I just read several links you referred someone else to -- regarding 2nd line treatments, but as some were written in 2008 + 2010, I'm asking the questions again as perhaps the answers are diff. now in 2014.
Today we will get the results of my mom's CT scan (1st since starting chemo in Feb.).
IF (God forbid) the carbo/alimta has not worked at all -- what would be possible viable options from there. Would Tarceva ever work if the 1st two drugs didn't work at all. What about Navelbine?
or any other options?
My Mother – dx @ 76 yrs old:
7/11 – dx NSCLC (adenocarc,, KRAS, suspected multifocal + slow-growing), 2 cm LL, few suspicious nodules RL, lymph nodes clear
10/11 — LL ling. resection, watch RL
10/12 — PET/CT – slight progression into LL Pleura
1/13, 4/13, 7/13 – CT’s — very slight progression if any in pleura, considered stable
1/14 — PET/CT – progress. in LL pleura, RL nod. from 1.4 – 1.9 cm, new dx tumor (left rib @incision + primary breast cancer
2/19 — 1st Chemo — CARBOPLATIN ONLY
3/12 — 2nd Chemo — Carboplatin / ALIMTA added
4/2 — 3rd Chemo — Carbo / Alimta
4/23 -- 4th Chemo -- Carbo / Alimat
Reply # - May 21, 2014, 10:17 AM
Reply To: next treatment if first line didn't work
The standard second-line treatment options (those approved by the FDA in the U.S.) remain the same - Alimta, Taxotere and Tarceva. Other drugs such as Navelbine and Gemcitabine, though not specifically approved for second-line treatment, are also active against NSCLC and could be considered. There are also clinical trials of new drugs, including a class of drugs called MEK inhibitors which have shown promise for KRAS patients: http://cancergrace.org/lung/2013/03/30/dr-leighls-highlights-in-lung-ca…
Although you should try not to draw any conclusions at this point until you see the (hopefully encouraging) scan results, subsequent drugs are less likely to be effective when a patient progresses through first-line therapy. It is more likely that a targeted therapy such as Tarceva or a MEK inhibitor will be effective, so it is common to "shift gears" in this way under such circumstances.
Hoping for good scan results so that you are not faced with a treatment change decision.
JimC
Forum moderator
Reply # - May 21, 2014, 03:54 PM
Reply To: next treatment if first line didn't work
Jim offered a great, concise answer. It's always possible but honestly unlikely that someone will respond better to second line chemo if they progressed early on first line chemo.
Outcomes tend to be better in patients who respond well ("responders respond", meaning that we often see a pattern where a cancer is just inherently, biologically more or less sensitive to many things we might try), but the targeted therapies are more of an unknown, more of a curve ball, compared with giving another chemo approach. That unknown may make it less appealing if chemo was quite effective but more appealing if initial chemo wasn't helpful. In that case, using a targeted therapy because "it's not chemo" could be a leading reason to try it.
Good luck.
-Dr. West
Reply # - May 29, 2014, 10:04 AM
Reply To: next treatment if first line didn't work
We finally got the results of my mom's CT scan -- stable (no shrinkage). Although we were hoping for shrinkage, I THANK GOD every day for it at least being stable. 2 more rounds of Carbo/Alimta are planned, and then maybe another CT scan
As of the last Nov., she has had a tumor at the incision site on/near her left rib under her skin, which every dr. keeps saying is sooo unusual to have it there. How often have you ever heard of this and how does this happens from the surgery. The size has not changed, so that is good. The concerning issue is that about 4-5" in front of that, also on /near the left rib, there is a new, little bigger lump. When they went to take her in for the CT scan, I specificially asked if it would cover her left side, and the tech assured me it would, but the report has extremely little detail. The PET w/CT scan from Jan. said: Foci of FDG abnormality are seen in the left pectoralis muscle, subcutaneous fat of the left lateral chest wall, and left latissimus dorsi muscle, consistent the metastatic disease.
CT scan rpt says: 2.0 cm focus of increased soft tissue prominence unusual left pectoral muscle corresponding to area of increased FDG uptake in priior study appears unchanged. Addit'll soft tissue nodules in the region of the left lateral chest wall and left latissimus doris are LESS WELL DEMONSTRATED.
Would you be concerned to get further details if you were the dr. ? What kind of test would show this to get additl. details about it?
Reply # - May 29, 2014, 11:24 AM
Reply To: next treatment if first line didn't work
Stable is very good. So congratulations on your mom's scan report!
I'm afraid your questions are very detailed and specific. They are best referred to the oncologist such as an explanation of what the radiologist meant. We can't guess at what someone meant. An onc will often confer with the radiologist to get a better understanding of what was meant. The question that comes to mind is how would treatment be affected by getting these answers. I take the "pick your battles" sentiment before asking the onc or even here on Grace and they mostly come down to how will it change treatment or if it's a symptom question how can we make it better.
In any case if you're worried about the skin nodules causing their own set of problems a discussion with the onc is definitely in order.
These threads are on the subject of cutaneous nodules with posts from Dr. West and Dr. Pinder. http://cancergrace.org/forums/index.php?topic=10852.msg88249#msg88249
http://cancergrace.org/topic/cutaneous-d/#post-1263222
http://cancergrace.org/forums/index.php?topic=5406.0
I hope these help in your discussion with the onc.
I hope too your mom feels alright,
Janine
Reply # - May 29, 2014, 04:28 PM
Reply To: next treatment if first line didn't work
Actually, here's a post I wrote about the very rare situation of "seeding" an area with cancer cells from surgery or a biopsy:
cancergrace.org/lung/2009/09/07/needle-track-seeding/
If there's a palpable nodule, you don't need to do detailed imaging studies to follow it. The doctor (and/or you) can measure how it's changing or not changing over time to provide a window independent of or between scans. It is uncommon to have nodules in or under the skin from lung cancer, but it can happen. The silver lining around that cloud is that you have a readily available index lesion to follow over the course of treatment.
Good luck.
-Dr. West