Docetaxel - 1268554

Hi Delia!

Good to see you, so to speak. :)

Docetaxel (taxotere) is the standard next treatment after first line platinum doublet, alimta, tarceva and doxetaxel are the 3 tested and most commonly given 2nd and beyond lines of treatment.
Docetaxel has a reputation of being more difficult single agent than some others and SOB has been assosiated with it on some occasions, http://cancergrace.org/forums/index.php?topic=7502.0

Dr. West said this about other options, " Other agents, such as standard chemotherapy drugs like Gemzar (gemcitabine), Navelbine, or perhaps other chemo agents may have some activity in previously treated patients, but they haven’t been as well studied, don’t have an established clinical benefit, and consequently remain poorly studied non-standard options in previously treated patients. Doublets have been shown to increase the response rate compared to single agent chemo, though this has been in the absence of any improvement in survival but associated with significant increase in clinically significant side effects, making sequential single agent therapy a current standard for previously treated patients at this time." http://cancergrace.org/lung/2010/10/04/lung-cancer-faq-2nd-line-nsclc-o…

It's not completely unusual anymore to move back to a chemo drug that worked in the past. Although there's no data to back up the practice. Alimta on its own might be a possibility for your husband since he never progressed while taking it. Too taking it alone will be much better tolorated than with a platinum.

All best,
Janine

On Mayo's website, http://www.mayoclinic.org/drugs-supplements/docetaxel-intravenous-route…

Hi Delia,

The FDA approval for afatinib (Gilotrif) was limited to patients with EGFR mutations (specifically "exon 19 deletions or exon 21 (L858R) substitution mutations") and even in patients with those mutations it has not tended to be very effective after treatment with Tarceva. In other patients the studies I've seen do not seem to indicate much benefit for EGFR negative patients, even when used in combination with other established drugs.

Here is a typical comment from Dr. West about the benefit of afatinib after failure with Tarceva (in the EGFR positive setting):

"The results we have thus far are that afatinib provides a transient benefit of a few weeks in duration for a minority of patient but no survival benefit — in fact, patients who received placebo instead of afatinib had a trend toward better overall survival by over a month. My personal experience has been that my patients who received afatinib after Tarceva experienced no benefit at all, just more toxicity in terms of skin rash and diarrhea than they had experienced on Tarceva previously, though I know a few patients here and there have had transient responses. I’m sorry to report that I personally have very little enthusiasm for it, based on my experience of treating patients with it in this setting." - http://cancergrace.org/topic/afatnib-after-tarceva-resistance#post-1258…

JimC
Forum moderator

Delia,

Not asked for but have you and or the docs looked into a possible trial of one of the immunotherapy drugs being tested. They are very promising though not put up for approval yet. Though hoping not to need it we even have one going on at UAB just down the street from us.

Too a new gen egfr tki are being tested with promising results for those with T790 mutation of EGFR positive tumors.

We have tons of info on the 2 subjects here's a couple of webcasts,
http://cancergrace.org/lung/2014/10/03/iaslc_roundtable_immunotherapy_l…

http://cancergrace.org/lung/2014/10/20/ar_forum_q_a_blumenthal_pennell_…

Janine