Hi all,

        I am back, and as the question with regard to chemotherapy did not
get a specific response, I will try my hand at it.

        I do not have much experience with Carboplatin and it's been a long
time since I have used cyclophosphamide.  But I know I can look in the
medical literature and find out a few things (not tonight, because I
do not have the texts available at this moment).

        Carboplatin is related to Cisplatinum, which, oddly enough, is the
one antineoplastic drug which is *not* contraindicated during
breastfeeding.  But this does not tell us about Carboplatin.  We do
know that 70% of the total drug is excreted in the first 24 hours,
most of that in the first 6 hours.  Since this is mainly by glomerular
filtration (in the urine), a woman who has renal insufficiency would
require more time to eliminate it.

        Cyclophosphamide (Cytoxin) is considered contraindicated during
breastfeeding.  It's metabolism is complicated, and in fact it is the
active metabolites that are the drug here, cyclophosphamide, if I
remember correctly, is not in fact active.  I do not have information
about how long cyclophosphamide or its active metabolites would appear
in the breastmilk, but I doubt it would be longer than a few days,
maybe a week at the most.

        Therefore, the mother who is getting these drugs at monthly intervals
could surely nurse most of the month.  It might be prudent to have the
milk tested daily to see what amount of cyclophosphamide and its
metabolites is present, and this would be useful information.  It may
be that the mother could restart nursing after 2 days, maybe only
after 10, but she could still nurse most of the time.

        Does this help?  Almost all problems can be overcome if we truly
believe they are worth overcoming.

Jack Newman, MD, FRCPC