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what makes a doctor chose


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You may want to ask our Dr. West this question. I can not find anyhting on this topic myself but He can he is the Oncoligist.

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TEHre is a link in, Ask the expert Forum. You will have to register but it is fre and a great service he provides us also with mmuch more info

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Dear Robin,

I suggest you ask your doctor that question. Everyone is different when it comes to treatments. What works for you may not work for others, and so on and so on. There is no right or wrong when it comes to chemos. It's a crap shoot any way you look at it. There aremany factors they take into consideration when they work up a chemo regimen\for a patient.

The good news is, chemo's have come a long ways over the last 10 years and they have a lot of new ones that work very well for people. Also the older chemos still work well too.

Please sit down and discuss this with your doctor.

Good luck.

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Of course everyone is different and you should ask your doctor, but I will share my mom's experience with you.

Mom initially was on the every 21 day plan, but after the 2nd chemo, she was put on the weekly program. Mom became very neutropenic after her first treatment. Also one month prior to beginning treatment, she had a blood clot on her lung and was started on Coumadin. Her oncologist was managing the Coumadin and she had to go in for regular blood tests. Between the neutropenia and the need for frequent checks for the Coumadin, her oncologist put her on the weekly program.

The chemo given every 21 days is stronger and can be difficult to tolerate which would be a reason to have it weekly.

Good luck to you.

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I wrote a post on the way that different regimens have been compared (http://onctalk.com/?p=227), with the overall conclusion that most of the platinum-based doublets (cisplatin or carboplatin with a taxane, navelbine, or gemzar) are all about the same in activity. So are most of the non-platinum doublets that combine something like gemzar and taxotere, for instance. Some of these drugs are given every week, and some are given every three weeks as a standard.

Docs might choose a particular regimen and schedule for a patient for any number of reasons. Most have a preferred 1-2 regimens that they are very comfortable with and for which they understand the management of side effects very well, which is a good thing. But there are some reasons to favor one regimen, or avoid another, in a particular patient:

1) people who live a long way from their oncologist may be better served by an every three week rather than weekly regimen

2) people with nerve problems, such as from diabetes, or who can't tolerate steroids (also often in the diabetic patient, because steroids increase blood sugar levels) may be recommended to get gemzar or navelbine (both weekly) instead of taxol or taxotere, since the taxanes require steroid premedication and are more likely to cause neuropathy (particularly taxol)

3) people who are more concerned about hair loss would be less likely to have this occur with gemzar or navelbine than the taxanes

4) if a patient is tentative/wary about tolerating chemo, or I feel a need to watch a patient more closely and adjust dosing more precisely, weekly chemo allows more fine tuning.

5) People with liver problems may have a harder time with the taxanes. However, other chemo can also irritate the liver.

I have a modest preference for carbo/gemzar if I'm not giving Avastin with it, because most of my patients who get carbo/gemzar feel very few side effects and just have a drop in their blood counts. However, if I'm giving avastin, I give it with carbo/taxol, which is the best studied combination with Avastin for lung cancer. I also use carbo/taxol or carbo/taxotere (more often taxotere, actually, just my preference) if not giving avastin but a patient is coming from an hour away for treatment.

Sometimes, the choice of chemo is really based more on what the oncologist is most comfortable with. Since they all produce very similar results, the experts don't really quibble over which doublet was used. Nobody thinks it matters much in terms of results, just which side effects you get.

-Dr. West

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  • 2 weeks later...

My mums Onc is putting her on Gematabine and Carboplatin and said we could have that or taxotere and carboplatin. we asked whats the difference, his simple answer was one of them you loose your hair with. Which i thought was a strange reply so i said well why would you go with the other one and he said... 'yes exactly why would you go with the other one' found him bit odd.

But now after reading what Dr West has said, it makes more since. Thanks for the information.

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