Response from Dr. Einhorn & Nichols...

[NixMom]

...re delaying chemo for white cell count. Dr. Nichols says "The standard is to not delay for any white count. I am always glad to talk to people about this". Dr. Einhorn, on the other hand, said "there probably is no concern with a delay tha is a week or less for good risk testis cancer. I would be happy to have Dr. Gaynor contact me if desired. We NEVER delay more than a week and for intermediate or poor risk we never delay at all."
I believe that as a IIC, even though it's pure seminoma, Nick is "intermediate risk."

Thanks everyone again for the advice & support---I can now pass this info along to Nick's oncologist, along with contact info for these 2 experts. Plus, since they're treating quite a few TC patients at Loyola right now, it may help other young men as well. Angels, all of you!

[Karen]

Those are two very special doctors.....good for you to get their input!

[mahalomom]

Carole,

Way to go Momma Tiger! Also, be sure to tell Nick's oncologist that Dr. E. is usually willing to consult with any oncologist directly.

Mary Ann

[dadmo]

Momma tigers are amazing. Great job Carole.

[ally30736]

You rock, Carole. Way to take charge. Happy Mother's Day this weekend.

Ally

[NixMom]

Thanks---and HAPPY MOMMA TIGERS' DAY ladies... what are the dads called???? Poppa Panthers? Daddy Lions???

[PROUDPOP]

I have read your posts and am quite impressed with your tenacity. Getting Dr. Einhorn involved was a great move. You are a wonderful mom and advocate for your son.

[Another Mom]

Great job Carol. Keep pushing them until they do what needs to be done. Best wishes to Nick and Happy Mother's Day weekend to you!

Cheryl

[TCdoc]

Having just had my 3rd cycle of EP delayed for a week because of a neutrophil count of 0.3 (having to have g-csf shots) I was more than interested in Dr Einhorn's reply that delaying chemotherapy for a week probably makes no difference in good-risk disease.

There is an interesting article from Sloan-Kettering which supports this:

The effect of a 7-day delay in chemotherapy cycles on complete response and event-free survival in good-risk disseminated germ cell tumor patients
Robert J. Motzer, MD *, Nancy L. Geller, PhD, George J. Bosl, MD
Genitourinary Oncology Service, Division of Solid Tumor Oncology, Department of Medicine and the Division of Biostatistics, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Center, New York, New York


"The effect of duration of induction treatment on complete response (CR) and eventfree survival (EFS) (time to death or relapse) was evaluated in 162 good-risk germ cell tumor (GCT) patients treated from November 1982 to July 1986 in a randomized prospective trial with VAB-6 (cyclophosphamide + vinblastine + bleomycin + dactinomycin + cisplatin; 81 patients) versus etoposide + cisplatin (EP; 81 patients). Patients received three cycles of VAB-6 every 28 days or four cycles of EP every 21 days. Treatment cycle with either regimen was routinely postponed for 7 days for leukocytes <3000/mm3 or platelets <100,000/mm3 and then administered regardless of blood count. The number of treatment days was calculated for each patient from initial treatment day to final induction date plus 28 days for VAB-6 and plus 21 days for EP. The proportion of CR and the EFS for good-risk GCT patients treated with cisplatin-based chemotherapy were not influenced by a 7-day delay resulting from chemotherapy-induced myelosuppression. Short, planned delays in chemotherapy for good-risk GCT patients (7 days per cycle) appear to be acceptable since they may prevent serious toxicity in this curable patient population. Delays of longer than 7 days are strongly discouraged except in extraordinary life-threatening circumstances" and can be found at:

http://www3.interscience.wiley.com/j...TRY=1&SRETRY=0