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What types of questions would be good to ask our doctor when deciding between Nivolumab vs. Taxotere + ramucirumab as a second line treatment following 10 cycles of first line chemo? If the studies comparing the immunotherapy to Taxotere didn't have the Ramucirumab added in, then is the survival benefit as clearly in favor of the Nivolumab as we are hearing from ASCO? What types of things should be considered in thinking about Nivolumab vs. Taxotere plus Ramucirumab as a second-line choice? (This is assuming that the Nivolumab is approved soon or that the patient is willing to pay for an off-label prescription). Cancer is stage IV and very aggressive.
Thanks,
Hammer
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Reply # - July 9, 2015, 06:20 PM
Hi hammer,
Hi hammer,
There aren't enough data to show whether nivo is better or worse in overall efficacy to say which is best. It does look like there will be an FDA approval for nivo in non squamous nsclc in the latter part of the year. Until then insurers aren't likely to foot the bill and private pay is most likely prohibitively high, somewhere around 13000 US $/month. It seems like those with non squamous nsclc at most likely to benefit from nivo if they have a high expression of PD L1.
Taxotere plus ramucirumab shows a small bit higher benefit than taxotere alone, http://cancergrace.org/lung/2014/12/13/cyramza-fda-approval-2l-nsclc/
One thing to think about and talk to the oncologist about is using alimta for 2nd line treatment. It wasn't tested against the doublet so it's not known how the 2 treatments compare. Alimta is used for non squamous and is often quite effective, well tolerated (sometimes much better than taxotere) and able to be used for quite a while.
Another thought is is whether or not the person has shown good response to first line chemo. Most often those who respond well to first line chemo will respond to other chemo lines. Unfortunately those who didn't respond well to first line chemo aren't likely to respond to more chemo...responders respond. This is something to think about with both alimta and the doublet of taxotere plus ramuciruab.
Another possibility might be a clinical trial. Many trials are opened only to those who are moving into 2nd line treatment. This may be a good read, http://cancergrace.org/cancer-101/2011/11/13/an-insider%E2%80%99s-guide…
I hope this is helpful.
Best of luck and hopes,
Janine
Reply # - July 10, 2015, 01:57 PM
Hi Janine,
Hi Janine,
Thank you for your insights! We will ask the oncologist about Alimta vs, the Taxotere in our particular case.
--Hammer