warfarin/heparin/irinotecan/cisplatin

[PamT]

Does anyone have info on any one or all of these meds? I believe cisplatin may be replaced with carboplatin to alleviate liver problems from the chemo.

[kimblanchard]

Cisplatin is a very commonly used chemotherapy drug that is the cornerstone for treatment of many cancers including lung cancer. It works by basically screwing up the DNA of the cancer cells. It would be pretty uncommon for it to cause liver damage but it is (potentially) very hard on the kidneys. It also can cause nerve damage and hearing loss. It is one of if not the toughest chemotherapy drugs for causing nausea which may hit late (sometimes 5 days after treatment). It does not typically cause hair loss.

Irinotecan is a newer chemo drug that binds to an enzyme called topoisomerase I which is important in cancer cells for repair of DNA damage, nice complement to cisplatin. It has primarily been used in gastrointestinal cancers, especially colon cancer. A large Japanese trial a couple years ago showed that the combination of irinotecan and cisplatin was better (longer survival, higher response rate) then the previous "gold standard", etoposide and cisplatin. Unclear if there might be an ethnic/genetic bias so this study is being replicated in the U.S. Irinotecan mainly causes diarrhea and sometimes lots of it. It can cause nausea, low blood counts and shortness of breath. Infections with this drug can be VERY dangerous. Can cause hair loss (but not always).

Irinotecan and cisplatin is an industrial strength combination, very effective but must be monitored very closely, often requires adjustment of the doses, especially with the irinotecan.

Carboplatin is a derivitive of cisplatin that in most circumstances has largely replaced it. It is equal in effectiveness (in most studies anyways) and much easier from a side effect standpoint. Tends to cause mild nausea, gentle on the kidneys, gentle on the nerves and ears. Harder on the bone marrow. No hair loss. Faster to administer (30 minutes). May not be as good when combined with radiation.

Heparin is an intravenous blood thinner with a very short lifespan so usually given in the hospital by continuous IV. Low molecular weight heparin is a longer acting safer version that can be given as a shot under the skin twice per day (sometimes just once) that has in most circumstances replaced the old fashioned heparin.

Coumadin is an oral blood thinner that inhibits vitamin K so your liver can't make clotting proteins. Widely used for blood clots, prevention of blood clots and strokes. Believe it or not, it is basically rat poison (still used in some rat poisons). Must be monitored very carefully, too much will make you bleed, too little won't do anything for you. Newer drugs in the pipeline that will replace this that are (we all hope ) much better.

That is those drugs in a superficial nutshell anyways.

[Carleen]

Oncodoc pretty much hit it on the head as far as my experience with any of these drugs.

My husband started his chemo treatments with Cisplatin and Irinotecan. His cancer was stable during this period, and he tolerated both really well (no hair loss). He did feel nuaseous following treatment, but was treated well with Emend. He also had diarrhea which he was able to control with Imodium AD. Roughly 3-5 days following treatment he felt back to 100%.

However, he started having ringing in his ears and doctors switched the Cisplatin for Carboplatin. The ringing stopped immediately, he still remained stable, kept his hair, not much else changed. He still had nausea which was kept at bay with less anti-nausea drugs than Cisplatin, but he did have some aching in his joints and legs and back. Supposedly due to the carboplatin in the bone marrow.

Hope that helps some.

[john]

Warfarin is also called Coumadin. Coumadin is the Brand name for Warfarin