Gemcitabine and Carboplatin or Docetaxel single agent - 1255102

apra
Posts:142

Hello everyone,

Some of the posts that I read on have said that Docetaxel is the most studied drug for third line or fourth line chemo.

I wonder whether anyone here has undergone Gemzar/Carboplatin as fourth line. This is the suggestion of our 1st Doctor. Our 2nd opinion Onc has said that if we want to continue Chemo then it should be Docetaxel. Ths will be his fourth line after Carboplatin Taxol three rounds, alimta Carboplatin six rounds, 10 rounds of maintenance Alimta and Tarceva from Sept. 2012.

The petscan was given for review in the Research hospital and compared to the last scan of November 2012 and they found progression both in the bones and pleura. His condition is also not good. Sleeping whole day with increase of pain all over. Unable to eat or drink. The doctor says right now he will be able to endure Docetaxel which they may give as a lowered dose for the first round. He said 100mg or 75mg.

We are praying this works and give us some more precious time together.

Thank you for listening.

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Reply # - March 25, 2013, 05:47 AM

heartspy
Posts: 37

Dearest Apra -
I know nothing about Docetaxel, sorry. I just wanted to hug you and your BRAVE husband.
My husband showed signs of progression in November on Tarceva. (EGFR +) - He tried one round of chemo in January, but the side effects were more than he cares to endure, ever again. He also has bone mets and the pain was increasing weekly. I recognized the sleeping more and eating/drinking less, also. We finally called in Hospice to help manage and cope. They have been on the job one week and already I notice an increase in comfort and a decrease in anxiety, for my husband. He woke up this morning and said, "I'm so hungry!" - Scrambled Eggs, Hash-browns, a slice of toast, with a side glass of OJ was requested and delivered! He ate all of it!!!! :-P
Please, know that I am thinking of you and your husband. Wishing for the magic wand to appear, for all of us.

Reply # - March 25, 2013, 07:25 AM

apra
Posts: 142

Heartspy,

Thank you for dropping by to give me a word of comfort inspite of your own troubles. I really appreciate it. I am so happy your husband has qualified for the CO 1686 clinical trial. I have heard of good reports about it from people who are EGFR + and have progressed on Tarceva and are now on the trial. I am sure your husband will benefit, specially if he continues to eat like that. I hope they call you soon.

I am surprised that Carbo Alimta had such a bad effect. It is one of the milder doable chemos. But everyone is different. My husband had six rounds of the combo.

Yes, I am praying that this fourth round will be THE round that finally turns this journey not smiles.

God bless you and your hubby. Take care and keep me updated. I am on Inspire too.

Apra

Reply # - March 25, 2013, 08:57 PM

Dr West
Posts: 4735

Apra,

I wish I had a good answer here. I'd have to confess that I would be very wary about giving either Taxotere (docetaxel) or any doublet chemo to someone who is spending most of the day in bed and not eating/drinking very well. There's a real risk that overly aggressive treatment could cause far more harm than good and even shorten survival.

Again, I don't have a great alternative option to suggest, but rather to say that when someone is sick enough, there's a very real risk that further chemotherapy will cause more harm than good.

Good luck.

-Dr. West

Reply # - March 26, 2013, 12:39 AM

apra
Posts: 142

Dr. West,

I can't thank you enough for your honesty. The second opinion onc called me aside and said my husband was in the last stages and it was up to us whether we wanted to give him anymore chemo or not. And if we wanted to give him more chemo he said Docetaxel was the best choice as it was the only one that may work in this situation.

We decided to take a chance on it. My husband cannot eat because anything that goes down into his stomach hurts him. I wonder whether cancer has spread to his stomach though the scan does not say anything. I wonder whether we can ask them to review the scan and look at the stomach portions minutely.

My husband himself has not given up, that is why we can bear to be around him. If he has given up then I am sure we will not be able to bear the grief and sorrow. He believes the chemo can help him and wants to do it. So we are going into it with heavy hearts praying that it will somehow work even for a short time.

I understand your concern about shortening survival. But we have no option. The Onc says its now or never regarding the Taxotere. He says he may be able to withstand it. But he has left it to our discretion.

