why can't we go back? - 1267991

Hi drgoogle,

The main issue is repeating treatment with the platinum agent, in this case carboplatin. Such drugs are tough on bone marrow function, and in general their use is confined to first-line use, although as is typical with cancer treatment exceptions may be made.

There is a discussion of this issue here. In that thread Dr. Weiss describes his thinking:

"In the 1st line, I treat to 4-6 cycles, then will always drop the platinum (I leave the question of maintenance and switch-maintenance without platinum to another day). In select patients whose cancers seem particularly platinum sensitive, I will sometimes "break the rules" and bring the platinum back in a later line of therapy; this is a common practice that many oncologists consider for select patients. The second caveat is that a small minority of oncologists consider this to be a controversial area. One very prominent oncologist in New York makes very reasonable arguments based on meta-analyses that there may be benefit to more than 4 cycles of platinum, perhaps even treating to progression. In my opinion, any small survival difference that may be accrued is not worth it (think Ned's BEVSEV) in terms of side-effects, except perhaps for the very most platinum-sensitive patients who tolerate platinum extremely well." - http://cancergrace.org/forums/index.php?topic=7276.msg52702#msg52702

At times oncologists return to a first-line agent (in this case vinorelbine) if there was a good response initially that was long-lasting, and that's not clear in your husband's case. On the other hand, the three FDA-approved drugs for second and later line therapy are Pemetrexed (Alimta), Erlotinib (Tarceva) and Docetaxel (Taxotere), so it's not surprising that your husband's doctor would recommend one of them. Since he's already tried one of the chemo agents (Pemetrexed), he's chosen the non-chemo agent Tarceva.

JimC
Forum moderator

In first line treatment, Tarceva is really only appropriate for patients with activating EGFR mutations, as patients without such mutations do better with standard chemotherapy agents. But Tarceva can provide a benefit to such patients in second and later lines of treatment, as described in this GRACE FAQ: http://cancergrace.org/lung/2010/09/21/benefit-from-egfr-tki-if-egfr-wt/

JimC
Forum moderator

Trial data show that tarceva can be effective in people without the EGFR mutation call wild type to maintain stability almost as well as some chemo drugs. This is why it's FDA approved for 2 line treatment (that's 2 and beyond lines to us, there are no "approved" lines beyond 2nd but of course we use them when possible.) Below is a video blog on the subject followed by a list of links on the subject. It's well used and discussed.
http://cancergrace.org/lung/2012/08/27/socinski-tailor-trial/
http://cancergrace.org/lung/tag/egfr-wild-type/

Who knows maybe your husband has the mutation and will do well for a long long time.

Hoping for the best,
Janine

Jim and Janine have provided all of the relevant information here, so I'll just welcome you and say that if you have additional questions, I and other people here will be happy to try to help.

Good luck.

-Dr. West