same drug for 2nd line chemo? - 1263079

Hi gigy, I'm sorry the EGFR tests came back negative. 18 months is a long time off treatment without having any progression so the alimta was and is very likely to be active. Whether or not to add platinum to the mix is an individual question. Most often it isn't considered especially if one has been on treatment. Since you haven't and if you're in good condition many onc would consider it a possibility. But again it's a question only you and your doc can answer.

As Dr. Pennell wrote:
“Although traditionally oncologists did not “go back” to drugs that have already been used, I would say that attitude is becoming less common with modern agents. I feel very comfortable re-challenging someone with a chemotherapy agent if that drug was stopped for a reason other than progression. For example, if someone has significant fatigue on Alimta after many cycles and wants a break, I would have no problem restarting it again if the cancer progressed many months later. If I was convinced that the cancer had become resistant to that drug, however, it would be rare to try using it again. We will sometimes reuse a chemotherapy drug if it has been a long time since it was used, usually more than a year.” – http://cancergrace.org/topic/progression-on-gemzar#post-1260439 . I picked that up from a recent post found, http://cancergrace.org/topic/no-more-stable

And a discussion on the topic of re-challenging platinum, http://cancergrace.org/forums/index.php?topic=7100.0

I hope you do well whatever course you take,
Janine

Gigy,

Yours is a "special case" that isn't the same as having progressed while on that chemotherapy. With an interval of over a year between administration of prior chemo and recurrence, some might presume that progression would have occurred in 6 or 9 or 12 months if that chemo hadn't been used, so it may be interpreted as being effective. It's a debatable point.

Over the past few years, as we have shifted toward offering more maintenance therapy in advanced NSCLC, thee has been a growing concept that we don't want to discard an effective treatment too early. So if a person's cancer didn't progress while that person was receiving that chemo, it's fair to think there is still activity in that chemo. Once progression is demonstrated, all of the options are still potentially available, so you might just consider this as progression from NOT being on the initial chemotherapy, rather than progression despite that chemotherapy.

Certainly, some thoughtful oncologists would consider moving on to a different chemo, but I think a strong argument can be made for resuming the prior therapy before discarding it. It may yield significant benefits for a long while before you need to move on to a next therapy.

Good luck.

-Dr. West

Argh. Janine and I provided answers at the same time, but I was more verbose and got mine in 2 minutes later.