Decisions

August 2, 2006 - I met with Dr. Ajay Dar today who is a Medical Oncologist to talk about adjuvant treatments while I undergo radiation. I was anxious to discuss the risk / benefits of the two drugs that Dr. Tonnesen discussed with me which are the traditional chemo drug cisplatin and the newer immunotherapy drug Erbitux.

In general terms, I'm very leary of chemotherapy. Not because of the short term effects; I can handle those. My concern is with the systemic toxicity of chemotherapy and the potential long term effects including damage to the liver, kidneys, heart and immune system, not to mention linkage to secondary cancers. I know radiation has some of these same risks but I don't have much of a choice there and anyway, radiation to the head and neck probably isn't quite as risky as radiation to say, the abdomen. All of the reading that I've been doing hasn't changed my opinion of chemo and, in fact, it has strengthened it.

So, I'm already leaning towards Erbitux. Not that this drug doesn't have its share of side effects and risks, the biggest one being that it's so new we really don't know what the long term effects on my body might be. But I'm willing to take that chance for the sake of a cure to my more immediate problem. Dr. Dar put me at ease by explaining that today, both treatments are considered 'standard of care' meaning they are both FDA approved and, theoretically at least, should show equal or similar effectiveness. He gave me some literature on Erbitux which showed it to be very promising for my type of cancer. Unfortunately, there is no side by side data to show the effectiveness of Erbitux vs. cisplatin. There have been no studies to measure them against each other. There was apparently one study that used cisplatin and Erbitux together but this apparently turned out very badly. It seems that together the drugs caused all kinds of heart conditions and death so the study was terminated early.

I have a few days to decide and I'll use this time to meditate on it so hopefully the answer becomes clearer however I think I already know what I'm going to do. Both drugs are administered intraveneously and would take about 1/2 day to complete although the Erbitux is given once per week during radiation treatments while the cisplatin is only given three times.

At the end of the appointment, I had to give some blood so they can test my blood counts, liver and kidney functions. Dr. Dar asked me to call him as soon as I knew when my radiation treatments would start so we could schedule my next visit.