Decision time - possible outcomes? - 1248539

charvnc
Posts:15

From the archives:

\"If topotecan does not control or shrink the cancer or does so for a period of time before the cancer starts growing again, it is feasible to treat with other chemotherapy drugs, but we don’t have good evidence to support the use of other chemotherapy drugs following the use of a platinum agent with etoposide in first line therapy followed by topotecan as second line therapy. The lack of data does not mean there is no benefit from such therapy, but rather that we don’t know if doing more chemotherapy is valuable or not.

If the general condition of the patient is relatively good, many oncologist may consider offering these patients other chemotherapy drugs such as Taxol (paclitaxel) or Gemzar (gemcitabine). It is important to remember that these patients could be considered for clinical trials evaluating investigational drugs. However, many patients in this setting are struggling with increasing cancer-related side effects and cumulative toxicity issues with chemotherapy. For such patients, supportive care rather than further anti-cancer treatment may be most advisable\"

This is where we are - trying to decide whether to go with supportive care (opinion 1) or possible CAV salvage chemo (opinion 2) The key here is \"if tolerated\" Could the doctors elaborate on the best and worst outcomes of each choice?
charvnc

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Reply # - October 2, 2012, 04:58 AM

christineleeds
Posts: 25

Dear Charvnc
A profile would be helpful showing when the treatments were given as the time between treatments and effect of each is very important in assessing further steps.We were certainly going to a third step if the infection had not intervened but Philip had good results with each stage.Also I assume sclc but you do not say
Regards
Christine

Reply # - October 2, 2012, 05:14 AM

charvnc
Posts: 15

Christine
For some reason my profile didn't post with my signature (I'm sure I did something wrong - again) anyway, I will paste it here:

My husband was diagnosed Jan 08 SCLC Limited - Chemo and 2x daily Radiation, PCI June 08/ Recurrence late 09 in adrenal - change to Extensive - Radiation only/ Recurrence Nov 10 - Adrenal only - surgery to remove Jan 11/ Recurrence multiple locations - repeat 1st line chemo June - October 11/ PET scan Feb 12 - NED!
Keep HOPE alive! Update 5/14/12 - Recurrence multiple locations - started Topotecan Update 9/28/12 - Completed 6 rounds, but PET scan revealed progression while receiving Topotecan

Thanks,
Charlotte

Reply # - October 2, 2012, 05:24 AM

charvnc
Posts: 15

Went through the steps again, copied and pasted my profile into signature - clicked save, now it wants me to add an email address - which is already there and won't let me re-enter it. Any suggestions folks?

Reply # - October 2, 2012, 06:06 AM

catdander
Posts:

Charlotte, we're both having a time this morning. I wrote a response to you about 30 minutes ago but I suppose I didn't hit send, grrrrr.
But YAY! you got your signiture to stick and I've requested a doctor to give input to your questions. As a matter of fact I just went back to check that I sent the right link. :roll:

I'm so sorry your husband has progressed on treatment. I know it's a very difficult time and decisions are all but impossible to make.

You should hear back within the day.

I'll keep you in my thoughts,
Janine
forum moderator

P.S. Thanks Christine for the help. We can use all we can get! 8-)

Reply # - October 2, 2012, 11:33 AM

dr johnson
Posts: 9

Hi Charlotte,
I'm sorry to hear about your husband's recurrence. Deciding to RE-start treatment can be difficult. While you certainly have an idea what to expect given your past experiences, each new regimen is a step into the unknown in that new drugs may cause new or different side effects. Ultimately, all treatment decisions require that patients weigh the potential benefits against the potential risks and decide which "balance" feels right. Recognize, unfortunately, that as a patient begins subsequent (2nd, 3rd, or 4th line, etc) lines of therapy, typically the benefits of treatment diminish and side effects can become more debilitating.

You didn't mention how your husband is feeling on the topotecan. To me, that's an important factor because the goal of all anti-cancer treatments are to delay cancer-related symptoms (shortness of breath, weakness, weight loss, etc). I assume he feels pretty good since he's been getting the topo since 5/2012.

To break it down into the decision-tree you are using:
Option #1 (supportive care): treat any symptoms rather than focusing on treating the disease. Best case scenario would be that your husband continues feeling well (or close to it!) for a nice long time. He's freed up from doctor visits somewhat and able to focus on living his life. Worst case scenario would be that without treatment the cancer starts growing faster than it was able to do while he was receiving topotecan.

Option #2 (give CAV a try): Typically side effects include fatigue, suppression of the blood counts, numbness in finger tips and toes, nausea, mouth sores, taste changes, constipation. Best case scenario would be that it stops the cancer from growing for a long time. Cancer-related symptoms may improve. Worst case scenario would be that it makes your husband take to bed due to feeling sick and therefore he is unable to go about his activities, or do the things he enjoys doing.

Hope this helps a little,
Dr. Johnson

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