3rd Line chemo for Sclc - 1271787

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msmith58
3rd Line chemo for Sclc - 1271787

My husband has just been removed from a clinical trial for relapsed Sclc after 4 rounds.He had significant response for liver mets on the drug and his lung tumor has been stable since radiation after first line. He did, however develop 3 brain mets. We are having gamma knife surgery next week and then have been offered the choice of doing nothing, Topotecan, taxol or irinotecan. Our oncologist has made it clear he doesn't like Topotecan, but is letting us decide. He is offering us no more than a 5% chance of any of these drugs working. My questions are: Was the experimental chemo really a fail since it worked so well on the liver? Do you have a preference regarding the 3 drugs offered. My husband is currently in good physical condition with no symptoms. Hi is 61 years old.

JimC
Hi msmith58,

Hi msmith58,

I'm sorry to hear of your husband's progression, but it is often does result in dismissal from a trial. Good results in one area with progression in another is called a mixed response.

Since the brain mets are being treated, it would be reasonable to hold treatment until there is further evidence of progression. If further treatment is chosen, it seems to make sense to try the SCLC drug not yet used (irinitocan).

JimC
Forum moderator

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>

carrigallen
As your oncologist mentioned,

As your oncologist mentioned, in this 3rd line small cell situation, the standard options are rather sparse and sobering. My guess is that your oncologist offered these 3 because she/he is not particularly excited about any of them.

Now, I'm going to assume that other clinical trials are not an option or available for you.

I have seen some great responses in this setting with nivolumab (Opdivo) with small cell lung on a clinical trial. I don't usually advocate for off-label but it seems reasonable to try Opdivo if a clinical trial is not an option. In general, if your insurance company does not approve this off-label use of Opdivo, the drug company has a patient assistance program that can often provide free drug, depending on the circumstances. Your oncologist would need to order the Opdivo and have you complete the patient assistance program forms, wait a couple weeks for the paperwork to be processed, and hope you can get access to the drug. I will advise you that many oncologists will not be comfortable with off-label usage in this setting because of the uncertainties, and that is totally understandable. Note I'm not giving a recommendation here, just presenting this as a potential option to consider.

Here is the early, preliminary results of the trial, presented by Dr Antonia at Moffitt: http://meetinglibrary.asco.org/content/146138-156

msmith58
Thank you for this very

Thank you for this very useful information. We will investigate this possibility.