Treatment after No Reponse to Third Line Chemo – EX SCLC

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This topic contains 6 replies, has 4 voices, and was last updated by  catdander forum moderator 2 years, 7 months ago.

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May 17, 2012 at 6:03 pm  #2202    

ctw15

My heart is breaking as I write this. My father, a young 66, was diagnosed with EX-SLCL on 12/1/11. Brain mets were also found, which were immediately treated with WBR. My dad then underwent 1st line chemo – Carboplatin+Etoposide. After 4 rounds, his cancer progressed to the liver and stomach. The doctor then moved him to 2nd line chemo-Topotecan. He was scanned after 2 rounds and we received the results today. The Topotecan did not work; more lesions were found in the liver and the tumors in the lungs have grown. The doctor recommended against further chemo. He says my dad’s performance status is borderline and further chemo will probably be ineffective and likely hasten his death. He thinks we should focus on “quality of life” treatment at this point. He’s going to look at a few clinical trials, including one I found at NCI that involves molecular level treatment, but he thinks that the drugs will be too toxic for my dad and that it will take him too long to get into one. There have been many tears today and my dad seems resigned to discontinuing treatment. Two weeks ago he spent most of the day working on his computer, watching television, and reading. He seemed relatively active to me given the circumstances. My mom, however, said he has been spending a lot more time napping on the couch in the last 10 days, bringing his “active” hours down to a couple each day. I thought he was doing better than “borderline” so the doctor’s view that my dad is probably too weak for more treatment came as a suprise.

Anyway, I’d love to hear thoughts in whether it’s time to through in the towel on further chemo/treatment. I want to make sure we have considered all the angles and aren’t missing anything.

Thanks so much.

C-

May 17, 2012 at 6:44 pm  #2203    

Dr Walko

CTW,
Let me first say I am sorry to hear of your father’s situation. Unfortunately, too many with lung cancer are forced to face the question your father is now facing, specifically when fighting the good fight with chemotherapy should be replaced with the ongoing action of supportive care and maximizing quality of life. I will let the docs and patients weigh in, but want you to know your family is not alone in this struggle. When to change the goal of treatment to palliation is a personal choice for each person, however in general when risk of toxicity outweighs benefit from chemo, this decision may become more clear. This is always the balance we healthcare professionals and patients must consider.

From what you have written, it seems that your father’s performance status is to the point that further chemo, especially third line or investigational drugs may produce more harm than good. The fight is not over yet though, the goal does change to maximizing quality of life and ensuring pain and other physical and emotional needs are met.

Keeping you and your family in my thoughts,
Dr. Walko


Christine Walko, PharmD, BCOP
Clinical Pharmacogenetics Scientist
Moffitt Cancer Center, Tampa, FL

Views expressed here represent my opinion, not those of GRACE or Moffitt Cancer Center. This information does not constitute medical advice and is intended to supplement and not replace medical information provided by your doctor.

May 17, 2012 at 8:58 pm  #2204    

Dr West

I’m afraid that I agree that further chemotherapy would be extremely unlikely to be helpful if he has progressed so readily through the first two lines of therapy. Moreover, I think it’s very possible that more chemo could be harmful to him if his performance status is marginal. It sounds like he would likely be better served by a focus on maximizing his symptom control and minimizing side effects from treatments, particularly if those treatments would be very unlikely to be helpful.

There’s no question that lung cancer is a very unfair disease. I’m sorry he and your whole family are dealing with it.

-Dr. West


Howard (Jack) West, MD
Medical Oncologist

Views expressed here represent my opinion, not those of GRACE or Swedish Cancer Institute. This information does not constitute medical advice and is intended to supplement and not replace medical information provided by your doctor.

