Went to see the last Oncologis today = Dr Mark Kris , Memorial Sloan Kettering.
First appt was at Hackensack Univeristy Medical Center, in Hackensack, NJ. Dr Harry Harper.
Here is what we have:
Treatment #1: Hackensack University Medical Center
Taxol and Cisplatin every 3wks for 4 sessions and see if treatment is effective.
Treatment #2: Memorial Sloan Kettering
Vinorelbine and Gemcitabine every 2wks again for 4 sessions.
Any suggestions / comments please share.
Lastly, I read something about Chemosensitivity testing.....is this something that we can ask for ?
Here is my inital post:
http://www.inspire.com/groups/lung-cancer-alliance-survivors/discussion/mom -diagnosed-with-squamous-cell-carcinoma-and-it-really-broke-me-down/
Thanks in advance !!!!!
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Two forms of treatment suggested, by two difference Cancer Centers
- By CrazyEddie
- Posted June 5, 2009 at 8:36 am · 40 replies
- In Treatment options
- Shared with the public
- Edited June 5, 2009 at 8:37 am
Explore topics in this discussion:
Cancer Taxol Surgery Chemotherapy Heartburn Progesterone Lung cancer
40 replies
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- By hhhdai
- Posted June 5, 2009 at 8:58 am
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I have no knowledge about Hackensack, but I know Dr Kris is the best, not only he is respected by colleagues all over the world, but he is such a nice guy.
- By jdmo
- Posted June 5, 2009 at 9:19 am
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Hi Crazyeddie.....i know just how you are feeling......we too live in NJ....and got multiple ONC opinions...one of whom was also Mark Kris.....I am told by various sources, including other docs, he is one of THE top Lung cancer experts in the country.....soooooo......my question is I wonder why in Kris's protocol there is no platinum drug involved....did your mom have any testing (ie: ERCC1) that would have indicated she wouldnt respond as well to platinum? My inclination would be to go with Mark Kris's recommendation, (based on his experitse and experience in lung cancer specifically) but i would want to know why no platinum, as that is usually part of the plan. I am not as familiar with squamous cell, as my husband is Adeno with BAC features, stage 3A.....After many tests, and consultations (fox chase, morristown , and Kris) we ultimatley went with his plan, though now getting treatment at the SLOAN facility in basking ridge NJ which is very close to our home....i hope i havent confuse you more, but this is the toughest time......all the decision making.
i dont remember, what stage is your mom?
Best of luck in your decision making.......janet
- By CrazyEddie
- Posted June 5, 2009 at 9:24 am
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Thanks for the replies hhhdai and jdmo
Jdmo,
They are saying my mom is Stage IV, lungs and some lymph nodes. I will look into what you are saying about the Platinum drugs.
Thanks again hhhdai, Jdmo.
- By ggullo
- Posted June 5, 2009 at 10:21 am
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Hi: My wife was diagnosed with stage 3b LC august 2008 the surgeon at UAB is considerd one of the best in the country by other medical professionals. He sent my wifes cancer cells to a lab to have them tested for chemo sensitivity. Her test came back showing that her cancer was very sensitive to carboplaten/toxal combo. She received 35 rounds of radiation on a daily basis and twelve rounds of chemo on a weekly basis. When finished the oncologist told us that the tumor shrunk 90% and the pet scan did not show any other tumors in or body. This was around 8 weeks ago. She will start alimta in about two weeks as a second lime chem. Her oncologist was not too excited about the test but agreed to use these to drugs. He has stated on various occassions that he is very very pleased with her resonse. I do not know what the answer is but I would definitely request a chemo sensiutiviy as another tool in the fight against cancer
- By gpawelski
- Posted June 5, 2009 at 4:16 pm
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CrazyEddie
Chemosensitivity testing (known as Oncologic In Vitro Chemoresponse Assays) is something that you can ask for. However, all the important information about them have come outside of NCI-sponsored university-based research. It may be why some doctors may have not yet made the effort to learn about this technology.
Good review papers exist on cell-based, cell-death assays and are increasingly appreciated, understood and applied by the private sector and European clinicans and scientists. The literature on these assays have not been understood by many NCI investigators and by NCI-funded university investigators, because their knowledge was almost always geared towards an assay technique (cell-growth) that hasnt' been used in private labs for over fifteen years now.
