Any insight into # platinum chemo cycles?

[skiingfiend]

So I'm about to start cisplatinum + etoposide chemo cycles on wed. next week for NECP/SCCP.

The first irritant I have of which I'm sure will not be the only one is:

I have no idea what the treatment plan is, I don't know how many cycles I'm scheduled for and what the treatment goal is.

Researching BC Cancer protocols I find:

- pallative 3 Cycles

- curative 4 Cycles

Also based on comments to some earlier posts I see guys have undergone

- clinical 6 Cycles

I think 3 and 4 Cycles are SOC and 6 Cycles is customized based on clinical factors.

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My suspicion is that they are going to offer me 3 Cycles.

What should I be pushing for?

What does 6 buy you over 3/4?

Is there a case for even more aggressive numbers, more than 6?

[antisocialsocialwrkr]

Hi, for my dad, I believe he was initially told he would be doing 3-4 cycles because they said many can’t tolerate past that. His scans after those first few cycles showed a big reduction in his liver tumors..plus, he had tolerated it well so they increased it to 6 cycles. My dad is young and has always been very active and healthy so I think that helped. However, those last few cycles really beat him up and didn’t decrease his tumors much more. Hope this helps!

[skiingfiend in reply to antisocialsocialwrkr]

Thank you, yes it does.

[skiingfiend]

Here is the positioning I have taken with MO:

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1. I am aware of a number of Phase 1/2 trials in the NEPC/SCCP space, which has been an underserved segment for many years, but there is a growing awareness that more needs to be done. I am preparing a package of what look like the most promising trials.

2. What is my treatment plan for chemo? Specifically how many cycles are planned?

I am aware that BC cancer protocols stipulate 3 cycles for palliative and 4 cycles for curative.

I am also aware that in US clinics upto 6 cycles have been given.

I am not prepared to accept a treatment plan of 3 cycles and then off to hospice.

I am interested in pursuing a strategy of 4-6 cycles and then follow with 1 or more clinical trials.

[TeleGuy in reply to skiingfiend]

I think that for #2 you have to take it as it comes and decide along the way based on your response and side effects. Hopefully that will be your MO's plan as well, assess whether or not to continue based on how you are handling it and what impact it is having.

[skiingfiend in reply to TeleGuy]

Yes I agree.

My experience with them is I need to push them to get them to get them off their default position, which is this case is probably 3 cycles. By trying to push them out to 6 cycles hopefully I can land on what you are recommending.

[TeleGuy in reply to skiingfiend]

Since you say you are stuck with your MO, then you might take a softer approach of saying "I'm assuming that we will do the number of cycles needed to suppress my disease as long as I can handle the side effects." I did 6 cycles of carboplatin+docetaxel (I have NE differentiation) and I was happy to stop there.

[skiingfiend in reply to TeleGuy]

Things are working out. I've got a new Consultant on my case and here is his response to my letter above:

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...

I think the way to go is still to start off with platinum chemotherapy. This can be with either carboplatin/etoposide, or carboplatin/docetaxel or carboplatin/cabazitaxel - the exact regimen we can decide after I've reviewed the biopsy.

As for how many cycles, I think we gauge that based on tumour response. I generally aim to give 4-6, and will look to do a repeat CT scan after 3 cycles. If the cancer is shrinking considerably then, that provides rationale to push to 4-6. If the response has been modest or the tumour is growing, pushing to 4-6 doesn't make sense, and we should think about other treatment options.

Let me know when you want me to take a look at the trial package you are putting together. I was recently down in San Francisco and was listening to Dr Himisha Beltran, who is a leader in the field of NEPC.

She was presenting some data about targeting DLL3 which may be of interest to you

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This is finally starting to look like proper cancer treatment planning and care. I'm actually having a 2-way conversation with a doctor for the 1st time in a year.

[CAMPSOUPS in reply to skiingfiend]

👍👍👍

[SimplyT]

I completed 6 cycles a year ago. Just finished round 1 of my second go with chemo after recent reoccurrence. Tolerated pretty well the first time last year. Not sure what this second round holds for me. My experience, bad hangover without the party 48 hrs or so after treatment.

[skiingfiend in reply to SimplyT]

Did you do 21 day cycles with 5 days chemo followed by 16 days off?

Based on you profile it looks like you got your chemo as part of the CHAMP trial, is that correct?

[SimplyT]

I did one round of both chemos every 3 weeks, Carboplatin and Cabazataxil.

Yes, I completed 18 treatments in the Champ study. The chemo ended after 6 rounds due to remission and I remained on the immunotherapy until reoccurrence on scans.

[skiingfiend in reply to SimplyT]

1 round = 1 day?

Did you do CHAMP before or after basic chemo?

[SimplyT]

Chemo regimen was part of the Champ trial.

[SimplyT]

Yes, one round was one day with the 2 drugs

[skiingfiend]

I'm really happy to have Ed back on my case. He is an outstanding young doctor and researcher from Australia doing a stint in vancouver. He started on my case at the beginning but then got reassigned. I trust him implicitly.

linkedin.com/in/edmond-kwan...

[TeleGuy]

This is good news, and is the "figure it out as you go" approach that can adapt to what happens in treatment. If carboplatin does as well as cisplatin for your liver mets, carboplatin is much less toxic. Adding etoposide is more typical for small/NE cell tumors, docetaxel and cabazitaxel more target the PCa side.

I mentioned that I was hoping to do something with DLL3, but my biopsy doesn't show the cancer exhibiting DLL3. I'm sure that you have seen that there are radioligands and also immunotherapy (HPN-328 BiTE) options in trials.

[j-o-h-n]

From a diamond in the rough to platinum. Holy shit..... that's a promotion..........

Good Luck, Good Health and Good Humor.

j-o-h-n

[skiingfiend in reply to j-o-h-n]

Maybe as a side effect after treatment my emissions will be less toxic.

[j-o-h-n]

"In days of old, when knights were bold"...............

Good Luck, Good Health and Good Humor.

j-o-h-n

[skiingfiend in reply to j-o-h-n]

“Whether 'tis nobler in the mind to suffer

The slings and arrows of outrageous fortune,

Or to take arms against a sea of troubles,

And by opposing end them?”

[Hotrod65]

Did you indicate your small cell Neuroendocrine??

[skiingfiend in reply to Hotrod65]

Don't know yet, liver biopsy is Monday afternoon. Better visibility after that.

[Ian99]

Really pleased to see you have an MO you trust and a serious treatment plan. Good luck.