr. 9/17 Gemzar; effective 16 mo. 8/18 -TAK788 Trial. 10/18 start Abraxane. 7/19 start Kadcyla.