Topic: Recurrent Small Cell Lung Cancer

Tagged: CAV, Hycamtin, relapsed SCLC, skin mets, topotecan

This topic has 9 voices, contains 13 replies, and was last updated by warriorprincess 73 days ago.

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February 21, 2012 at 6:35 pm #6519
gil1075	My husband was dx. in July 2011 with SMLC went through chemo and did good. Chemo ended in Oct. scans have been good until today. Recent scan has shown that the tumors in the lung and liver are growing again. So back on chemo again starting Monday. So many questions I don’t know where to start. Most important is this the beginning of the end???? Drug of choice this time is going to be Topotecan given 1 day per wk for 3 weeks and then off a week, but from what I’ve read on the internet they say given 5 days per week so I’m confused. Don’t get me wrong we love our doctor but just want some input if anyone else is using this drug or has used this drug. Also how bad are the side effects, and does it work or will we go through this again in 3-4 months. This reply was modified 91 days ago by gil1075.
February 21, 2012 at 7:48 pm #6522
Dr West	Unfortunately, SCLC becomes progressively harder to treat effectively over time, with the probability of a good response decreasing quite a bit once the cancer progresses/relapses, after typically being quite responsive to initial therapy. Topotecan (brand name Hycamtin) is the FDA-approved and most commonly given second line therapy. It’s true that it is approved as a daily infusion for 5 straight days every 3 weeks, but at the FDA-approved dose, it typically causes a very significant drop in blood counts and problematic fatigue, as well as just the practical challenge of five straight days of chemo at a time when we’d prefer to have patients not spend lots and lots of their time in the cancer center. There is pretty universal consensus among oncologists that the FDA-approved dose and schedule is completely infeasible and too toxic for patients. The dose is reduced over those 5 days, or people give just 3 days instead of 5, or it’s given on a weekly schedule. I don’t think there is a significant difference among these options, but all provide an opportunity to keep the side effects from being prohibitive for most people. Here are a couple of additional links that may be helpful to review to get a better idea of the situation with relapsed SCLC: http://cancergrace.org/lung/2010/08/07/treatment-of-small-cell-lung-cancer/ http://cancergrace.org/lung/2008/09/25/wird-relapsed-sclc/ Good luck. -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.
February 22, 2012 at 8:19 am #6540
gil1075	Thank you so much Dr. West, I’ve read the articles you attached and found them to be very helpful. We have a long road ahead of us, with 36 yrs of marriage, 3 beautiful children and 6 grandchildren I’m not ready to lose him yet.
February 22, 2012 at 8:29 am #6541
laya d.	Hi gil1075: I just wanted to pop in to wish your husband lots of luck with his upcoming treatment. Please do keep us posted on how he is doing. All my best, Laya 1/10 – My Mom (58) dx w/ NSCLC-Adeno 3a; 1 cycle of neoadjuvent Carbo/Alimta before finding out EGFR+ (Ex. 19), then switched to 7 wks of neoadjuvent Tarceva/150 mg (major shrinkage); 4/10 – right pneumonectomy; 6/10 started 3 rounds of adjuvent Cis/Alimta w/ concurrent chest radiation (7 wks); 8/10 – NED; 11/10 – small nodule in left lung; 1/11 – 3 small nodules in left lung, start Tarceva/100 mg; 4/11 – suspected sclerotic met to hip, continue w/ Tarceva, add XGEVA, brain MRI clear; 9/11 – solitary 3 cm met (adeno w/ T790m mutation) to cerebellum, surgery and gamma knife, up Tarceva to 150 mg; 11/11 – 2 left lung nodules growing, biopsy on 1 shows mutation from adeno to squamous (shocker!), brain MRI clear, continue Tarceva & Xgeva; 2/12 – brain MRI clear, CT scan, remaining nodule slightly bigger – – monitor for now, Tarceva (reduced to 100 mg) & Xgeva continued; 4/12 progression and rebiopsy (confirmed adeno), stop Tarceva, switch to Carbo/Alimta.
February 22, 2012 at 9:40 am #6543
certain spring	gil1075, we’ve got a number of members who either have SCLC themselves or have experience of it in someone close to them, so hopefully one of them will come in on this topic soon. 48-year-old non-smoker, dx stage IV NSCLC May 2010 (squamous tumour of the left lung with multiple brain metastases). Radiotherapy to chest and brain; progressed through two cycles carbo/gemcitabine. Repeated lung collapses; pneumonia in collapsed lung, Nov 2010; bronchial stent placed, Dec 2010. Declined second-line Taxotere. Mutation testing Feb 2011, surprise EGFR exon deletion 19, ALK negative. Started Tarceva (150mg), Feb 2011.
February 23, 2012 at 6:34 am #6611
gil1075	Any added information I can get would be greatly appreciated.
February 23, 2012 at 7:39 am #6612
Dr. Aggarwal	I agree with Dr. West. As he mentioned in his post, Topotecan is currently FDA approved for the treatment of relapsed SCLC, but, there are other options, like Taxol and gemcitabine. I think it is reasonable to start with a weekly schedule of topotecan in an effort to minimize toxicity. —————————————————————————————————————————————————– Dr. Charu Aggarwal University of Pennsylvania Views expressed here represent my opinion, not those of GRACE or University of Pennsylvania. This information does not constitute medical advice and is intended to supplement and not replace medical information provided by your doctor. Dr. Aggarwal University of Pennsylvania Views expressed here represent my opinion, not those of GRACE or University of Pennsylvania. This information does not constitute medical advice and is intended to supplement and not replace medical information provided by your doctor.
March 8, 2012 at 1:59 pm #7431
