Gemcitabine vs Docetaxel as 2nd Line for NSCLC - 1268362

Tue, 02/03/2015 - 18:54

My mom's oncologist is recommending docetaxel as the protocol directed 2nd line chemo now that her cancer has grown after 2 rounds of cisplatin/pemexetred, but he wants to wait a bit to let her recover and see a radiation oncologist for palliative care for the bone mets. She saw a second oncologist who suggested she needs to go on new chemo right away since he feels her cancer is very aggressive, (symptoms first appeared in Sept and dx in Nov with progression seen on CT after 1st 2 rounds of chemo). He recommends gemcitabine or vinorelbine or a combination of the two since they are less toxic than docetaxel and won't beat her up as badly.

My mom is inclined to go with the less harsh side effects option. Is this a reasonable alternative? Is there any harm in trying the gemcitabine first and then use docetaxel as a 3rd line treatment (or try for a clinical trial) if the gemcitabine doesn't work?

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Hi uchtach,

Welcome to GRACE. I'm sorry to hear that your mom's first line chemo has not been effective. The most well-tested agents for second line treatment, aside from pemetrexed (Alimta), are Docetaxel (Taxotere) and Tarceva (erlotinib). Although gemcitabine and vinorelbine are both approved first-line treatments for lung cancer and are often used in later lines, the evidence for their efficacy in that setting has never been established. If your mom's cancer is progressing rapidly (a judgment call for her doctors), a strong argument can be made against saving the best-tested treatments for later, as there is a possibility that after another agent has been tried and found not effective her cancer may have progressed to the point that she cannot tolerate further treatment. Dr. West discusses second-line treatment in more detail here.

The other factor is whether your mom needs palliative radiation for her bone mets. If they are causing her great pain and/or are threatening fracture of a weight-bearing bone, that radiation may be necessary and be a priority.

I hope that she will find an effective treatment.

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