3rd line tx options - 1242651

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3rd line tx options - 1242651

Not that I am a pessimist, but I like (read need) to be a step ahead of the battle.  Diagnosed 3/08 with stage IV adeno w/ BAC features, non-mucinous, multi-focal, former smoker. No mutation testing etc. done @ time of dx. Tarceva for 8 mos. till CT showed progression, then Alimta/Carbo for 6cycles with shrinkage and on to Alimta maintenance since 4/09 with stability. Had a chemo break from 8/10 to 3/11 until CT showed progression so back on Alimta again achieving stability for the past year. Functional level is good, and other than fatigue I tolerate Alimta quite well every 4 wks. However I know at some time it will no longer be effective or I won't be able to tolerate, so I am asking what viable options there are for 3rd line tx that still allow a modicum of quality life and demonstrated effectiveness.

certain spring
Reply To: 3rd line tx options

msp, just wanted to say hallo and glad you are doing well on Alimta at present. I know exactly what you mean about the one-step-ahead thing. Very best.

Dr West
Reply To: 3rd line tx options

These days, the best evidence really suggests that people with advanced bronchioloalveolar carcinoma (BAC) are best served by following the same general treatment approaches as other people with an adenocarcinoma. So essentially, we're guided by molecular markers and would favor an EGFR tyrosine kinase inhibitor (TKI) as first line therapy in someone with an activating EGFR mutation, or XALKORI (crizotinib) in a patient with an ALK rearrangement. Alimta (pemetrexed) is often particularly helpful in patients with a lung adenocarcinoma, including BAC, and chemotherapy is the first line treatment of choice, with or without the antiangiogenic agent Avastin (bevacizumab) in patients without an EGFR mutation or ALK rearrangement.

Here's a summary of how many of the leading oncologists approach previously treated advanced NSCLC:


The best studied agents are Tarceva (erlotinib), Alimta, and Taxotere (docetaxel), so if a patient hasn't received one of these, the option not given tends to be a leading choice if a patient is well enough to tolerate it. Other agents like Gemzar (gemcitabine), Navelbine (vinorelbine), or perhaps Hycamtin (topotecan) or Camptosar (irinotecan), or some others can also be given, though they aren't as well studied and are less common choices.

Finally, if a clinical trial with a novel agent is available, this is also a great choice for many patients and can lead to a better understanding of the disease and perhaps a new treatment option for lung cancer.

-Dr. West

Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education