Cisplatin Side Effects Peripheral Neuropathy

Howard Jack West What to Expect During Mesothelioma Chemotherapy

Hi I'm Jack West, Medical Oncologist at Swedishcancer institute in Seattle, Washington. I wanted to talk briefly about the questionof what to expect from chemotherapy for mesothelioma. I'm going to focus on the most commonly prescribedand FDA approved regimen for mesothelioma, which is called Cisplatin and Alimta or Pemetrexed.This twodrug combination is given by vein, typically given every three weeks, and itcan be a challenging one, and is not something that everyone is ideally suited to receive.Cisplatin has been around for forty years, actually and it is still used even as so manynewer drugs have come onto the scene because

it just works very well for many kinds ofcancer, and specifically for mesothelioma. In contrast Altima, Pemetrexed is a relativelynewer drug that was paired with it and was shown to improve survival compared to justCisplatin alone for patients. So Cisplatin is given by vein and it has some of the sideeffects that I think many people think about when you envision chemotherapy. It can causea good bit of nausea and vomiting, although one of the biggest advances in cancer treatmentover the last several decades has been the remarkable improvement in nausea medicationthat we have available, so that really reduces the risk of it being a severe problem in patients.As I said the chemo is given by vein typically

one day every three weeks, and it's a longday in the infusion suite. Usually its an outpatient chemo, sometimes given inpatient,but it's a long day because Cisplatin needs to be given with a lot of fluids, hydrationIV, which is essentially just seawater, saline, given before and then after the chemotherapyin order to flush it out and help protect the kidneys as well as possible. Cisplatincan also cause numbness and tingling in the fingers and toes, this is called peripheralneuropathy and it tends to get gradually a little worse over the course of ongoing treatmentover many cycles, many months. And it can also cause hearing loss or ringing in theears called tinnitus, or tinnitus. In contrast,

Alimta tends to be very well tolerated; itdoesn't add a lot of additional side effects. It does drop blood counts as most of our conventionalchemotherapies do, and with that drop in blood counts there is some pretty much invariablefatigue in people, and it really just varies whether people have a little bit of fatiguefor a day or two after, or fatigue that lasts for a week or longer in the three week, socalled cycle of time when you've completed chemotherapy, blood counts go down over thenext ten to fourteen days, and then in the last week before we tend to do chemotherapyagain, the blood counts have come up to where it is safe to repeat the chemotherapy. Pemetrexedor Alimta can also occasionally cause a rash,

its not a common finding, and it can alsosometimes lead to some transient irritation of the liver as measured by blood tests ofliver enzymes that can become elevated, and that means abnormal, when we follow them overtime, and we regularly check those blood tests regularly every few weeks while someone isreceiving chemotherapy, to make sure their liver and their kidneys are doing okay. Importantly,Alimta and this combination of Cisplatin and Alimta don't actually cause people to losehair except in rare cases; it's really not a regimen that is associated with any appreciablehair loss. So the main issues are really fatigue, sometimes nausea, numbness and tingling thatmay occur, possibility of hearing loss also

relatively uncommon, and sometimes peoplewith decreased blood counts may need a transfusion along the way, but this is something thatcan be managed. There are certainly also rarer side effects but the highlights are reallythe ones that I mentioned. So those are the main points and I will emphasize that theresults will vary from patient to patient, and in any one person we really cant knowhow they're going to do until you give that first cycle and see how it goes. I regularlysee and discuss their side effects with them afterwards and if patients have such a hardtime that we're concerned that the treatment is worse than the disease or just infeasible,we'll make changes whether its dose reductions

Category: Neuropathic Pain

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