billyv	Dr West, My wife was given 5days of chemo with Topotecan, 2 days after she finished she was admitted to Hospital , her wbc rbc cells and her plattes were 0.4 the nurse said she never saw the counts that low, also the dose was 1.5 for five days straight ,two weeks later she passed not from cancer but from chemo ,she had extensive small cell ,also had 25 treatments of radiation to brain and spine ,thank you billvicino@comcast.net
March 8, 2012 at 7:47 pm #7446
Dr West	billyv, I’m sorry about your wife’s decline, which is of course something we hate to see: our treatments cause a patient’s decline or demise. The dose that was given is actually the same dose that is used in the major clinical trials and in the “package insert” that describes the guidance for how the drug should best be used, per the FDA…but as I mentioned above, many oncologists find that the regulatory bodies have it wrong and that the “textbook answer” dose of topotecan is precariously toxic for many, if not most, patients with relapsed SCLC. -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.
March 9, 2012 at 10:45 am #7465
don450sl	Hi Dr West, My name is Don, I have Stage 4 NSCLC and my Girlfriend Penny has SCLC extensive. I am still stable after 33 months, but my question today is about Penny Penny just received her pathology report back from her biopsy that was done on February 13th on a nodule on her back just under the skin. The report shows the cancer has mutated from Small cell to Large Cell Neuroendocrine Carcinoma, but showing small cell characteristics so it may be a combo of both small cell and large cell. Her original dx was SCLC ext stage. She had 6 rounds of cisplatin/etopocide with initial good response that was short lived, after the first 2 rounds tumors ceased to shrink and actually grew a few mm. She then had an ablation to mets on my liver/adrenal with great results, followed by 15 rounds of double radiation to the left chest and 10 rounds of PCI. They got a good response from the chest radiation except Penny developed radiation pneumonitis and an ulcerated (with a hole!) esophagus! Then about 7 or 8 weeks ago she found a lump in her left armpit/breast and went to see her doctor, the doctor found an additional lump on her right shoulder blade. That is where her mets developed is on the skin, the biopsy is coming back high grade neuroendocrine carcinoma, consistent with large cell neuroendocrine carcinoma. Submitted immunostains show that the tumor cells are positive for CK7, TTF-1, chromogranin and synaptophysin, while negative for CK20, Napsin A, ER and Mammoglobin. Penny is being offered IV Doxorubicin, Cyclophosphamide and Vincristine and should start next week as long as the ulcerated esophagus has healed. Penny and I value your opinion and was wondering what your feelings are about Doxorubicin, Cyclophosphamide and Vincristine as a second line treatment over Tepotecan or Temodar for SCLC extensive. Don
March 9, 2012 at 1:21 pm #7474
laya d.	Hi Don: I have nothing to add here on your medical questions (and, like you, look forward to responses from our doctors), but just wanted to say that I am so very sorry that both you and your girlfriend are dealing with lung cancer. This is just awful! I’m so very sorry. I also wanted to mention that there is another member – - ReginaC – - who also has developed mets on he skin (on her scalp, I believe). Her disease is NSCLC – Adeno (so, different from what Penny is dealing with). Hopefully Regina will pop in herself to add some additional insight here. Anyway. . .I wish you and Penny all the best. . . Laya 1/10 – My Mom (58) dx w/ NSCLC-Adeno 3a; 1 cycle of neoadjuvent Carbo/Alimta before finding out EGFR+ (Ex. 19), then switched to 7 wks of neoadjuvent Tarceva/150 mg (major shrinkage); 4/10 – right pneumonectomy; 6/10 started 3 rounds of adjuvent Cis/Alimta w/ concurrent chest radiation (7 wks); 8/10 – NED; 11/10 – small nodule in left lung; 1/11 – 3 small nodules in left lung, start Tarceva/100 mg; 4/11 – suspected sclerotic met to hip, continue w/ Tarceva, add XGEVA, brain MRI clear; 9/11 – solitary 3 cm met (adeno w/ T790m mutation) to cerebellum, surgery and gamma knife, up Tarceva to 150 mg; 11/11 – 2 left lung nodules growing, biopsy on 1 shows mutation from adeno to squamous (shocker!), brain MRI clear, continue Tarceva & Xgeva; 2/12 – brain MRI clear, CT scan, remaining nodule slightly bigger – – monitor for now, Tarceva (reduced to 100 mg) & Xgeva continued; 4/12 progression and rebiopsy (confirmed adeno), stop Tarceva, switch to Carbo/Alimta.
March 9, 2012 at 7:03 pm #7498
Dr. Weiss	You may find this post helpful to start: http://cancergrace.org/lung/2010/08/07/treatment-of-small-cell-lung-cancer/ In summary, topotecan is actually the best proven 2nd line SCLC therapy, and less toxic for the average patients than CAV. It’s typically considered a more standard choice.
March 9, 2012 at 8:29 pm #7506
Dr West	I entirely agree with Dr. Weiss about topotecan over CAV. I favor topotecan, and it is really the standard second line therapy. In truth, the differences are not phenomenal. There was no difference in efficacy detected between then, but patients did better from a symptomatic standpoint with topotecan. Here’s a post that describes the trial that directly compared the two therapies: http://cancergrace.org/lung/2007/01/07/treatment-of-recurrent-sclc/ -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.
March 10, 2012 at 11:51 pm #7541
warriorprincess	Hi Don, I did CAV as my second line chemo. I found it had less side effects than carbo/etop which I did for 1st line chemo…. obviously this is different for each person. In Australia, it seems topotecan is used less commonly than in US. *************************************************************************** Diagnosed ex-SCLC at 42y.o in June 2010. never smoker. 1st line carbo/etop. PCI Nov 2010. 2nd line CAV may 2011. severe hip/leg pain sept 2011. lung and spine radiation in hosp Nov 2011. 3rd line carbo/etop Jan 2012. progression march 2012. 4th line irinotecan.