Is maintenance chemo the next logical step? - 1255988

Hello oldbrit, Welcome to Grace. I'm very sorry your cancer has recurred. I believe you will find Grace a excellent source for learning and compassion.

I'm with you and think a break is very possibly very much in order. It's not common to use more than 4 to 6 cycles (one line of treatment) of a platinum doublet. People tend to become hypersensitive to more than 4 or 6 cycles of a platinum. Add concurrent radiation twice and you've had an aggressive go at it. When the goal is cure then these types of risks can be worth while though if the cancer is to recur now it's unfortunately not going to be thought of as curable moving forward. A balance of treatment and quality of life becomes very important piece to treatment options.

While Dr. Weiss is speaking about squamous not adeno (very similar in many respects) the statements about watching and waiting apply to you because of the aggressive nature of both your treatments, "The standard of care for squamous cell carcinoma is to indeed watch and wait after 4-6 cycles. Watching and waiting does not mean doing nothing. For this to be a viable plan, there indeed needs to be regular imaging. But with this monitoring, this is the most commonly pursued treatment strategy and a very standard one." from, http://cancergrace.org/lung/topic/chemo-done-suggestions-please/

I responded to a post just this morning very similar to this so I want to send you there for links and finding resources on Grace. http://cancergrace.org/topic/maintenance-chemo

Again welcome and don't hesitate to ask for more info,
Janine
forum moderator

The best answer is that we don't know, but I'd also say that I would term further therapy as "consolidation therapy" and not maintenance therapy. Maintenance therapy is a treatment approach that is essentially indefinite in a setting where you know you're not going to kill the last cancer cell, with the goal of suppressing the cancer for as long as possible. Consolidation therapy is still a limited duration of treatment being given in a curative setting, with a goal of improving the chances of killing some potential last cancer cell.

If we were treating someone for unresectable locally advanced NSCLC for the first time, the established approach is chemo with concurrent radiation, and the only duration of chemo that has an established benefit is 2 cycles of cisplatin/etoposide or about 7 weeks of weekly low dose carboplatin/Taxol (paclitaxel). That said, we often do give more, most commonly another couple of cycles (6-8 weeks or so), but that's based on a bias that more treatment should be better. There's no evidence that treating with more chemo improves outcomes, though, even if it's a reasonable idea.

I will also say that the treatment of surgery followed by chemo and then radiation for incidentally discovered stage IIIA N2 node-positive disease at surgery is very appropriate. Concurrent chemo/radiation could be done, but many and probably most experts favor a sequential approach, given how hard it is to get through all of these modalities of treatment.

You'll note that what I'm not giving is an answer, because I can't. That would imply that there actually is a real best answer, when it truly should be a matter of individualized judgment based on how you're doing, and the acceptability about potentially over-treating vs. under-treating when there isn't true evidence to guide a decision.

Good luck.

-Dr. West

oldbrit, I'm a middle-aged Brit (though currently feeling 103), so just wanted to offer solidarity and hope that you feel better soon. Best wishes.