Cell-based assays have been well proven to have predictive accuracy with that of estrogen receptor, progesterone receptor, Her2/neu and the newer molecular tests. In fact, that was the criteria when Medicare established reimbursement coverage for cell-based assays when it officially recognized cancer chemosensitivity tests as a special test category in Federal Regulations (42 CFR 414.510(b)(3), 71 FR 69705, 12/01/2006). The "standard" of retrospective correlations between treatment outcomes and laboratory results is sufficient in the case of ALL laboratory tests. It is what established FDA-approval for the test kit.
The selection of chemothrapy for cancer patients has been traditionally based on results from phase III comparative trials (population studies) that define the most active drugs and drug combinations. Unfortunately, few patients with advanced disease are helped using currently available regimens.
In order to improve the selection process for individual patients (not average populations), various types of in vitro tests that assess the activity of standard and targeted drugs on a patient's tumor have been developed. Significant predictive correlations between in vitro drug response assays, and cancer patient response and survival have been demonstrated.
By investing a little time on the phone speaking to one of the assay lab medical directors, you should have enough knowledge to present the concept to your own physician. At that point, the best thing is to ask your physician, as a courtesy, to speak on the phone with the medical director of the laboratory in which you are interested, so that he/she will further identify this protocol for the physician, and at the same time, educate them about the merits of assay-directed therapy, what the rationale is and what the data which support what is being considered.
Two U.S. labs with the most extensive experience with this technology:
http://www.rational-t.com/patients/extra.aspx
http://weisenthalcancer.com/
- By peyz33
- Posted June 5, 2009 at 5:15 pm
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I went to NYU in NY - had cisplatin and navelbine every friday for 16 weeks - lol - one of each - My onclogist is a genius - bedside manner aside.....Dr. Abe Chachoua -
karen
- By sheilake
- Posted June 5, 2009 at 5:50 pm
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I'm with gpawelski and would recommend the chemosensitivty test. I used Rational Therapeutics and it saved my life. I wouldn't have had time (only had two months when diagnosed) to see what didn't work. It's now eight months later and I feel great.
Good luck,
Sheila
- By HighlandGuy
- Posted June 5, 2009 at 6:08 pm
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Let's face it. Memorial Sloan Kettering is recognized as one of the two best cancer treatment facilities in the country.
Lung cancer is unforgiving, often lethal, young lady!
HighlandGuy
- By GHANBIDGE
- Posted June 5, 2009 at 6:23 pm
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I highly recommend assay testing I had it ten years ago for primary stage sclc it was through Rational Therapeutics in Long Beach
- By cuddles53
- Posted June 5, 2009 at 9:38 pm
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If you want the facility e-mail address for the test in California it is by a Dr. Nagourney it is www.rationaltherapeutics.com this is one I am going to use if my cancer returns , I am in remission for over 3 years, they used carbo/taxol on me and it was too harsh for me then switched me to Gemzar alone, I went into a remission from that Thank God, but I would definitely recommend contacting this company and then talking on the phone with them, some insurance pays for it and some do not
Good luck, be thankful you at least know about this, I had no clue when I started my chemo those few years ago or I could have made a better decision, I got very lucky with what was given to me. God Bless Sandy
- By CougarLady
- Posted June 5, 2009 at 9:40 pm
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My BF is going to NYU for diagnosis. 4 weeks ago a CT scan was done, and last week a scope. As of today there are no results other than the blood work for the liver looks good. His belly is extended and feels like it is going to "pop". Doctor says it is "part of what is going on". (My guess is fluid) Dr. suggests that he see another doctor for an MRI (he will set it up). No diagnosis or staging has been given to us. The vomiting blood is now slowing down and there are a lot of pieces of tissue in it. Dr. says tumor in airway to right lung, blocking lung is the reason for the vomiting. Am I being impatient ? How long should it take to diagnose ?
- By CrazyEddie
- Posted June 6, 2009 at 12:03 am
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thanks for all the replies. all are truly appreciated.
JDMO,
i called Dr Kris' office to see if I can get an answer on why no platinum drugs. the Nurse said he is out until Monday, but I should have an answer by then.
Sloan Kettering nor Hackensack University Medical Center offer the Chemosensitivity test. I am going to reach out to Dr Kris, to see if he would consider the results of the test if I were to have it done.
