Is Taxotere considered a standard second-line option in my husband's case? (Please see his profile). I feel as though the oncologist didn't present it as an option, but as "This is what we are going to do." I do a fair amount of research on this site and others, and I am more excited about the immunotherapies Lucanix and Stimuvax, although it looks as though clinical trials for these are not accepting new participants. I also feel as though we should have more tissue testing done so we can fine-tune his treatment. He is ALK and EGFR negative. My questions: are there any other "vaccine" clinical trials available, and am I right in feeling that more testing should be done, and that the Taxotere is being given just because this is what our onc usually uses next?
Reply # - September 15, 2012, 04:01 PM
I'm sorry to hear of the need for a change in your husband's treatment. I see from his profile that he started with carbo/taxol/avastin (certainly a very common and appropriate first-line treatment for adenocarcinoma of the lungs), then was treated with Pemetrexed (alimta)/Avastin. There are three drugs that are FDA approved for second line treatment of stage IV lung cancer - Tarceva, Alimta and Taxotere. Each has been thoroughly proven in trials in the second-line setting. (Xalkori has also been approved, but only for ALK positive patients). Therefore, either Taxotere or Tarceva would be standard choices for his next treatment. Without an activating EGFR mutation, there wouldn't necessarily be a reason to favor Tarceva over Taxotere. Other options would be for drugs that are FDA approved for lung cancer, although not in the second-line setting, such as Navelbine or Gemcitabene, or investigational drugs in clinical trials.
You can read about choosing second line treatment in the GRACE FAQ: http://cancergrace.org/lung/2010/10/04/lung-cancer-faq-2nd-line-nsclc-o… And you can read about clinical trials in these previous posts:
Hope that helps and that Taxotere is effective for him.
Reply # - September 15, 2012, 05:28 PM
Jim provided a great summary of the lay of the land. While in people who have a non-squamous NSCLC there is reason to do EGFR mutation testing to determine how to prioritize Tarceva (erlotinib) compared with standard chemo, and also in non-squamous NSCLC it's generally advisable to try to test for an ALK rearrangement, those are really the only clearly recommended molecular tests.
Right now the vaccine approaches remain investigational and are certainly provocative but not commercially available or of any established value just yet.
In the meantime, Taxotere (docetaxel) is, as Jim stated, a commonly used treatment for previously treated patients with proven value, so the reason it's being recommended is because there is more evidence to support choosing it than just about anything else. Tarceva would be considered pretty comparable, but some evidence suggests that it may be inferior to Taxotere in people whose tumor doesn't have an EGFR mutation.
Reply # - September 16, 2012, 11:19 AM
Okay. This makes me feel better. Even with all of my research, it wasn't clear that there were three treatments that are FDA approved for second-line. There is a lot of reading to wade through, and of course it is normal to jump ahead to read about new treatments. We still haven't gone for a second opinion. That is my task this weekend---making a decision on where to go.
Reply # - September 18, 2012, 07:28 AM
Hi maplecrest, Just doing some filing and wanted to make sure you've seen this; http://cancergrace.org/cancer-101/2011/11/13/an-insider’s-guide-to-the-second-opinion/
Please let us know how things go,
Reply # - September 18, 2012, 08:51 PM
Thank you, Janine. I had read this months ago, but I looked at it again just now. I find I have to read things multiple times because there is so much to learn.