Overwhelmed in San Antonio Tx

Dear Dr. Saini:  I have been reading the posted answers to questions since discovering your website a few minutes ago.  I have been diagnosed with SCLC, have received three sessions of chemo using cisplatin and vp16, and was told that radiation therapy will be a possibility if the cancer can be reduced in size.  It is in the upper left lobe of my left lung.  I  have, i know, only my chronic smoking for over 45 years to blame  (this, of course, is also part of my current battle -- smoking cessation, and I am trying very hard to quit, but it is very difficult.  Since I've been home from the hospital, I have smoked approximately 6 cigarettes per day  -- and I know seriously that this must stop).

One of the pressing questions that I have at this time concerns the chemo I am receiving.  I lost much of my normal hearing after the second treatment (which was the vp16 only).  My chemo doctor has said that when I come back for more chemo, he will discontinue the cisplatin and I am not sure what he said he will use in its place.  I had researched the web and did find a medical finding stating that the cisplatin can cause tinnitus.  Do you know what would be the next chemo drug usually used in its place?

I also wonder if I should be going for a cancer trial therapy, or if I should just remain confidently obtaining my care through my current caregivers, who where provided to me via my medicare HMO?

And, of course, I would like to ask your professional opinion of my chances for remission.

Respectfully, Utfutball

[Kamal S Saini, MD, MRCP (UK), DM]

Hi,
SCLC is typically treated with cisplat and VP 16 (etoposide). If the disease is in the limited stage, ie the mass is small enough to be incorporated within one radiation field, then concurrent radiation is also given.
Your hearing loss may be related to cisplatin, as this is a common (partially reversible) side effect. Alternatives to cisplatin in this setting include carboplatin, which also causes hearing loss, although a bit less than cisplatin.
Irinotecan - platinum combinations have also shown some promising results in recent trials. Topotecan, gemcitabine, vinorelbine, taxanes, and VEGF blockers are also being evaluated in clinical trials.
I would strongly urge you to quit smoking immediately (please seek professional help for this if needed) as continued smoking would greatly compromis your chances.
You are receiving the standard treatment for SCLC now, and you should consider a clinical trial if re-evaluation shows progressive or stable disease.
All the best, and God Bless!