Retrying a failed drug? - 1250799

Hi Sunnymom3, I'm very sorry your mom is facing these difficult decisions. Each new turning point must feel progressively more difficult to overcome. You've stated your mom is squamous type yet remained stable 2 1/2 years on Alimta. That's very unusual so I wonder how it was decided to try it.

From what I understand doctors don't usually go back to drugs that quit working and less often go back to drugs that didn't work the first time around. However your mom is 5 years out which is reaching a lot of unknown territory so I would think unusual is going to be par for her course.

Other drugs that are given at 3 and above lines of treatment are gemcitabine and Topotecan.

I'll ask a doctor to comment.

Good luck to your mom,
Janine
forum moderator

hi Sunnymom3

I'm sorry to hear about your mom, your question is a good one and highlights many key areas that patients and oncologists struggle with. After 5 years it's not surprising that she has gone through basically all of the more standard drugs we would try for lung cancer.
As Janine mentioned it is somewhat surprising that she was given and responded to Alimta,, that drug does not usually work for squamous cancers. That being said, sometimes the initial diagnosis of lung cancer is made on very small amounts of cancer tissue, through fluid collation or a small needle, and so it can make it hard to distinguish between adeno and squam. Especially as a nonsmoker it may be that she has adeno, on the other hand we do sometimes see squams in never smokers. In any case I'm not sure it makes much of a difference at this point, more of an academic question.

If there is any possibility of a clinical trial that would always be my first recommendation, that's true at any stage of disease.

I think its reasonable to try the taxotere again, it has been many years and if she was on it for 3 months then maybe it did do some good. if that was too toxic or didn't work then maybe gemcitabine could be considered, I probably wouldn't use topotecan, were getting pretty far down the list of useful drugs. In reality there comes a point when the toxicity of chemotherapy is far greater than any chance of benefit. The more chemotherapy a cancer "sees" the less likely it is to respond to the next one, especially after 3 types of drugs. It's not ideal, it's not what we want, but it can be the reality that just because we can think of a drug to try, it may not be the right thing to do to a person. Your mom may or may not be at that point, this is a general comment.

I hope this answers some of your questions. I wish you and your mom the best of luck!

Dr Laskin

Sunnymom3, I'm sorry about your mother. I appreciate what Dr Laskin has said about cancer being less responsive the more chemo it is exposed to, and her point about taxotere. However, given that Alimta was the one drug that worked - and for a long time - might there be a case for going back to that?

That really is wonderful - I once tried to go out to dinner while on chemotherapy and didn't weather it very well: I started to fall asleep before we'd got to the main course!
Just a thought - was your mother ever tested for any mutations (EGFR/ALK?). It's unusual to find these mutations in squamous tumours, but your mother's tumour sounds rather unusual. If she had the EGFR mutation, you'd have seen a better response to Tarceva, but I was just wondering about the ALK? Very best.

That's wonderful that she tolerates chemo so well, it makes trying more drugs tempting I'm sure. It's all a great unknown as to which drug might work for which person, so if she's up for trying taxotere that's worth a shot. I have retried Alimta on patients, but usually not if they genuinely progressed on the drug. On the other hand, if it was several years ago you could try that.

Alk is not tested for in squamous cancers, but as I said before, your mom might not have a squam, that would depend on how much tumor tissue the pathologist had to make that diagnosis. And given her response to Alimta it may not be a squam so is perhaps worth testing. The are several trials with alk blocking drugs, that might be something to ask your oncologist about, in part because the test can be done In the context of a trial and then drug would then be free also. All of this might also depend on your specific insurance.

Phase 1 trials are often made to sound scary or not worth trying, but this is often because our job is to make sure patients clearly understand that these are new drugs (usually, sometimes they are old drugs tried in a new way). Statistically the chance of a cancer responding is small, but statistically the chance of a cancer responding to any drug after 3 or 4 different chemos is equally small. My bias is that a carefully considered phase 1 trial is a very good thing, this is how we find new drugs and new niche targets in complex cancers. I would not rule these trials out. It may just be that we forget to tell people how exciting these new drugs might be.

Sunnymom3, might your mother consider a clinical trial, as Dr Laskin outlines? Is she anywhere near a big research hospital?
What a lot your mother has been through and yet still come out the other side - she sounds like a formidable lady.