NSCLC-Squamous -Chemo Options & Treatment option - 1260303

reply2stevejohn
Posts:17

Well after 9 weeks of my Journey to this cancer world, I'm back to seek your opinion/suggestion:

My Dad is aged 72 years -Diagnosed for Squamous -NSCLC-stage 4 during August 2013 as Inoperable state-Stage 4 with chest wall invasion -Localized Advanced Invasion and cancer is not spread yet apart from Advance localized.

Currently the Tumor size after 1st line of GEMCARBO Chemo is (55mmx60mmx50mm (Previous ..62mmx52mm)..Though reduction is seen but not too drastic to tak in terms of percentage but at least we are Glad that it is Stable atm after 3 rounds of GEMCARBO which itself is consider success in a way.…

I don't find any PD-1 Trials in India though still in process of hunting for one close to this part of the world and with respect to mutation test, we are getting mixed opinion for squamous, with two different Onc , one Onc# suggesting to do ALK & EGFR test and another Onc is of the opinion that for Squamous EGFR & ALK test doesn't make sense...we haven't yet done mutation test.What's your Opinion on this as it is not part of standard protocol for Squamous.

We did seek Second opinion from well know Onc , they suggested to try ==>Paclitaxel +Cisplatin for next 3 infusion.

1) How effective is Paclitaxel +Cisplatin for Squamous..Is it Standard protocol for Squamous.
2) What other Chemo Drugs are options for Squamous.

I'm really curious to attend webinar on 12th Nov from Dr. David Spigel on Squamous Lung cancer and treatment regime and the progress in immunology.

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Reply # - November 5, 2013, 07:50 AM

Dr West
Posts: 4735

Paclitaxel (Taxol) and cisplatin is a fine choice but not standard of care after first line treatment. The general approach to advanced NSCLC is to start with a platinum-based doublet and then transition to sequential single agent treatments after that. This is in part because there is no good evidence that giving more than a single agent after first line is superior to giving single agent chemo, and in part because most people are less able to tolerate the rigors of combination chemotherapy after several months or more of initial chemotherapy. That said, it is a reasonable option to consider in individual patients who are both strong enough and motivated enough to accept the additional challenge of greater side effects with combination chemotherapy after first line.

The treatments that really have evidence of a survival benefit in squamous NSCLC, at least in reasonably large studies, are Taxotere (docetaxel) and Tarceva (erlotinib). Other treatments may potentially emerge as valuable, but we don't have clear evidence to support improved outcomes at this time.

It is not standard of care to do EGFR and ALK testing in squamous NSCLC. Though it is possible to detect these in patients with squamous NSCLC, current recommendations do not favor it because the probability is felt to be too low to justify routine testing.

Good luck.

-Dr. West

Reply # - November 8, 2013, 07:11 AM

reply2stevejohn
Posts: 17

Thanks Dr. West to provide your opinion, Even I have noticed few people with Squamous have seen benefit from Taxotore (doctaxel) on the forum.....Tomorrow we have Chemo after first 3 round of gemcarbo, still Its not clear whether we should stick with Paclitaxel (Taxol) as suggested by Onc 2 or seek opinion about Taxotere (docetaxel) ...Obviously we are not doctors to understand very fine lines....Dr West, I would appreciate, if you can help us to give some pointers on any clincial trails results on squamous with either of Taxol+Cisplatin or docetaxel.....

Also what is the treatment regime ( 3 week cycle or weekly cycle) in either case and also potential obviuos side effects

what would be the most appropriate path consider these two drugs choice for any Squamous NSCLC.

Regards,
Steve

Reply # - November 8, 2013, 09:15 AM

catdander
Posts:

Hi Steve,
You'll find many references to trial data shown in the blog posts our faculty doctors write. The links show up within the text in green. Also in the blog posts there are often graphs picturing data. I'll paste a couple and you can search yourself however if you're using explorer browser you'll need to log off to show the results of the search. Also at the end of the posts there are links to similar posts. Please take advantage of what we've already got to offer and never hesitate to ask followup questions.

