Carbo/Alimta as doublet vs. sequentially - 1262445

Hello, Just a bit of clarification, when we speak about concurrent vs sequential it's usually assumed to be about giving chemo and radiation concurrently or separately. Also platinum based chemos, like carbo are not normally given alone and are known as the main drug in the "doublet" setting.

There is an excellent post by Dr. West on the subject of deciding on a carbo doublet or a single agent in first line treatment for frail and or elderly people.
Since this blog post was written Alimta has become a leading choice in chemo drugs for non-squamous nsclc.
In the post Dr. West says, "The available evidence shows that either a carboplatin doublet (I don’t advocate for cisplatin here) or single-agent chemo are feasible and associated with our best results."
He goes on to say, "Single agent approaches can be a great choice for a patient wary about the potential side effects who you think could benefit from chemo if they give it a try. While I don’t want to twist anyone’s arm, I’ve nudged several leery elderly patients to just give single agent therapy a try, most of whom were surprised with how well they felt on treatment, some barely even noticing it. And quite a few have had gratifying responses and gone on to try two or three different single-agent regimens over time." http://cancergrace.org/lung/2008/09/07/wird-ps2-adv-nsclc/

Since your mom is shown to have an indolent cancer it may not be a problem to take things slow and easy.

I hope this helps,
Janine

Hello,

In addition to the excellent information and link Janine provided, Dr. Weiss posted an excellent discussion of the history and theory of chemotherapy for NSCLC in which he stated: "adding a second drug to platinum or adding platinum to another drug improves both response rate and survival." You can read the entire post here: http://cancergrace.org/lung/2010/04/16/introduction-to-first-line-thera…

JimC
Forum moderator

To delve a little deeper, you asked about carbo alone and then Alimta (pemetrexed) alone. Frankly, that's a pretty unusual recommendation, as just about every lung cancer specialist I know of would favor giving the Alimta portion, not carbo alone, if you're not going to do the doublet with carboplatin. Carboplatin's efficacy as a single agent in this setting isn't 30% -- it's more in the range of 10% or less. And it hasn't been studied in lung cancer as a single agent over the past 15 years because it's known to be not especially impressive as a single agent in lung cancer.

There have been a few studies that now show that carboplatin/Alimta or some other partner with carboplatin is superior in efficacy to a single agent (omitting the carbo, not the other agent), even for elderly and/or frail patients with advanced lung cancer.

Good luck.

-Dr. West

That is true - Carboplatin is rarely used except in combination with another drug.

It's certainly possible to try carbo/alimta and discontinue it if it proves too toxic, but you also don't want to knock down a patient to the point where it is difficult for her to continue treatment. That's why Dr. West recommends an individualized approach, especially in older patients. The issues you cite in your mom's situation (part-tme use of oxygen, somewhat fatigued, 78 yrs.old) are certainly the kind of factors which could lead to a decision to use single agent therapy, but your mom's doctors, who have the most medical information about her as well as the opportunity to examine her, would be best equipped to make that individualized evaluation.

Good luck with whichever path is chosen.

JimC
Forum moderator

My mom tolerated Carboplatin/Alimta doublet very well. Good luck.

It's true that some people do get sick on carbo/alimta. It usually gradually worsens as treatments progress. It's just varies too much to guess how your mom will do.
The following link can help you better understand what's possible and what can be done to mitigate side effects. http://cancergrace.org/cancer-treatments/2012/06/07/selected-asco-abstr…

Usually oncology team will send home info on the specific drugs and what to expect. You can also find that info on the makers online site.

The truth is that there's no easy way to predict how an individual patient will tolerate a regimen, and it's harder to predict in a 78 year-old than in a 60 year-old. Yes, in medicine, we learn to speak in more general terms, and I do think it's fair to say that carbo/Alimta is generally well-tolerated -- some people have a difficult time, but there's no way to say which patients until they get it for the first time.

The evidence has only mounted in the last few years to support doublet chemo for older and frail patients. If they can't tolerate it, you can always drop the dose of both or drop one drug entirely (which would almost always be the carboplatin, not the Alimta).

-Dr. West