Low-dose chemotherapy

This topic contains 9 replies, has 7 voices, and was last updated by tanyadean tanyadean 12 months ago.

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October 1, 2013 at 9:15 am  #1259572    

watu

I was reading some articles on low-dose gemcitabine and it seems that in some studies it has shown a longer “time to treatment failure” than the standard dose.

Does this have any scientific explanation?

A higher dose of a chemo agent is certainly expected to be more effective, but is it possible that it also “stimulates” a faster resistance from the cancer?


Father (72), no smoker.
4/09 suspicious nodule, upper left lobe.
7/09 lobectomy, 2cm adeno (T1N0M0). No adjuvant chemo.
1/10 found another nodule, lower left lobe (probably unnoticed in 2009).
4/10 completion pneumonectomy, 2cm adeno, 2 positive regional lymph nodes (T2N1M0). No adjuvant chemo.
9/10 PET-CT: negative.
4/11 PET-CT: positive lymph nodes (mediastinal, superclavear).
5/11 biopsy of 1 superclavear lymph node, adeno met, EGFR+ mutation.
6/11 start Iressa.
9/11 PET-CT: negative. Great response to Iressa.
2/12 PET-CT: negative.
7/12 PET-CT: positive lymph nodes (mediastinal, superclavear, axillary).
9/12 PET-CT: positive lymph nodes, higher SUV.
12/12 CT scan: 7.5mm and 3mm brain mets, multiple 3-4mm nodules in right lung, 10mm lesion in liver and osteolytic areas in the XI rib and L3 vertebra. Stop Iressa and switch to Taxotere.
4/13 CT scan: good response to Taxotere. After 5 cycles, only three 3mm nodules visible in liver, brain mets stable.
5/13 Taxotere no longer tolerated + dizziness, nausea, vomiting, aphasia, hearing loss (brain mets?). Start re-challenge with Tarceva (150mg per day). Significant improvement of physical conditions after only 2 weeks of treatment.
8/13 Tarceva seriously affecting kidney function. Dose reduced to 100mg every other day.
9/13 Sudden onset of neurological symptoms. CT scan shows 4 brain lesions (29mm, 28mm, 16mm, 15mm) with cerebral swelling + multiple micro nodules in right lung. WBR carried out (2000cGy over 5 fractions).
10/13 Significant physical and neurological decline soon after WBR. Only palliative care.
12/13 CT scan: all brain lesions disappeared (only one single 6mm nodule left), micro nodules in right lung significantly reduced (were they really cancer?). Still with significant neurological impairment, likely to be associated with radiation-induced necrosis. On palliative care only (dexamethasone + nimodipine)
02/14 Dad passed away peacefully on Feb 8th 2014.

October 1, 2013 at 11:36 am  #1259574    
catdander forum moderator
catdander forum moderator

Hi watu, I hope you’re feeling alright.

I’m all for less drug. I’ll ask one of the doctors to comment.

October 1, 2013 at 2:55 pm  #1259583    

Dr. Weiss

I am not aware of any data indicating the lowering the dose of gemcitabine for lung cancer improves outcome. There have been a variety of studies in pancreatic cancer looking at different durations of infusions, but it’s not clear even there that there were any advantages to the alternative regimens.

Formally, the dose indication in the US is 1250mg/m2 days 1 and 8 of a 3 week regimen. I, and many US oncologists do prefer a dose of 1000mg/m2, again on days 1 and 8. But I don’t reduce the dose because I believe that efficacy will be higher; I reduce it because 1250mg/m2 is hard for most patients to tolerate.

October 1, 2013 at 3:13 pm  #1259584    
Dr West
Dr West

I just wanted to say that I agree completely with Dr. Weiss. I know of no high quality data to support increased efficacy with lower dose gemcitabine. I also give a lower dose than the FDA-approved one in the clear majority of patients, but that’s because the 1250 mg/m2 dose is infeasible for administering on the intended schedule in the real world.