Thank you so much. I will never forget Cancer Grace and the service you re providing people afflicted with this dreaded disease. Without you the journey would not have come this far.

I am going to ask them about intravenous feeding and rehydration as he is not drinking water much. I wonder how they will send food to his body. God is with us.

Apra

Reply # - March 26, 2013, 05:03 AM

JimC
Posts: 2753

Apra,

I am sorry that your husband has reached this point. I know that it is a difficult decision whether to choose more treatment. I understand your husband's determination to "keep fighting". I can only relate my experience when my wife reached this point. Her situation was very similar in that she was sleeping most of the time and had trouble eating and drinking. She did not want to "give up" either but after a frank discussion with her doctor she came to the understanding that further treatment would not prolong her life but only make her remaining time more painful. At first she did not want to acknowledge this sad fact, but in just a few hours she came to accept it and despite my own sorrow I could see that she was much more at peace.

As far as whether stopping treatment is "giving up", her oncologist reminded us that from the beginning the goal of treatment for Stage IV lung cancer is to improve both the length and quality of life, and that hadn't changed - we were simply changing our focus from prolonging life to providing for her comfort.

Finally, I think the patient often is more concerned about his loved ones than himself, and feels he needs to "keep fighting" for them. I think it can be helpful for the patient to understand that what we really want is what is best for them, even if that means ceasing treatment and focusing on comfort in our beloved's final days.

My thoughts are with you, your husband and your family.

JimC
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Reply # - March 26, 2013, 10:43 AM

laya d.
Posts: 714

Dearest Apra:

I'm so very sorry that your husband and the rest of you are going through this. I feel so helpless here behind my computer and wish there was a way to help you.

I also was wondering if the option exists where chemo is not completely taken off the table, but maybe the doctors can maximize comfort care for a few weeks with the hopes of your husband regaining some of his strength back and getting him in a position where he can tolerate the chemo better.

With a heavy heart,
Laya

Reply # - March 26, 2013, 09:51 PM

apra
Posts: 142

Jim,

Thank you or your kind words an sharing your own experience with your wife. We know that everything is in God's hands and we are at peace. We just want to do everything humanly possible, leaving no stone unturned. Actually God has comforted our hearts that we are not desperate either way. Thank you and God bless.

Laya,

Yes, the doctors are doing just that. They are giving him comfort care with extra parental (?) nutrition given through IV and IV fluids. ( he is also eating by mouth). Tramadol 100 mg is being given through IV three times a day. I am thinking of asking them to change Tramadol to Voveran. He seemed to respond better to Voveran last time. We are in the hospital now since yesterday taking these steps.

The cause of his stomach ache when eating has also been attributed to progression in spine in D1 and D6. The possibility of radiating tis is going to be discussed with the radiologist although he received radiation to D4, D5, and D6 in 2011. Maybe a short Targetted radiation will be possible. I was wondering to ak them about Cyberknife or stereotactic radiation or gama knife whichever one will be more suitable.

After he becomes stronger, the Onc is thinking of giving him Docetaxel at two divided doses, one dose of 60 or 80 mg on the first day and the next dose on the 8th day. So the chemo is still on the table and will continue to be on the table for a long time :) thank you for your suggestions and concern.

Apra

Reply # - March 26, 2013, 10:04 PM

laya d.
Posts: 714

Although I remain quite worried for your husband, I like what I'm reading with regard to the treatment plan you have outlined for us. It sounds like everyone is on the same page - - i.e., to help him try to get his strength back, and then to continue with treatment.

So, I continue to wish your husband all the best...and hopefully they will be able to radiate the spinal mets and quickly alleviate his eating issues.

All my best to you both, and here's to your husband improving and regaining his strength very very soon...

Laya

Reply # - March 26, 2013, 11:42 PM

apra
Posts: 142

Yes, Laya, but I suppose the cancer itself is causing this fatigue and urge to sleep. But anyway we are glad some proactive action is being taken. Thank you for your kind words, I really appreciate the time you take to continue to be on this board giving out words of comfort to everyone. The world of cancer is not a cheerful place. I can understand people running away from it the moment their loved ones leave them. But people like you and Jim have stayed on blessing us with your experiences. Thank you.

