At end of October, my fiance finished chemoradiation (two rounds cisplation/etoposide + 33 days radiation)
CT scan just done shows that the very large mass shrunk apprx. 60% (now it's down to apprx. 4cm x 4cm x 5). The radiation oncologist said he thinks the results are remarkable.
From what was discussed at diagnosis, we thought that now surgery would be the next step, but since the tumor is still abutting some structures, they say there is only apprx. 20% chance of curing him by removing it.
The oncologist said she would consider doing a few more rounds of chemo right now, 2 months after the chemoradiation finished in hopes that the cancer would shrink some more to maybe make the surgical odds better. When she said more chemo so soon after chemoradiation, I was shocked because I have read on this site about studies done that said consolidation chemo after chemoradiation is not beneficial and just increases toxicity to the patient.
Am I correct about the study I mentioned above? if not could you explain why? Do you think giving more chemo 2 months after chemoradiation would be feasible and/or warranted in this case ?
If you do see any point to more chemo, would you do more cisplatin & etoposide or something different
I would think that if no surgery is done, they would have just monitored with CT scan every 3 months till progression and then begin a diff. chemo than done with chemoradiation then.
Reply # - December 22, 2015, 08:03 AM
Hi healmymom,
Hi healmymom,
Congratulations to your fiance on his good response to treatment. You are correct that the study showed no benefit to continuing with more chemotherapy after chemorads, but that was in an unselected population. Dr. West has expressed his view (shared by others) that in some cases survival may be increased with consolidation chemotherapy:
"Today, many lung cancer specialists and general oncologists alike feel that we just haven’t studied the question well enough to conclusively say that stage III patients can’t/won’t benefit from additional treatment before or, more commonly, after the initial chemo/radiation, and we may be inclined to recommend additional treatment for some of our patients.
My strategy is to be selective in how I approach patients with locally advanced NSCLC, favoring consolidation chemotherapy for the patients who I feel are likely to tolerate a more rigorous treatment, especially if they have unfavorable features of their cancer (larger tumor, poorly differentiated, etc.), but the absence of any proven benefit for the “more is better” concept makes me very comfortable stopping after completing the core 7 weeks of chemo/radiation for patients who I suspect are more likely to be harmed than helped by additional treatment without evidence of a survival benefit.
Overall, then, even though we’ve done studies for decades trying to identify the best way to treat locally advanced NSCLC, it’s still a setting in which there’s plenty of room for judgment and interpreting how a person is doing over the course of treatment." - http://cancergrace.org/lung/2015/07/20/many-faces-of-stage-iii/#more-16…
With this in mind, if his doctors feel that your fiance is fit enough to withstand more chemo, he may benefit from it, perhaps to the point at which surgery may be possible, although that will still depend on the location of the tumor.
JimC
Forum moderator
Reply # - December 22, 2015, 09:42 AM
Hi Jim, Thank u so much for
Hi Jim, Thank u so much for such a detailed response. Now I see where the oncologist came up with suggesting consolidation chemo now, since I believe my fiance is prob. is a good candidate that could withstand more chemo. It would be prob. advisable since his tumor is still pretty large, even with the remarkable shrinkage already seen, and the mass still there does show avidly hypermetabolic on the PETscan just done.
After talking to our oncologists, now came up the question as to whether to start carbo/alimta right now or ok to wait till scans show beginning of progression
Since there are no further clinical studies done yet on consolidation therapy, would it be possible to show my post to the drs. to comment on their experiences giving their fit patients consolidation therapy, I realize every case is not the same, but it would be very helpful to know what they've seen for results in their many years of experience in their own practices and patients.
I am sorry for so many questions, but as Dr. West quotes over and over, this stage of cancer is about the hardest to figure out what is the best next step, and as such we are very confused as to how to tell the drs. to proceed, cause they give the options but it is up to us to tell them which option we want to follow.
Reply # - December 23, 2015, 04:05 AM
He also only had two
He also only had two infusions from what you say in your post. When doing radiation the dosage is normally lowered for the chemo. So following up with two full dosages when the cancer is still present makes sense to me. What stage is he? Take care, Judy
Reply # - December 28, 2015, 11:02 AM
Jim,
Jim,
could you please comment on my last questions listed again below ... thank you very much
After talking to our oncologists, now came up the question as to whether it's important to start carbo/alimta right now or ok to wait till scans (every 3 months) show beginning of progression.
Since there are no further clinical studies done yet on consolidation therapy, would it be possible to show my post to the drs. to comment on their experiences giving their fit patients consolidation therapy, I realize every case is not the same, but it would be very helpful to know what they’ve seen for results in their many years of experience in their own practices and patients.
