If an asymptomatic patient requires a delay up to a week before starting chemotherapy for Stage III lung cancer, do you also push back the radiation start date?
Our medical oncology team wants to give a patient Vitamin B12 and Folate 1 week before chemo- do we need to push back the RT start date to start both concurrently?
Answer from: Radiation Oncologist at Academic Institution
Typically, the reason for B12 and folate prior to chemotherapy is related to the drug that will be used, pemetrexed. Giving the premedication reduces hematologic and gastrointestinal toxicity to tolerable levels.
One week typically will not make a difference and I would usually wait to start. Howev...
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Answer from: Radiation Oncologist at Community Practice
I would first ask the medical oncologist why they are planning on giving Vitamin B and folate and why that has to delay chemotherapy initiation by a full week. If there is a good reason for this, if the patient is asymptomatic, and if the kinetics of disease growth is relatively slow, then a 1-week ...
Answer from: Radiation Oncologist at Academic Institution
I agree with my colleagues. My presumption in this case is that this is a definitive treatment for stage III. Stage III patients requiring urgent symptomatic relief by RT are not patients I would have been entertaining concurrent therapy to begin with. Since one of the (presumed) benefits of the add...
Comments
Radiation Oncologist at University of North Carolina
While I agree that typically we consider there is ...
While I agree that typically we consider there is ...
Radiation Oncologist at University of North Carolina
Key point: Radiation by itself or Chemo by itself ...
Key point: Radiation by itself or Chemo by itself ...
Radiation Oncologist at University of Washington School of Medicine
@Gregory M. Videtic, I fully agree. Radiosensitiza...
@Gregory M. Videtic, I fully agree. Radiosensitiza...
Radiation Oncologist at University of North Carolina
Platinum/Pemetrexed is given on a q 3 week cycle. ...
Platinum/Pemetrexed is given on a q 3 week cycle. ...
Answer from: Medical Oncologist at Academic Institution
While I do not see tremendous harm in delaying therapy for a week, I do not really feel the delay is necessary and would avoid it.B12 and folate are given to minimize toxicity of pemetrexed. While I do not typically use this regimen for stage III NSCLC, it is certainly a reasonable one. Vitamin supp...