Chemo delay a good idea?

This topic contains 5 replies, has 2 voices, and was last updated by  sezz 2 years ago.

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October 26, 2015 at 9:55 pm  #1271606    

sezz

My husband was diagnosed with 3b NSCLC in early July. He’s finished 3 hits of Cisplatin/Alimta and has delayed his next treatment because he couldn’t eat and didn’t feel up to it.

One oncologist told us it didn’t matter if he delayed the treatment because it wouldn’t make much difference. (Doing the 4th chemo early next week so it will be 5 1/2 weeks between the 3rd and 4th treatment.)

A 2nd doctor told us the risk with delaying chemo was the cancer would progress and then they would have trouble getting it under control.

Doctor also said he could have up to 6 of this double chemo and that was the maximum, but could stop after 4 if he wanted. Then they will go to just the Alimta until progression.

How can we decide what is best? If it doesn’t make much difference, why go through the chemo since it makes him sick? If it doesn’t increase duration of life there seems no point because it decreases his quality of life.

Would it be best to finish the 6 treatments with Cisplatin? Would it be better to try and keep the 3 week schedule for the last 3 treatments?

October 27, 2015 at 10:01 am  #1271608    
JimC Forum Moderator
JimC Forum Moderator

Hi sezz,

Welcome to GRACE. Treatment delays are not at all uncommon, and at this point in your husband’s treatment a delay of 2-3 weeks should not pose a problem. In general, the greatest benefit occurs in the first two cycles, and a total of four cycles is often chosen. There isn’t any evidence that extending platinum-based chemo beyond 6 cycles provides any significant benefit, while adding increasing toxicity.

I hope he feels better soon and that he does well with his remaining chemo.

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

October 27, 2015 at 5:15 pm  #1271609    

sezz

Thanks Jim for your welcome and your reply.

Are you aware of any evidence about the benefit of doing the 5th and 6th cycles? He’ll definitely do the 4th one next week, but the oncologist said doing the 5th and 6th was up to him. We’re not well informed about the intricacies of chemotherapy, so I feel overwhelmed with making a treatment decision like that.

I’ve tried to find info about it but couldn’t see anything about the benefits of 6 cycles versus 4. You say 4 cycles is often chosen. Reading a few threads on this website, it looks like some of the doctors make the decision based on patient desire since there is no hard evidence to favour one or the other.

I tend to think it might be better to give him a break if the benefits of the 5th and 6th treatment won’t be substantial. I mean if you have 6 weeks of treatments, and those 6 weeks are poor quality, you’d need to be gaining months of duration of life to justify it. That’s my logic anyway, but don’t know if it’s the right way to think about it. There are so many things I don’t know I wonder why we should be the ones to make the decision.

No one has given us any hope of cure. If there was some hope of that, you might be tempted to continue the platinum double chemo. Life expectancy estimates of 12 months with chemo, 3-6 months with no treatment, so this sounds like you only gain a few months and you spend them all doing chemo. Is this why the decision is so difficult, no one knows what will happen next, so they revert to patient preference? Duration of life is only possible with chemo so even though he feels unwell, he’d feel worse if he wasn’t doing it?

Then the next huge decision will be whether to go to maintenance Alimta or take a break from all chemo and the info I’ve read seems just as inconclusive about that with doctors favouring different options. Arghhh!

October 28, 2015 at 5:55 am  #1271613    
JimC Forum Moderator
JimC Forum Moderator

Sezz,

Uncertainty and the need to make difficult decisions are two of the most troubling aspects of a cancer diagnosis, and I’m sorry that these factors are causing you such anguish.

A better understanding of prognosis and survival statistics may help you. With regard to an individual patient, it’s really not helpful to focus on a time period such as twelve months. That is a median taken from the experience of large groups of patients, but has no meaning for an individual. Some patients have very aggressive cancer and have short survival with or without treatment, while others achieve long periods of stability, at times stretching into several years.Your husband may very well be one of those patients.

Perhaps this story will help. At one point early in my wife’s battle with lung cancer, we were discussing a particular drug with her oncologist. He said that a clinical trial had shown a positive result, that the drug had extended survival by two months compared to a proven treatment. That statement did not sit well with my wife, who thought of going through the rigors of another treatment regimen just to gain two months of life. But to get to a median improvement of two months, some patients on that trial must have gained much more benefit from the drug, so when you try another therapy you are not looking to get the median benefit from it, you are hoping to be in the statistical “tail” comprised of patients who respond very well and for extended periods. Dr. Pennell wrote a wonderful post about all of this which you can read here. It really should be required reading for anyone who has been given a specific time period for their survival.

[continued in the next post]


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

October 28, 2015 at 5:57 am  #1271614    
JimC Forum Moderator
JimC Forum Moderator

[continued from previous post]

In addition, in the past few years many new treatments for lung cancer have been developed, with others still in the pipeline. Because survival statistics are historical by nature, they do not even accurately represent the likely probabilities for a person newly diagnosed, as those new treatments have helped lengthen the lives of many patients.

So please try to stay optimistic, and do not focus on twelve months or any other time period you may be quoted.

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

October 29, 2015 at 7:28 pm  #1271663    

sezz

Jim, Thanks so much for your replies. That was very helpful. I really appreciate it.

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