Judy, thank you for your response. Yes, he had two rounds of cisplatin/etoposide, which is the standard to go with radiation, but if they do give him more chemo right now, it will not be two full doses of the same thing, they will switch it to carbo/alimta already -- for 2 - 4 rounds. He is stage III (not sure if A or B, but since it's abutting pleura and endobronchial tube, I would think it's B)
Reply # - December 28, 2015, 02:06 PM
What happened to doing
What happened to doing surgery? Have you seen a thoracic surgeon or is all your info coming from the onc?
I had a 5.2cm tumor removed from LRL that was invading the pleura and then did adjuvant chemo. I also had no lymph node involvement and it seems he may have N2 involvement.
Take care, Judy
Reply # - January 13, 2016, 11:18 AM
Jim, I haven't checked this
Jim, I haven't checked this site in a few weeks, but see you still have not responded to my questions below. We are very confused as to whether to start chemo now OR ok to wait and see what shows at the next scan in 3-4 months. Could you PLEASE comment on my questions listed again below … thank you very much......
After talking to our oncologists, now came up the question as to whether it’s important to start carbo/alimta right now or ok to wait till scans (every 3 months) show beginning of progression. The dr. says it's ok to wait the 3 months, BUT the normal protocol is to start right now, but no explanation why this is. It would be preferable for my fiancé to wait the 3 months if it really is ok, as he could use this time while he's feeling good.
Since there are no further clinical studies done yet on consolidation therapy, would it be possible to show my post to the drs. to comment on their experiences giving their fit patients consolidation therapy, I realize every case is not the same, but it would be very helpful to know what they’ve seen for results in their many years of experience in their own practices and patients.
Judy, thank you once again for your response. Regarding aborting the surgery possibility, after the recent PET scan, the surgeon said he does not recommend surgery because it is abutting the pleura but also has evidence of endobronchial extension and it is close to the spine, and it is not clear if he would end up having to take out the whole right lung, which would not be a good option.
Reply # - January 13, 2016, 07:03 PM
When treating stage III nsclc
When treating stage III nsclc with chemo and radiation 4 cycles of chemo are usually given for curative intent. More chemo isn't known to increase chances of a cure. It's difficult to know if nodules showing activity on a pet are scar tissue or inflammation or cancer and our doctors can't make that guess. 8 weeks out from treatment is pretty long to go back now and continue. As curative stage III treatment a wait and see approach at this point is pretty standard.
It's not possible for our doctors to suggest one way of proceeding is better than another. However it's very appropriate to get a second opinion at this point. One very important question to ask of the oncologist is whether she is treating with curative intent. That will inform your questions of when treating should take place.
I'm sorry we can't give you more information than we have but will are limited by law and really not having enough info. These answers need to come from those involved.
All best,
Janine
Reply # - January 13, 2016, 07:20 PM
Jim, thank you for responding
Jim, thank you for responding. How common is it that if we hold off on more chemo now after the chemo/rad. that in 3 months the cancer could have grown and/or spread considerably?
Also, I thought that if they did 2 -4 rounds of carbo/alimta now it would mean that he'd have to stay on it indefinitely cause if stopped the cancer would become immune to it, but I see in Judy's bio that she was on Carbo/alimta till NED then put back on it a few years later, so I guess the cancer doesn't become immune to it?
Reply # - January 14, 2016, 03:17 AM
That's not true. I had SBRT
That's not true. I had SBRT to the two tumors in my upper and lower right lobes then I did 4 rounds carbo/alimta. I did not do maintenance and you rarely if ever see maintenance in stage IIIA. I was off all treatment for 2.5 years not months and then had a local recurrence. I then had surgery and 3 rounds of the same chemo, no maintenance. It's been 2 years since that recurrence and will post later this month about my follow-up scan. I'm NED. If he's not being seen at a top rated cancer center, then get a second opinion.
I did both times and always would. I recommend that everyone get a second opinion no matter how you feel about your doctors. Take care, Judy
Reply # - January 18, 2016, 02:29 PM
To echo Janine's comments, I
To echo Janine's comments, I also vote against more chemo. I will proceed with the assumption that your fiance truly had Stage 3 lung cancer. For the situation you described, it sounds like your fiance has completed definitive treatment for Stage 3 lung cancer. (cisplatin + etoposide x 2 with radiation). Congratulations, he has already completed a very rigorous treatment schedule.
As you mentioned, the available trial evidence shows that 'tacking on' consolidation chemotherapy makes no difference in longterm outcome.
It has been over 3 months now since finishing radiation, and it sounds like he is in remission. At this point, I think that more chemotherapy will just cause toxicity. It seems unlikely to be helpful; and unlikely to improve his odds of cure. Cancer recurrence is certainly possible over the next 5 years, but more chemotherapy is very unlikely to change that.