May 18, 2012 at 7:16 am  #2205    

catdander forum moderator

I am so sorry that your dad and family are faced with such awful news. It does sound as if you are trying to find every reason to accept that it’s time to stop fighting the cancer. As much as I do not look forward to that period of my husband’s treatment I do think that after the decision is made a focus on comfort will be more direct than trying to beat back this awful disease. I have pasted links below to blog posts that address palliative care and hospice. There is also a forum thread that includes an article that I think will be helpful at this time. I’ll keep you and your dad in my thoughts,

very thoughtful forum thread with New Yorker article: http://cancergrace.org/forums/index.php?topic=5558.0

a blog post by Dr. West: http://cancergrace.org/cancer-101/2010/01/16/when-is-the-right-time-to-discuss-prognosis-hospice-and-other-end-of-life-issues/#more-1352

a blog post by Dr. Harman: http://cancergrace.org/cancer-treatments/tag/hospice/

a blog post by Dr. Ramchandran: http://cancergrace.org/cancer-treatments/2011/03/10/what-is-hospice-fact-and-fiction/


My husband, 53 @ dx of stage 3 squam nsclc R. pancoast tumor 8/09 caused destruction of 3 ribs, touching brachial plexus. 2 core and 1 VATS undx biopsies. Open thoracotomy for 1 positive biopsy (unresectable). Chemorads, 9/09. MRI by pancoast specialty surgeon 11/09 spine met found, stage IV, Rad to spine, Chemo changed from cis/etop to navelbine/carbo. 6 cycles total. Tarceva 2/10-11/10. 3cm tumor L lung, biopsy undx w/collapsed lung. Gemzar, 12/10 through 7/12. NED 3/12, stop tx 7/12. Remains NED as of 8/14.

May 18, 2012 at 1:19 pm  #2206    

Dr West

Great links.


Howard (Jack) West, MD
Medical Oncologist

Views expressed here represent my opinion, not those of GRACE or Swedish Cancer Institute. This information does not constitute medical advice and is intended to supplement and not replace medical information provided by your doctor.

May 18, 2012 at 5:29 pm  #2207    

ctw15

Dr. Walko and Dr. West,

Thank you so much for your thoughtful and helpful responses. They have really helped to reinforce my view that my dad is making the right decision and that we as a family should now focus on quality of life and supportive care. I also very much appreciate your thoughts, care and concern and acknowledgment that lung cancer is a very unfair disease. Thanks again for helping me and others out here who have reached this point in the journey with a loved one.

Catdander,

Thank you very much for your response and sympathy. I’m so sorry that your husband is battling cancer but am happy to hear that the recent scan suggests NED. I wish you all the best and will keep you and your husband in my thoughts and prayers. Thank you for the terrific links. The New Yorker article and the blog posts are excellent. I’m still trying to accept the decision to stop chemo, although I’m confident in my heart it’s the right one. It’s just difficult to accept that my father is going to die soon. The doctor couldn’t put a time on it of course but his guess is 2-4 months. Who knows, though; could be less, could be more. We’ll just take it day by day until it’s his time to go.

On hospice, I’m very much in favor of it for the many reasons expressed in the New Yorker article and blog posts. My father seems open to it but my mom is extremely resistant and gets mad when I raise the topic. It’s very frustrating. My parents are very private people and never have people over to the house. My mom sees it as in intrusion into their privacy, which might be a cultural thing (she’s Asian). I think it’s short-sighted, especially since my dad’s life could be prolonged on hospice and our family could use the help, but I don’t know how to get her to accept it. I’ll keep working on it.

Thanks again everyone.

C-

May 19, 2012 at 7:18 am  #2208    

catdander forum moderator

C, thank you for the well wishes. I hope your mom will come to change her mind about hospice care. Perhaps you can add tidbits of information from the links to your conversations without her feeling too pushed. Your dad may be able to sway her also. As you’ve read hospice is also for the family/your mom and you.
hopes that tomorrow will be a better day.


My husband, 53 @ dx of stage 3 squam nsclc R. pancoast tumor 8/09 caused destruction of 3 ribs, touching brachial plexus. 2 core and 1 VATS undx biopsies. Open thoracotomy for 1 positive biopsy (unresectable). Chemorads, 9/09. MRI by pancoast specialty surgeon 11/09 spine met found, stage IV, Rad to spine, Chemo changed from cis/etop to navelbine/carbo. 6 cycles total. Tarceva 2/10-11/10. 3cm tumor L lung, biopsy undx w/collapsed lung. Gemzar, 12/10 through 7/12. NED 3/12, stop tx 7/12. Remains NED as of 8/14.

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