Docetaxel

This topic contains 7 replies, has 3 voices, and was last updated by  delialolly1 2 years, 9 months ago.

Viewing 8 posts - 1 through 8 (of 8 total)
Author Posts   
Author Posts
February 19, 2015 at 1:49 pm  #1268554    

delialolly1

I hope that i am posting in the right place.

Is Docetaxel a reasonable treatment choice in a patient with extensive interstitial lung disease who also experiences increased SOB?

If not, what might be a better choice after a good response to cisplatin/alimta, tarceva and again alimta/cisplatin. Then an 8 month treatment break followed by 72% progression?

Thanks in advance.

Blessings,

Delia


17 July 2012: Husband 46, previous smoker, presented with huge plural effusion, hospitalised (stopped smoking about a week or two before dx) 23 July 2012: Drain fluid and do biopsy , 24 July 2012: Dx adeno nsclc, stage 3b, poorly differentiated tumor, , tx alimta four times, showed shrinkage, 31 Oct 2012: Start with tarceva 150mg, not sure whether EFGR was tested 15 Nov 2012: Stop Tarceva for 4\5 days due to severe facial rash. 20 November 2012: Back on Tarceva, more determined than before….

February 19, 2015 at 2:38 pm  #1268557    
catdander forum moderator
catdander forum moderator

Hi Delia!

Good to see you, so to speak. :)

Docetaxel (taxotere) is the standard next treatment after first line platinum doublet, alimta, tarceva and doxetaxel are the 3 tested and most commonly given 2nd and beyond lines of treatment.
Docetaxel has a reputation of being more difficult single agent than some others and SOB has been assosiated with it on some occasions, http://cancergrace.org/forums/index.php?topic=7502.0

Dr. West said this about other options, ” Other agents, such as standard chemotherapy drugs like Gemzar (gemcitabine), Navelbine, or perhaps other chemo agents may have some activity in previously treated patients, but they haven’t been as well studied, don’t have an established clinical benefit, and consequently remain poorly studied non-standard options in previously treated patients. Doublets have been shown to increase the response rate compared to single agent chemo, though this has been in the absence of any improvement in survival but associated with significant increase in clinically significant side effects, making sequential single agent therapy a current standard for previously treated patients at this time.” http://cancergrace.org/lung/2010/10/04/lung-cancer-faq-2nd-line-nsclc-option/

It’s not completely unusual anymore to move back to a chemo drug that worked in the past. Although there’s no data to back up the practice. Alimta on its own might be a possibility for your husband since he never progressed while taking it. Too taking it alone will be much better tolorated than with a platinum.

All best,
Janine

February 19, 2015 at 2:40 pm  #1268558    
catdander forum moderator
catdander forum moderator

On Mayo’s website, http://www.mayoclinic.org/drugs-supplements/docetaxel-intravenous-route/side-effects/drg-20068305

February 19, 2015 at 3:06 pm  #1268559    

delialolly1

Hi Janine

Yes – its good to ‘see’ you too☺. Thanks for your response and the links. I have scanned through them quickly and much of it confirm
my concern – the possibility of increased SOB with docetaxel. Our onc did in fact talk about going back to single agent alimta but he thinks it might be too soon. Well, I guess the final call is on us. But thanks again.

Another question please. EGFR – but we have an application in for afatnib which will most likely be approved. Is there any evidence of any benefit in afatinib in egfr- patients?


17 July 2012: Husband 46, previous smoker, presented with huge plural effusion, hospitalised (stopped smoking about a week or two before dx) 23 July 2012: Drain fluid and do biopsy , 24 July 2012: Dx adeno nsclc, stage 3b, poorly differentiated tumor, , tx alimta four times, showed shrinkage, 31 Oct 2012: Start with tarceva 150mg, not sure whether EFGR was tested 15 Nov 2012: Stop Tarceva for 4\5 days due to severe facial rash. 20 November 2012: Back on Tarceva, more determined than before….

