Change in Diagnosis After Two Rounds of Chemotherapy - 1263534

sawyer6
Posts:45

First off, I just wanted to share that this forum has been a tremendous source of inspiration, information and comfort since my dad's lung cancer diagnosis in mid-March. Thank you.

My 83 y/o dad ,who smoked between 9 and 15 pack years (his memory has always been poor:), and quit 50 years ago was originally diagnosed with poorly differentiated squamous cell carcinoma of the lung, with features of adenocarcinoma (the oncologist wasn't confident that his cancer could be considered adenosquamous). The initial IHC report was equivocal; it showed markers for both squamous and adeno carcinoma. However, yesterday, my mom and dad met with Dr. Matthew Gubens at UCSF who has been providing a second opinion (on both treatment and diagnosis) and it appears, according to my mom, that the diagnosis, based on UCSF pathology review, has been changed from squamous to adeno. I am trying to get a hold of the pathology report to confirm this change.

My dad has had two rounds of carboplatin/taxol and it appears that he is having a clinical response (his cough is almost gone, and his experience of cancer-related pain seems to be decreasing). In light of the likely new diagnosis and my dad's (apparent response to chemo), I was wondering the following:

1) If the diagnosis is in fact adenocarcinoma, have we screwed up by not using the other chemo combinations recommended for first-line treatment of adenocarcinoma?

2) Can the adeno specific chemos (I think I'm referring to Alimta / Cisplatin) used as second-line treatments with the same response?

Thanks again.

Seth

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Reply # - May 1, 2014, 02:01 PM

JimC
Posts: 2753

Hi Seth,

Welcome to GRACE. We're glad to hear that the site has helped you. It's also good to hear of your dad's clinical response. In response to your questions:

(1) There is just not that much difference among the various approved first line treatment regimens. What you'll commonly hear said is that "responders respond", meaning that those who respond well to one regiment tend to respond well to other regimens. You can read about first line treatment choices in the GRACE FAQ (and the posts linked therein) at: http://cancergrace.org/lung/2010/09/18/lung-faq-ive-just-been-diagnosed… It should also be said that if there is any doubt about whether the cancer is adeno or squamous, using taxol instead of alimta is a very sound choice.

(2) For second line therapy, three agents are FDA approved: Alimta, Tarceva and Taxotere. Any of these would be a good choice. It's not likely that any of them would provide the same response as if they had been used first-line, because first-line treatment (whichever agent is chosen) tends to provide the best response in terms of tumor shrinkage while second line treatment, although it can also less commonly result in shrinkage, is considered successful if the cancer remains stable. The most notable exception is when using Tarceva as second-line therapy for a patient who has an activating EGFR mutation. In such a case the response can be more dramatic.

The bottom line is that you should not be worried that you have chosen the wrong therapy. They're all fairly equivalent, and you dad's improvement in symptoms certainly points to a good response. I hope that his first follow-up scan shows exactly that.

JimC
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Reply # - May 1, 2014, 02:16 PM

catdander
Posts:

HI sawyer6, I'm very sorry your dad has lung cancer and know it's difficult for the whole family.
The treatment your dad has gotten is very appropriate whether he has adeno or squamous. Second and beyond treatment don't involve platinum.
This is a good thread on the topic,
http://cancergrace.org/lung/topic/squamous-vs-adenosquamous/

And this is the search result from a search on adenosquamous carcinoma with an abundance of info.
http://cancergrace.org/search-results?q=adenosquamous%20carcinoma%20que… are links about maintenance and 2nd line treatments.
http://cancergrace.org/lung/2010/09/24/lung-cancer-faq-im-coming-to-the…
http://cancergrace.org/lung/2010/10/04/lung-cancer-faq-2nd-line-nsclc-o…

I hope this helps explain some of your concerns about treatment,
Janine

Reply # - May 1, 2014, 07:36 PM

sawyer6
Posts: 45

JimC and Janine -- The links / information you provided have given me reassurance that the current treatment plan is a good one. I also appreciate the kind words. I expect that I will have more questions in the future, and am glad to have this resource available.

Seth

Reply # - May 1, 2014, 09:40 PM

Dr West
Posts: 4735

Seth,

I have little to add after Jim and Janine provided a great assessment shored up by some additional helpful links. Indeed, you'll find that there is no mention of a "best regimen" here for first line therapy. Even if there are subtle differences in results for one regimen vs. another, they are truly far more similar than different, except perhaps that Alimta (pemetrexed)-based chemo is a poor choice for a squamous (or predominantly squamous) NSCLC. Beyond that, we don't get too heavy-handed about there being a regimen of choice...instead, there are a choice of regimens that largely get you to the same place.

And as Jim noted, Alimta remains a fine choice after first line for a predominantly non-squamous NSCLC. It was first tested and FDA approved as a second line therapy, after all.

Good luck to your dad.

-Dr. West

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