Gemzar Question

Portal Forums Lung/Thoracic Cancer NSCLC Stage IV NSCLC Gemzar Question

This topic contains 2 replies, has 2 voices, and was last updated by  scohn 2 months, 3 weeks ago.

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May 21, 2018 at 9:03 am  #1294442    

scohn

Hi everyone.

A gemzar question on scheduling has come up, and I wondered if anyone has any information one way or the other. My wife has been on a 2 week on/1 week off schedule for Gemzar, which showed strong tumor reduction, then stability for several months now. Because of some recent travels we had, she went on a 1 week on/1 week off schedule for the last month.

The oncologist has now asked her which schedule she would prefer – he doesn’t have a problem with either one. Is there any general sense of whether there is much difference between the 1/1 schedule or the 2/1 schedule in terms of strength of effectiveness? Her RBCs do get a little lower (but not significantly) with the 2/1 schedule.

The reason I ask is that if we understand the oncologist correctly, if she wants to go on the 1/1 schedule for a while, and we start to see any tumor growth at all, they would probably go to a new treatment first rather than try the stronger 2/1 schedule again.

My wife told the oncologist she would stay on the 2/1 cycle (although with some summer stuff going on it will likely still be 1/1 for the next month anyway). So, I guess I am asking if there is a general rule of thumb – is it generally best to go for the stronger Gemzar dosing as long as it is tolerable? Is there much information on the effectiveness of one Gemzar dosing over the other?

Thanks!


Wife, lifelong non-smoker, dx 4/24/15 adeno NSCLC stage IV-2 bone mets, 1 lymph node. HER2 Exon 20 mutation. 6x Carbo/Alimta – >50% reduction in primary tumor, lymph nodes, & bone. Alimta maint. not effective -growth & new liver mets. 11/15 – Opdivo; Not effective-add’l growth. 4/16 – PF-7020- large reduction of tumor and mets. 11/16-mixed results, liver mets stable. 2/17-All Stable. 8/17- Add’l growth-off Pfizer trial, 9/17 Gemzar- reduction then stable. 8/18 – Mixed results – new treatment?

May 21, 2018 at 6:57 pm  #1294446    
JimC Forum Moderator
JimC Forum Moderator

Hi scohn,

I haven’t been able to find a study that compared the various Gemzar regimens. The prescribing information describes two regimens (which are first-line therapies that also include cisplatin): a four-week cycle (3 weeks on, 1 off) and a three-week cycle (2 on, 1 off), without describing either as superior or preferable.

Dosage adjustments such as those made by your wife’s oncologist are common, and they are often based on tolerability or convenience issues. The fact that your wife’s oncologist is comfortable with either regimen tends to indicate he hasn’t seen or doesn’t anticipate a significant difference in efficacy. That’s probably why he would look to change to another therapy upon progression, although you could make the argument for the higher dose if the progression is very slow.

Unfortunately, I think this is one of those situations where there just isn’t data to drive the decision. It’s a later line of therapy, used at this point as maintenance therapy, and the cancer is stable. That’s not easily tested in a clinical trial, so it is a judgment call with no right or wrong answer.

I wish we could do better than that, but after a certain point in cancer treatment there is no clearly “best path” to follow.

Wishing you and your wife continued success with Gemzar.

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

May 22, 2018 at 6:28 am  #1294448    

scohn

Thanks Jim!


Wife, lifelong non-smoker, dx 4/24/15 adeno NSCLC stage IV-2 bone mets, 1 lymph node. HER2 Exon 20 mutation. 6x Carbo/Alimta – >50% reduction in primary tumor, lymph nodes, & bone. Alimta maint. not effective -growth & new liver mets. 11/15 – Opdivo; Not effective-add’l growth. 4/16 – PF-7020- large reduction of tumor and mets. 11/16-mixed results, liver mets stable. 2/17-All Stable. 8/17- Add’l growth-off Pfizer trial, 9/17 Gemzar- reduction then stable. 8/18 – Mixed results – new treatment?

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