I am not a doctor nor will I be so arrogant to tell one of the most reputable doctors in my area how to do his job. it is my hope that he understands that I am willing to look high and low to help my Mom.
the thing is i was told by both doctors that after so many treatments, the chemo drugs can be toxic in the system. Not sure how this varies from person to person, but with this in mind, why would they not consider the Chemosensitivity test.
Thank you all for chiming in with your suggestions, comments and consideration.
Oh....looks like we will start with Sloan and see how this works.
- By molar
- Posted June 6, 2009 at 12:48 am
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I am no expert, but I think the cisplatin and taxol would be a rough chemo. I'm 61, had carboplatin/taxol/avastin for first line chemo in Nov 2007. That was a rough chemo, fatigue, nausea, terrible heartburn. I am now taking gemzar for 4th line and have found it the easiest chemo I have been on. I have also have heard that the other chemo that Sloan has suggested, navelbine, is also easier to tolerate. I had great success with carbo and taxol, significant shrinkage. I also think having an assay would be very helpful. Best of luck!
Sue M
- By cjtexas
- Posted June 6, 2009 at 8:43 am
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I have the same type cancer 3b dx 1/08, treated at military base, they used cisplatin/etoposide, plus radiation at the same time, so far I'm cancer free, breezed through the treatments, very tired and bad sore throat but only lost 8 lbs, darn I was really hoping for alittle more. I'm sure your Dr has his reason's so your doing the right thing by asking. Believe me I drive all my drs crazy asking questions, i'm done with radiation but my rad dr still see's me every 3 months, i asked him why last visit, he said you always come with interesting questions and I like following your case, have to keep those occ drs on the ball.
- By Ilene
- Posted June 6, 2009 at 10:08 am
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Neither regimen is a new one, but the one Kris is suggesting is more recent than the one recommended by your Hackensack oncologist.
Still the one Kris recommends has been around more than five years, so you could ask him for a comparison of survival stats.
Good luck.
Ilene
- By Alisa
- Posted June 6, 2009 at 10:09 am
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Same thing happened to me in 2000, during my original diagnosis. I went to a third opinion, and when 2 out of the 3 agreed, I chose from among the two that agreed on protocol.
You may want to get a third opinion from the practice at Columbia Presbyterian on 168th St., Manhattan. They are excellent there. I had Dr. Steinglass, who retired, but Drs. Sonnett (the director, who I am now using) and Dr. Gorenstein (also highly recommended, my boss uses him and really likes him).
When I went for my third opinion, I didn't tell them the first two opinions, I went from scratch to see what they said, and they suggested the same protocol as Columbia, so I went with Columbia because of the thoracic surgery department there.
It's all so overwhelming, but the truth is, sometimes all their opinions are correct, even if they are different. What one person responds to, another may not, but they all hae their own protocol with what to start with.
About chemo sensitivity testing, that was not available when I was diagnosed. I'm sure there's others on the board that know about it and can help.
Take care,
- By peyz33
- Posted June 6, 2009 at 10:36 am
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Cougar Lady - I went to NYU - who is her onc? and who is her surgeon - if you dn't mind my asking...I had my results the same day as test - or next day at the latest...I'm very surprised to hear this story......NYU is an amazing Cancer Center -
Karen
- By luckeyone2
- Posted June 6, 2009 at 12:43 pm
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sheila my mom is 82 how old are you if I may ask? Thanks
- By gpawelski
- Posted June 6, 2009 at 12:46 pm
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In the interest of clarity, the reality of it all is that patients would certainly have a better chance of success had their cancer been chemo-sensitive rather than chemo-resistant, where it is more apparent that chemotherapy improves the survival of patients, and where identifying the most effective chemotherapy would be more likely to improve survival.
- By pilot27k
- Posted June 6, 2009 at 7:55 pm
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My dad has stage IV NSCLC and started with Carboplaten/Taxol chemo. He had a two bad reactions to taxol and the doctor switched him to Carboplaten/Gemcitabine chemo.
From what they told me a lot of people have bad reactions to Taxol. The doctors basically look at what drugs work the best for the majority of people with a particular kind of cancer. They start with the ones that have the most success and do PET scans to see if the cancer is reacting to the drugs (shrinking).
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