February 20, 2015 at 8:40 am  #1268566    
JimC Forum Moderator
JimC Forum Moderator

Hi Delia,

The FDA approval for afatinib (Gilotrif) was limited to patients with EGFR mutations (specifically “exon 19 deletions or exon 21 (L858R) substitution mutations”) and even in patients with those mutations it has not tended to be very effective after treatment with Tarceva. In other patients the studies I’ve seen do not seem to indicate much benefit for EGFR negative patients, even when used in combination with other established drugs.

Here is a typical comment from Dr. West about the benefit of afatinib after failure with Tarceva (in the EGFR positive setting):

“The results we have thus far are that afatinib provides a transient benefit of a few weeks in duration for a minority of patient but no survival benefit — in fact, patients who received placebo instead of afatinib had a trend toward better overall survival by over a month. My personal experience has been that my patients who received afatinib after Tarceva experienced no benefit at all, just more toxicity in terms of skin rash and diarrhea than they had experienced on Tarceva previously, though I know a few patients here and there have had transient responses. I’m sorry to report that I personally have very little enthusiasm for it, based on my experience of treating patients with it in this setting.”http://cancergrace.org/topic/afatnib-after-tarceva-resistance#post-1258354

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

February 20, 2015 at 12:36 pm  #1268573    
catdander forum moderator
catdander forum moderator

Delia,

Not asked for but have you and or the docs looked into a possible trial of one of the immunotherapy drugs being tested. They are very promising though not put up for approval yet. Though hoping not to need it we even have one going on at UAB just down the street from us.

Too a new gen egfr tki are being tested with promising results for those with T790 mutation of EGFR positive tumors.

We have tons of info on the 2 subjects here’s a couple of webcasts,

http://cancergrace.org/lung/2014/10/03/iaslc_roundtable_immunotherapy_lung_cancer/

http://cancergrace.org/lung/2014/10/20/ar_forum_q_a_blumenthal_pennell_west/

Janine

February 20, 2015 at 2:38 pm  #1268575    

delialolly1

Thanks Jim. That confirms what i thought i had read here. Will talk to our onc about this.

Janine trials are very hard to come by in South Africa unfortunately. However, my husband had his first docetaxel infusion today. Its 00:27 here..he had it in the morning at 11:00 and has been fine all day. We will keep a watchful eye on this. I am particularly concerned about his existing extensive ild. His case is so complicated – really a low cancer burden but the compromised lung capacity and ild caused by the mixed connective tissue disease complicate treatment choices…or thats how I see it. His total cancer measurement is 78mm, if im right, made up only of rul and rll nodules and hilar and mediastinal nodes. Still no spread outside the original lung but progressive ild damage.

Thanks again Jim and Janine.

Blessings,

Delia


17 July 2012: Husband 46, previous smoker, presented with huge plural effusion, hospitalised (stopped smoking about a week or two before dx) 23 July 2012: Drain fluid and do biopsy , 24 July 2012: Dx adeno nsclc, stage 3b, poorly differentiated tumor, , tx alimta four times, showed shrinkage, 31 Oct 2012: Start with tarceva 150mg, not sure whether EFGR was tested 15 Nov 2012: Stop Tarceva for 4\5 days due to severe facial rash. 20 November 2012: Back on Tarceva, more determined than before….

February 20, 2015 at 2:45 pm  #1268576    

delialolly1

Correction. I just checked – total disease measurement is 94mm.


17 July 2012: Husband 46, previous smoker, presented with huge plural effusion, hospitalised (stopped smoking about a week or two before dx) 23 July 2012: Drain fluid and do biopsy , 24 July 2012: Dx adeno nsclc, stage 3b, poorly differentiated tumor, , tx alimta four times, showed shrinkage, 31 Oct 2012: Start with tarceva 150mg, not sure whether EFGR was tested 15 Nov 2012: Stop Tarceva for 4\5 days due to severe facial rash. 20 November 2012: Back on Tarceva, more determined than before….

Viewing 8 posts - 1 through 8 (of 8 total)

You must be logged in to reply to this topic.