-Dr. West

February 18, 2015 at 8:59 pm  #1268540    

healmymom

Dr. Weiss and Dr. West — do you use Gemcitabine often as 2nd line therapy for elderly patients ? (my mom is 79 and performance # approx. 2.5) Taxol would prob. have the best efficacy, the would most likely be much too harsh for my mother, and she would definitely loose her hair, correct ?

I thought I had read somewhere where a study showed that a 1000 mg dose didn’t show very good results, but a little higher dose would.

What is it that patients can;t tolerate if the dose would be 1250 mg ? the blood counts issues ?

February 19, 2015 at 8:06 am  #1268544    
Dr West
Dr West

I would say that there are not significant differences in side effects overall among the agents that would be more commonly given as a single agent. Gemcitabine is certainly as drug that is often well tolerated, and it’s uncommon to lose hair (even then, it’s usually more thinning than significant hair loss). However, the response rate is low, under 5%, and there is no survival benefit — and the question of dose hasn’t been studied well enough to say that a higher dose will provide a significant survival benefit. Higher dose is definitely associated with a higher risk of low blood counts complicating attempts to treat on a regular schedule.

The only agents that have a proven survival benefit in patients who have received prior chemotherapy are Taxotere (docetaxel), Alimta (pemetrexed), and Tarceva (erlotinib). Though you could use gemcitabine as second line therapy, I don’t favor it over the agents that have a proven benefit. Knowing that we have no evidence of it significantly improving outcomes in patients who have received prior chemotherapy, I generally recommend it as a later line of treatment only in patients who have had good responses to several lines of prior chemotherapy and still have a good performance status — such patients are the ones most likely to have an unusually favorable result from gemcitabine.

Good luck.

-Dr. West

March 9, 2016 at 10:35 pm  #1273197    

merilee

Dr .. I was diagnosed last May with Adenocarcinoma Non Small Cell stage 2A.
Due to involvement of a lymph node. Wedge resection and lymph nodes removed. I had 4 rounds of Amilta ? And Cisplatin. I had local recurrence after the chemo in lymph nodes in mid chest. No other areas . That was only app 9 months after original diagnosis. I will now have 6 wks radiation daily and 4 rounds. Possible Dr said 6 rounds.The chemo Taxol/ carboplatin low dose .. Is low dose chemo less like to help the radiation work rastherbthanbs regular dose ? ZI have asked your advice before and it us so appreciated…Thank you all for all the help…you give everyone… and thanks for any replies. M. M

March 9, 2016 at 10:39 pm  #1273198    

merilee

Sorry my question to try above is the medications etc pretty standard for local reinsurance re stage 2A..I have heard success rates are good. Which I am happy about though. Thank you. M M

March 10, 2016 at 9:21 am  #1273201    
catdander forum moderator
catdander forum moderator

HI Merilee,

Low dose is pretty standard with radiation. There really isn’t a standard of care for recurrent curative treatment but your plan sounds typical of what oncologists do that’s been curative. Chemo doses are very often lessened for radiation because radiation can cause the chemo to be more potent and have worrying side effects. Original diagnosed curitive treatment with low dose chemo and concurrent standard rounds of radiation very often have curitive results, better so than full doses done separately.
The research show 4 rounds of chemo are as effective as 6 but many oncs give 6 rounds if the person can withstand is and many can. So it’s kind of like a little more might get that last cancer cell but there really isn’t any proof and many oncs feel it’s not worth the side effects. These decisions come in the realm of more art than science.

I look forward to hearing lots of good news and few to no bumps in the road :)
Janine

November 24, 2016 at 4:44 am  #1289255    
tanyadean
tanyadean

Exposure to high level of radiation can cause serious health problems while the low dose rate radiation have been shown to have less side effects than the normal one. There are many studies that show low dose is some degree a protective effect against the other causes of cancer.

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