Reply # - March 27, 2013, 01:28 AM

Jazz
Posts: 279

Apra,

Just wanted to send best wishes and hope to you and your husband during this trying time. It appears he's had quite alot of carboplatin already, so perhaps a good idea to let that go. I hope you can resolve the issue with his stomach/eating soon.

Hang in there, one day at a time.

Jazz

Reply # - March 27, 2013, 02:05 AM

apra
Posts: 142

Jazz,

You are a survivor! How are you now? Thank you for stopping by.

We have one away with the thought of Carboplatin just now and just concentrating on Docetaxel single agent. I see that you have experienced this drug in first line.

Right ow my husband is getting nutrition and pain relief from the hospital to build up his strength. We are interested in Cyberknife now for painful spine mets. The Onc says his stomach pain and inability to eat s being caused by his spine mets in D1 and D6. Right now he is not on any cancer medication. Still very tired but eating better.

Please give me an update on your situation.

Apra

Reply # - March 27, 2013, 05:48 AM

heartspy
Posts: 37

Hi Apra,
Just me again - wanted to share this information with you that a friend sent to me, regarding patients with bone mets, I think it is worth the investigation : [video]https://www.youtube.com/watch?feature=player_detailpage&v=IfJemqkby_0[/…] and the website for the company Insightec: http://www.insightec.com/ - there is a list of locations on the website that are currently offering this technique.
My husband has little interest in this, right now. However, I think once Hospice has enough time to keep his pain managed, he will regain a positive outlook and might be willing to hear more about it. His appetite seems to be on a steady increase and his anxiety is on a steady decrease. This makes for a Happy Heartspy!!! :-D
Now, we just need to get him out of bed, more often. Hoping the wheel chair helps to encourage him to come outside and roll around with the dogs.

Laya & Dr. West : Thank you for your kind comments and support. And might I add, Dr. West, your new profile is showing off your recent weight loss and all your joy! Congratulations!

To all you brave GRACE posters: Thank you for all of your experience, honesty and influence. There are not alot of places or people I feel connected to right now. You fine folks and a hot cuppa cawfee (full blown NY accent intended) give me moments of sanity, early in my day. Sending cyber hugs filled with gratitude.

Reply # - March 27, 2013, 06:34 AM

apra
Posts: 142

Heartspy,

Thank you. But I could not open the you tube. Maybe because connection is not so good today or maybe because I am using an iPad. But I tink it is a new technic for Ultrasound guided surgery?

Will try to open later. We are looking into Cyberknife. Will talk to the Onc tomorrow. Today is Holi, an important Indian Spring Festival of colours so the hospital is almost empty.

So happy your husband is eating and regaining his health. Any improvement is reason fr celebrating. Being able to eat is one of the biggest blessings in this journey. Your husband has age on his side. A very young 43. So is he still on Tarceva? Glad hospice is there to help. In India we do not have such an organisation. May the Lord's face shine upon us all.

Apra

Reply # - March 27, 2013, 06:58 AM

heartspy
Posts: 37

Ahhhhh Apra - Enjoy your Holi - day and all it symbolizes. Rebirth and Rejoice.
Sorry you could not open youtube link. You might be better to just go to website: http://www.insightec.com/
My husband was not a candidate for cyberknife. Exablate, however, is actually non-surgical, MRI guided Ultrasound. Oh, and no, my husband is no longer taking Tarceva. He just wants an opportunity to feel ok - giving his body a rest from chemicals. Like you, I support the hubby 100%, in any of his decisions. His life, His cancer, His treatment & His Decisions. Anyway, just know that we are loving you, supporting you and praying for you, sweet woman.

Reply # - March 29, 2013, 11:13 AM

apra
Posts: 142

Heartspy,

Holi is not something I enjoy except for the holiday part. On this day people should not go out in the streets otherwise they will be deluged with coloured water. Your clothes and skin will get spoiled. People usually stay indoors or party with their own groups.

It is popular among the Hindus but not among the Christians.

Your husband is a brave man, and you are a wonderful woman supporting him in all his decisions not thinking of your own needs. God bless you and give you many wonderful days together.

Thank you

Apra

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