Confused

[Savin16]

Well, it's my brother's birthday, 34, to bad it hasn't started out to great. We just returned from the oncologist. He does need "Salvage Chemo" now you all gave your input on this one, first we can all agree that we hate the name. Quick review. 10/05 R I/O, Surveillance, chemo 7/06 4 rounds of BEP, which I have to interrupt because I'm confused on that. From what I have read here it's either 3 cycles of BEP or 4 of EP, my bro had 3 cycles of BEP and another week of all the same meds minus the bleo because it caused some lung damage. Then he had his RPLND on Dec 11th 06, 29 lymph nodes removed 2 active cancer, now it's salvage chemo, I said to the Dr. is he having Adjuvant chemo, which most of you said would probably be what he's having he said no it's salvage chemo. VP-16 (Etoposide) Platinol, cisplatin and Ifosfamide. Any clue on why it's salvage and not Adj. (I know I should have asked the Dr.) and why was the chemo initially different. I did ask if it spread to the lungs, the answer was no from what the cat scans showed. So next week he is having a Pulm check, Cat scan, he now needs a port, imagine he went through all that chemo without one, now needs one for 2 cycles, he really didn't want that. I should mention that throughout this his tumor markers never changed, so that hasn't help the Dr.'s in determining things. His oncologist also was in contact with one of Dr. Einhorn's associated, I thought it was him himself, and they also said more chemo. My brother said this is it, no more he's done after these 2 cycles. Is there anything else that can possibly happen? I've read about needing bone marrow transplant, can this also happen to him? Any help would be greatly appreciated. Does he need a last minute second opinion?

[Savin16]

Salvage chemo

Thanks Chris for the reply, as you see, no one else wants to touch this one. As for the markers, the Dr. said oddly they never changed throughout, that they were always normal so that never helped in staging. I'm worried on what his survivial rate is now. I'm too scared to ask the question while my brother is in the room. I understand the part of salvage chemo for refractory chemo resistant, I do remember another Dr. saying that he was infact refractory, but that is when he only had two cat scans in front of him and no change was seen, (he was our second opinion urologist) when we got him all the scans he said the chemo did do what it was suppose to do, that all the tumors were gone except for the 2 that needed to be taken out from the RPLND, which they were and they were active. I just pray to GOD that this is just and added precausionary measure in making sure the cancer is gone, but I have this feeling that it's not.

[Karen]

Krista,
So sorry to hear this. I had nothing to offer in a response other than what Chris said, have an expert involved. It does sound like he will need the chemo with 2 active nodes having been found. What is the porposed treatment so perhaps others who traveled that road can chime in? I hate the term "salvage" as well...I prefer to think of it as "Plan B".
Hang in there. If you are with your bro in talking to the docs maybe you can call them and talk frankly and perhaps your fears are worse than the reality. Good luck and please keep us posted!

[Scott]

I'd read through all the information on salvage therapy in the NCCN guidelines. There's still a good chance of cure.

Excerpts:

Patients who do not experience a complete response to first-line therapy are divided into those with a favorable or unfavorable prognosis. Favorable prognostic factors include a testicular primary site, prior complete response to first-line therapy, low levels of serum markers, and low-volume disease. Standard therapy for patients with these features is 4 cycles of cisplatin and ifosfamide combined with vinblastine or paclitaxel. Approximately 50% of patients treated with the vinblastine regimen experience a complete response, and 25% experience durable complete remission. If the patient experiences an incomplete response or relapses after salvage chemotherapy, high-dose chemotherapy with autologous stem cell support is the preferred option.

It doesn't sound as though this fits your situation exactly; it's a really good thing you're getting expert help.

[Savin16]

Thanks for the info. I will read it.

[dadmo]

I know how everyones head spins when they first meet with the doctors. It really is information overload. My notes from our first visit with the oncologist at Sloan clearly stated that if he had live cancer in the nodes after chemo he would need 2 additional rounds of treatment. It certainly isn't good that the cancer wasn't killed by the first round but this is not that odd of a situation. Your brother should still have an excellant chance for a cure. As far as salvage or adj. or second line it really is all the same (it stinks) but salvage sounds so despirate in a situation that really isn't.

[Savin16]

Dadmo, thanks for that little boost, I really need it today, I'm loosing it. I just can't stop the tears today.

[Scott]

Hang in there, Krista...

[Savin16]

Thanks for the responses. My brother has his appts. for next week, which include a PFT, cat scan, and his port will be put in, then Dr. on Fri to review scan with us, then chemo starts again that following Mon. I will try to ask some questions on Fri, I know me if the scan shows bad results, I'll freeze in fear of hearing more. I will keep you posted.

[Davie]

Krista,

You should read this article. It is very thorough and cover many patients from TC centers across Europe who had cancer cells remaining after an RPLND which followed primary chemotherapy.

http://www.jco.org/cgi/content/full/19/10/2647

One very interesting thing it concludes is that the 5 year overall survival rate was 100% if the patient was initially good prognosis, had less than 10% cancer cells resected, and there was a complete resection of the mass.

Your brother will pull through.

Davie

[Davie]

Krista,

I forgot to add that it is highly likely that, even though they found cancer cells after a postchemotherapy RPLND, your brother is likely cured by the RPLND, given this surgery typically resects all the remaing tumor.

Davie

[Savin16]

Davie,
It is my Birthday, and that was the best present. Thank You Thank You Thank you.

[Savin16]

Thank you all for the info and help. Your all so great, and Robert2112 your right in saying the RPLND should have been first, that's what our second urologist said, too bad we talked with him too late, but he performed the RPLND and did a great job. my brother is just so weak, he would spend two hours a day, 7 days a week at the gym, no body fat, nothing but muscle, and to see him thin and weak is terrible. We just got him a stationary bike, it's in front of his TV and some light weights, maybe that will help. Thanks again everyone.

[Scott]

He'll be back. Staying active, without overdoing it, is a great thing.

[Savin16]

Robert thank you for all your help. I feel so much better after reading your post. I could have saved myself some heartache if I just had the courage to ask these questions to the Dr. So thanks, and let's just pray when we go Fri to view the scan results, nothing new is found.