Taxotere side effects maybe difficult to take but it has shown benefit for those with squamous however the side effects usually limit the amount given. So giving it with another drug can be too much especially cisplatin another drug among the most harsh of harsh drugs.

http://cancergrace.org/lung/2010/09/24/lung-cancer-faq-im-coming-to-the…

http://cancergrace.org/lung/2008/01/24/selecting-2nd-line-nsclc-rx/

pubmed website has the largest database of trial results I'm aware of. This is abstract to a trial dated 1994 when taxotere was first being researched. The "Related citations in PubMed" are found in the column to the right. The site is easily searchable but there is a lot that can't be accessed without a pass.
http://www.ncbi.nlm.nih.gov/pubmed/7909941

I hope this is helpful,
Janine

Reply # - November 8, 2013, 02:18 PM

Dr West
Posts: 4735

I really don't have trial data to offer on these specific combinations you're asking about as second line and later treatments. As I mentioned, platinum doublets are a clear standard of care for first line therapy and are not well studied in later lines, in part because there is very little enthusiasm for going back to drugs already used. You can do a search for information as Jim has suggested, but the short answer is that there are no data to compare cisplatin/Taxol to docetaxel, especially looking specifically at squamous. Your doctor should discuss the list of leading side effects with you, or you can find these by searching for that information online. I can't really recapitulate that here for you, especially since it's a regimen I have never prescribed for lung cancer.

Good luck.

-Dr. West

Reply # - November 12, 2013, 11:01 AM

reply2stevejohn
Posts: 17

Having discussed with Onc#1 about Taxotere (docetaxel) & Paclitaxel (taxol). and also side effects....Onc#1 suggested that he will start Chemo with Taxotere (docetaxel) + Cisplatin tomorrow with reduced dosage to see How my 72year Old Dad would response. Keeping my fingers crossed to see How he would respond to this drug combination....

Reply # - February 28, 2014, 07:53 PM

reply2stevejohn
Posts: 17

Dr. West/ Dr David Spigel..Thank you for session hosted on Squamous Lung cancer sometime back (12th Nov) which helped us to decide on Placitaxel & Carboplatinum doublet for next attempt of chemo based on statistics shared after we had initial attempt with GEMCARBO (3 cycles and PET scan result was stable).

My Dad started his first round of chemo - Placitaxel ( weekly basis) with Cisplatin, Cisplatin was too harsh for him to sustain as he had shortage of breath and we switched to Carboplatin for next two rounds of chemo with out any side effects

And I wanted to share this Good news with recent PET scan that the tumor size had significant reduction where currently it is measuring 2.5cmX4.4 cm & SUV max 10.4 (previous PET scan dated in Aug 2012 - 5.2cmX6.2 cm & SUV max 33). And also reduction in medistinal lymphonode size as per PET scan and lung cancer is local advanced and not spread anywhere yet.

Yet to consult tour Onc....With this current status, Is my Dad candidate for surgery or he should continue with chemo and then radiation (what kind of radiation....What is the standard protocol...Pls do suggest.

Reply # - February 28, 2014, 11:02 PM

Dr West
Posts: 4735

The decision to pursue one treatment approach or another is usually based on the initial staging and is typically not modified based on imaging findings along the way. The stage dictates the treatment plan, and the stage doesn't go down even after a good response, so it would be unusual to change treatment approaches and pursue surgery when it wasn't the appropriate treatment in the beginning.

Radiation for lung cancer is most typically given on a daily basis Mon-Fri over about 7 weeks. Your radiation oncologist would be able to provide more details.

-Dr. West

Reply # - March 1, 2014, 12:10 AM

reply2stevejohn
Posts: 17

Dr West, Staging wasn't very clear from day 1 for us as it varied between different Onc's..where it got varied between 3 to 4.

http://cancergrace.org/topic/nsclc-stage-4-squamous-cell-treatment-opti…
Pls check Dr Ben's view here.
____________________________________________________________
Because of right side small pleural nodules which was not sure whether it was Cancer cell or not as some concluded it has cancer cell. Now with recent PET scan those right side pleural nodules are stable (which is not reduced or increased in size) . Can we rule out that right side are not cancer cell with recent PET scan to remove ambiguity or any other way to find same.

Thanks RT input.

Reply # - March 1, 2014, 08:06 AM

JimC
Posts: 2753

The only definitive way to determine whether those pleural nodules are cancerous would be to biopsy one or more of them. That might make staging clearer.

In your earlier thread, you mentioned that at diagnosis there was chest wall invasion and total destruction of a rib. Was that thought to be the result of metastasis? If so, the stage would clearly be stage IV and local therapy would likely not be indicated.

JimC
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