SCLC Ext - Onc is continuing Carbo/Etop indefinitely - 1274417

chinagz
Posts:1

My 43 year old friend was diagnosed in January 2016 with small lung cancer with mets to bone. He has done so well on carbo/etoposide, that the Onc wants to keep going indefinitely. He's done 7 rounds and is scheduled for the 8th in two weeks. Chemo has been getting progressively more difficult, but he still managed to bike 20 miles 6 days after finishing the 7th round, he's put on a ton of weight (he needed it!) and his hair has grown back. He hasn't had a scan since after round three because his insurance takes 8 weeks for approval. Once we get the scans done, he'll get a second opinion at the City of Hope. We wanted to look into immunotherapy, but Onc doesn't want him to quit chemo for an unknown. My question: is it safe to continue chemo in this fashion and what could be the consequences? Onc says he's not showing any signs of toxicity.

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Reply # - June 18, 2016, 08:47 AM

JimC
Posts: 2753

Hi chinagz,

Welcome to GRACE. I'm sorry to hear of your friend's diagnosis, but it's good that he has done well on carbo etoposide. Usually chemotherapy is only continued indefinitely ("maintenance" chemo) when it is well-tolerated, and it sounds as though that isn't the case for your friend. Platinum agents in particular (such as carboplatin) depress bone marrow function over time, making it difficult or impossible to receive further chemo if necessary. Since your friend has not had a scan in a while, it's unclear if the chemo continues to be effective, but if disease progression is discovered at some point, you wouldn't want compromised bone marrow function to limit his treatment options. As a result, generally most oncologists do not continue platinum beyond 6 cycles. As Dr. Weiss has said:

“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 ... 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

I think a second opinion is a good idea.

JimC
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