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Gemcitabine+Carboplatine versus Gemcitabine+Cisplatin
I have just been diagnosed with Stage IV NSCL lung cancer with advanced lymph node involvement. Inoperable so I was told but then this was contradicted with "well we could operate but it would not take it away"! Have been offered chemotherapy Gemcitabine plus Carboplatin... or clinical trial BTOG2 currently in phase III in the UK of Gemcitabine plus Cisplatin 80mg versus Gemcitabine plus Cisplatin at 50mg versus Gemcitabine plus Carboplatin AUC 6. Am in total confusion as to what to choose. Have done some internet research on these drugs but still non the wiser. Can anyone advise me on the best combination either from experience or information they may have.
Hi,
The current standard is to use combination therapy with a platinum agent. Both cisplatin and Carboplatin are platinum agents. The current evidence shows a small advantage for Cisplatin for shrinking tumors but the overall performance (meaning how long the tumor is controlled, how long is the expected survival) is the same. Enrolling in a trial would have an advantage of more stringent monitoring (you’ll probably be asked to have more extensive tests, more frequent visits) as compared to regular care. For some patients with lung cancer, there is a drug called Bevacizumab (Avastin) which could be included in the chemotherapy. You can discuss this drug with your doctor if you are a candidate for it. Stay positive.
The current standard is to use combination therapy with a platinum agent. Both cisplatin and Carboplatin are platinum agents. The current evidence shows a small advantage for Cisplatin for shrinking tumors but the overall performance (meaning how long the tumor is controlled, how long is the expected survival) is the same. Enrolling in a trial would have an advantage of more stringent monitoring (you’ll probably be asked to have more extensive tests, more frequent visits) as compared to regular care. For some patients with lung cancer, there is a drug called Bevacizumab (Avastin) which could be included in the chemotherapy. You can discuss this drug with your doctor if you are a candidate for it. Stay positive.
Thank you so much for your reply. I had an up to date CT Scan this week and saw my Oncologist the following day. She said that at the moment it is stable, not growing and there has been no changes since my last scan 2 months ago. This has made me a feel a little more positive and feel it is good news, hope i'm right? We discussed Avastin, which unfortunately is not available on our National Health Service, but she believes it would not be suitable for me at the present time anyway as the lymph nodes involved are close to the heart and there would be a risk of bleeding. So, the plan is a 12 week course of chemotherapy and if it works well for me the possibility of radiotherapy later on and Tarceva too. So now I have to chose which drugs to go with and maybe I'm wrong but I'm thinking that if the Cisplatin works better in reducing the tumors I may have a better chance of the radiotherapy also working more effectively too. I am due to start chemo on 5th November and am thinking I will take my chances on the trial and hoping I will be chosen for Cisplatin although I feel a bit hesitant of the possibility of the increase in side effects of Cisplatin than the Carboplatin, especially as I am presently asymptomatic apart from feeling a discomfort in my chest when breathing deeply and want to try to remain active and continue working as much as I possibly can. I would appreciate your thoughts on this. With many thanks.
Hi,
Your concerns are pretty valid. The increased likelihood of response may have some effect on subsequent radiotherapy in that the area to be radiated may be slightly smaller. If your case is stage 3, then the role of radiation may be bigger (the radiation may be done to improve control of disease and effect survival overall), so you would probably be more willing to take a chance with the Cisplatin. For stage 4 disease however, the role of radiation is palliative, so the extent of radiation delivered would probably not take advantage of whatever gain the Cisplatin could attain. If you have symptoms that is attributed to the size of the mass, a higher chance of shrinking the tumor may be important (but you mentioned that you don’t seem to have any). Ultimately, you’ll never really know until you try it. If you do try the Cisplatin and have difficulty tolerating it, you could consider shifting to Carboplatin. Stay positive.
