Hi all,

I deleted my earlier post due to updated info I have received.

Papa needs Radiation therapy but it is our choice whether to go with Erbitux or Cisplatin so this is what I am trying to decide ASAP.
I am looking for studies about erbitux effectiveness both when used +rt and +rt+chemo compared with rt+chemo alone. If you know of any please send the link.

Quick pathology overview: Staging is T2N2M0. Papa's pathology indicated 8mm deep tumor during partial glossectomy and clear margins with 2/33 nodes showing small involvement and perinodal extension in level II.

The doctor said that we wouldn't be combining Erbitux with cisplatin because Indians seems to be less tolerant to aggressive treatments than those euoropean and american patients who are used in the studies on which Erbitux related treatments are based.

If we do go with Erbitux we might have to pay for it. Is it an added benefit that is worth the added cost?

Thanks,
Tasha

Hello Tasha

Positive points to show it helps improve the odds:

• EXTREME, a randomised clinical trial examining the effect of first-line combination of cetuximab plus cisplatin or carboplatin and 5-fluorouracil compared to cisplatin or carboplatin and 5-fluorouracil in patients with recurrent of metastatic SCCHN has now completed.
  It shows an improved result with Cetuximab which does not currently have a UK marketing authorisation for the treatment of metastatic and/or recurrent SCCHN. However, NICE is now in the process of appraising this.
• Cetuximab in combination with radiation therapy is currently indicated for the treatment of patients with locally advanced SSCHN. But because the evidence that it is better than platinum based chemotherapy was not available, the last NICE Technology Appraisal on cetuximab (No. 145) could only recommend cetuximab in combination with radiotherapy as a treatment option only for patients with locally advanced squamous cell cancer of the head and neck for whom all forms of platinum-based chemoradiotherapy treatment are contraindicated (for patients who could not tolerate the side-effects of platinum chemo.) and whose Karnofsky performance-status score is 90% or greater (meaning in good health as it had worked best in only the healthy patients).

The oncologists I asked, said they would use cetuximab for themselves! While cetuximab has side-effects too, platinum is worse according to patients. Since cetuximab inhibits the proliferation of cells dependent on EGFR activation for growth, it may be worth to check that the cancer cells genotype for susceptibility. Ask your oncologist for advice. There is no clear right answer as most oncologists have the most evidence and experience for the platinum chemos.

Hope that helps!

Best wishes
Vinod

This message has been edited. Last edited by: Dr Vinod K Joshi,

Hi Dr Vinod,

Your message really makes me and Papa smile. We found out today that Papa is blessed to be among a priveleged few who can receive erbitux in India. He is a retired brigadier but it still took a lot of effort on our parts to get the approved funds. Without this forum neither of us would be smiling as of now. God bless you and take care.

Hi Tasha,

I was diagnosed with Squamous cell cancer at base of tongue, Stage II, no node involvement. Because of the adverse effects that chemo could have on my liver, it was decided that I be treated with erbitux & radiation only. I finished radiation on July 10th, and am still being given erbitux for an extended period of time for precaution.

My radiologist believes that they got all of the cancer with this treatment plan, but he can't be 100% for another month or so until I have another cat/pet scan.

My side effects with Erbitux was mainly a rash which at first effected my chest and neck area. It wasn't too severe, but itchy. The rash on top of the radiation burns though, wasn't very comfortable at times, but controlled with prescription cream. It seems now that my radiation is over the rash is mainly confined now to my arms! I wasn't expecting it on my arms, but not too bad.

There was another disadvantage of Erbitux also that I didn't like, but hey, it's only one summer. No sun exposure! The two don't mix. I love summer and sitting outside on a beautiful day, listening to music and reading. I can't wait until next summer!!!!

The worse experience I had was my onocolgist decided he wanted me to get a ethonyl (? spelling ?) shot every day of radiation to prevent mouth sores and mucous in my mouth and throat. Turned out that the Erbitux shot (given once a week) and the ethonyl shot on the same day wasn't tolerated in my system too well. I experienced a high fever and was hospitalized for 4 days. They continued the ethonyl but didn't give it to me on the same day as my erbitux infustion.

The final decision for your dad will have to be decided by dad, family and your cancer team, but I just thought I'd chime in with my experience.

All in all, I, personally, preferred this treatment plan over chemo.

Hope this helps a bit though,

Best wishes, Cricket

This message has been edited. Last edited by: Cricket,

hi cricket,

I am pretty much the person in charge of making papa's medical plan; he prefers that I do it, I suppose because I have become more knowledgeable on the subject and consult with a range of survivors and doctors so he can simply focus on being with the family and healing.

I believe the drug you are referring to is ethyol (amofistine is the brand name). we also want to try ethyol but for beuracracy reasons it would require hospitalization during papa's treatment.

our medical oncologist has only a small bit of experience with erbotux and our radiation oncologist has only a small bit of experience with ethyol, so I am making sure things are done very carefully. your information is helpful and I will mention to them about not using ethyol on the day of the erbitux. i hope you are healing well and getting on with life.

take care,
tasha

Hi again, You are totally correct in the name of the shot Ethyol. I'm surprised that your father would have to be hospitalized for it though.

For my shot, I had to get to my oncologist's office a hour before my radiation treatment. My blood pressure was taken first, then I was given the shot. 5 minutes after the shot, my blood pressure was checked again. Then the pressure was checked one more time 20 minutes later. (Every blood pressure check resulted in a lower number, but a safe number for me. This tends to be common with the shot for most everyone). By the way, the injection site of the arm tends to get sore! Kind of like a tetnus shot, but not quite as bad. Tender though!

The shot did do partially what they told me it would. Although I had a sore throat, it was not bad and I didn't suffer any mouth sores. For that I was grateful! But it didn't help at all with the mucous, which I had and still have plenty of!

With the erbitux and the ethyol combined the same day, I can't say whether your father would have the same problem as I did. All cases are probably different, but it would probably be wise just to ask your doctor about it.

Anyway, just thought I'd chime back in. Hope all goes great!

Best wishes, Cricket