What has worked best as second line treatment? - 1246215

Hello gabitaylor, I hope your father is doing alright. It is very common to move from cisplatin to carboplatin when there are toxic side effects. There just isn't enough of a difference in efficacy between cis and carbo.

When we talk about what works and what doesn't we talk on a scale of hundreds or even thousands of people who have gone through research trials. That way we can know exactly how likely a treatment will work for a particular group of people with common disease elements. The fact that my husband has done particularly well on gemzar has more to do with the way his disease biology acts in his body than how it would probably work on your father.

With that said and by your description of your fathers treatment so far I assume he has adenocarcinoma nsclc stage 4. The fact you said he is thinking about 2nd line suggests it may be what is called maintenance treatment. That just means that a person who is stage 4 goes through 1st line as you described above. They the person either stops treatment until the cancer progresses, at which time they start 2nd line treatment. Or. They finish 1st line treatment and move directly into the next treatment without a break; this is called maintenance.

Maintenance treatment can be alimta alone or tarceva, there are other drugs also used. I have posted links at the bottom for much more clarification.

Second line treatment for adeno has 3 standard options, alimta, tarceva, and taxotere. Again I've pasted links with more explanation.

I hope this helps and please let us know how we can further help,
Janine
forum moderator

I'm sorry I left out the links I promised in my first post.

Please so take advantage of our very helpful search feature. We have enough written on the subject of nsclc to keep you learning for a while.

the first 2 pertain to maintenance treatment.

http://cancergrace.org/lung/tag/switch-maintenance/
http://cancergrace.org/lung/2010/04/08/maintenance-therapy-in-nsclc-pro…

About 2nd line options.
http://cancergrace.org/lung/2010/10/04/lung-cancer-faq-2nd-line-nsclc-o…

As a small technical point, I'd say that we'd really consider it second line treatment only if a person has demonstrated progression. In contrast, it would be more in the range of maintenance therapy if the change is for some other reason (such as an intended switch or poor tolerability). However, that's really just semantic issues, and some might say that dropping a treatment because of cumulative side effects would be called completion of a first line therapy and possibly lead to the next therapy being considered second line.

The treatments best studied as either maintenance or second line treatments are Taxotere (docetaxel), Tarceva (erlotinib), and Alimta (pemetrexed). Obviously, if someone continues on an agent previously given, that's not second line, but would instead be considered continuation maintenance. I think most experts would favor moving on to Taxotere (another standard chemo, typically given IV every 3 weeks) or Tarceva (targeted therapy given as a daily pill) as the leading option after someone discontinues Alimta in the first line setting. However, the increased hearing problems are far more likely to be from carboplatin than Alimta, so I think many oncologists would still be inclined to continue Alimta alone if a patient hadn't experienced any other significant side effects and wasn't demonstrating progression.

It's also worth noting that most oncologists favor a maximum of 4-6 cycles of a platinum-based chemo doublet, so 10 is definitely on the high side.

-Dr. West