Your concerns are pretty valid. The increased likelihood of response may have some effect on subsequent radiotherapy in that the area to be radiated may be slightly smaller. If your case is stage 3, then the role of radiation may be bigger (the radiation may be done to improve control of disease and effect survival overall), so you would probably be more willing to take a chance with the Cisplatin. For stage 4 disease however, the role of radiation is palliative, so the extent of radiation delivered would probably not take advantage of whatever gain the Cisplatin could attain. If you have symptoms that is attributed to the size of the mass, a higher chance of shrinking the tumor may be important (but you mentioned that you don’t seem to have any). Ultimately, you’ll never really know until you try it. If you do try the Cisplatin and have difficulty tolerating it, you could consider shifting to Carboplatin. Stay positive.
Hi,
Thank you for your comments. I have been told there was some confusion as to whether it was a stage 3 or 4, apparently due to a new staging system? However they settled on a stage 4. T2 N3 M1. I have seen my CT scan and X-rays and been informed there is a 3.5cm mass on the outside of the upper right lobe, a 5cm mass on the lower right lobe (which may include some infection) and a diagnosis of non small cell - suggestive of squamous cell carcinoma was made from a mediastinoscopy of the lymph nodes. Last weeks scan showed it has been stable for 2 months and no signs of it having spread to the liver, stomach or bones. I realise how serious this is and of course my main concern is a treatment which may give me the best chance of quality of life an prolonged survival and my main worry about the Cisplatin is that the trial is to try higher doses of either 50mg or 80mg. Of course, the computer could pick me for treatment arm Carboplatin anyway so it's all a bit of a lottery! I have until wednesday to decide..... Have never experienced so much trauma or stress as the last 3 months and am very grateful for the advice you have given me so far. Any further comments would be much appreciated in helping me make the decision.
Thank you for your comments. I have been told there was some confusion as to whether it was a stage 3 or 4, apparently due to a new staging system? However they settled on a stage 4. T2 N3 M1. I have seen my CT scan and X-rays and been informed there is a 3.5cm mass on the outside of the upper right lobe, a 5cm mass on the lower right lobe (which may include some infection) and a diagnosis of non small cell - suggestive of squamous cell carcinoma was made from a mediastinoscopy of the lymph nodes. Last weeks scan showed it has been stable for 2 months and no signs of it having spread to the liver, stomach or bones. I realise how serious this is and of course my main concern is a treatment which may give me the best chance of quality of life an prolonged survival and my main worry about the Cisplatin is that the trial is to try higher doses of either 50mg or 80mg. Of course, the computer could pick me for treatment arm Carboplatin anyway so it's all a bit of a lottery! I have until wednesday to decide..... Have never experienced so much trauma or stress as the last 3 months and am very grateful for the advice you have given me so far. Any further comments would be much appreciated in helping me make the decision.
Hi,
The general consensus is to use a platinum agent, which is either the Cisplatin or Carboplatin. My perspective is that the participation in a trial usually means the safety standards are more rigorous. It also aims to individualize the treatment more, which would also be in your favor. It may mean that you would also need to participate more, but this more likely to be in your favor. Ultimately, you will decide upon the dose based on how well your body is able to tolerate the medication. You could inquire if the trial is aimed at evaluating quality of life as well, if it is, then your concerns about this aspect of the treatment are at the forefront. Stay positive.
The general consensus is to use a platinum agent, which is either the Cisplatin or Carboplatin. My perspective is that the participation in a trial usually means the safety standards are more rigorous. It also aims to individualize the treatment more, which would also be in your favor. It may mean that you would also need to participate more, but this more likely to be in your favor. Ultimately, you will decide upon the dose based on how well your body is able to tolerate the medication. You could inquire if the trial is aimed at evaluating quality of life as well, if it is, then your concerns about this aspect of the treatment are at the forefront. Stay positive.
Hi,
Thank you for your comments, you gave me lots to think about and helped me to finally decide to take part in the trial. I heard today that I have been picked for Gemcitibine 1250mg/m2 + Cisplatin 80mg/m2 with a maximum of 4 treatment cycles and start on 5th November. I feel comfortable with this decision and am obviously hoping for the best and trying to stay positive.
Thank you for your comments, you gave me lots to think about and helped me to finally decide to take part in the trial. I heard today that I have been picked for Gemcitibine 1250mg/m2 + Cisplatin 80mg/m2 with a maximum of 4 treatment cycles and start on 5th November. I feel comfortable with this decision and am obviously hoping for the best and trying to stay positive.
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