Ceasing treatment - 1262479

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Ceasing treatment - 1262479

My name is Felix. My mother was diagnosed with stage 4 NSCLC Adenocarcinoma in November 2013. She is 61, not a smoker and was diagnosed EGFR-,ALK-.

The main tumor is in the lower right lobe 5.7cm*5.5cm with multiple enlarged lymph nodes.
There is also a met on the spine(Vertebra C7).

She started 4 rounds(every 3 weeks) of Carboplatin/Paclitaxel/Bevacizumab, without any significant side effects. The results after 4 rounds where a decrease in all the enlarged lymph nodes and the main tumor decreased to maximum 1.8 cm.

Her oncologist stopped the chemo treatments and recommend that she continue with the maintenance Bevacizumab(every 3 weeks) with checkup CT's after every two treatments.

Would you recommend stopping the treatment so early, while it is still effective?
Is it possible to continue this treatment later on?

Thank you very much for taking the time,

Reply To: Ceasing treatment

Hi Felix,

Welcome to GRACE, and congratulations on your mother's great response to treatment.

There isn't any evidence that continuing a platinum-based doublet (or triplet such as your mother received) beyond 4 or 6 cycles provides any additional benefit, but it definitely adds side effects. The platinum drug (Carboplatin) is especially tough to handle for an extended period, and most oncologists tend to stop after 4 cycles because they have found that the additional two cycles don't result in much additional response.

You can read about this in the GRACE FAQ on ending first line treatment here: http://cancergrace.org/lung/2010/09/24/lung-cancer-faq-im-coming-to-the-...

Although with some drugs (especially those which are well-tolerated) oncologists will consider returning to a therapy when progression doesn't occur until many months have passed, but that is not usually the case with platinum based therapy. As Dr. West has said:

"Most often, people receive 4-6 cycles of cisplatin- or carboplatin-based doublet chemo as first line therapy and don't go back to it. It's possible to do so, but side effects with cisplatin can be considerable and tend to be cumulative; carboplatin is often better tolerated, though increasing problems with blood counts can be a real problem (as it sounds like it's been for him), and there's also a risk for developing a hypersensitivity reaction (essentially, an allergy) to carboplatin that often occurs with longitudinal use, and which makes it increasingly challenging and even potentially dangerous to continue to administer." - http://cancergrace.org/forums/index.php?topic=9933.msg79082#msg79082

Good luck with the Avastin maintenance treatment.

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>

Reply To: Ceasing treatment

Hello Felix.

I have no expert advice, just want to add that it sounds similar to my wife's treatment, although she has a scan scheduled for this Friday to ascertain the response of her four treatments of carboplatin/paclitaxel/bevacuzimab. There was response indicated by a CT scan after the first two treatments.

She will be randomized into a three arm trial of bevacizumab, pemetrexed or a combination thereof, that will start next week.

I am heartened by the fact that there has been a response, our oncologist discourages me from looking ahead too much, trying to keep us focused on the here and now.

Tom Norkunas

Dr West
Reply To: Ceasing treatment

Yes, just to reiterate, the approach of doing 4 cycles of the platinum doublet, then switching to maintenance with as minimal a treatment as needed to keep the cancer from progressing, is absolutely appropriate.

It might be tempting to push hard, but the goal is to manage this cancer over a long haul (hopefully), so you need to think about it like pacing during a race. It's not just about being way in front in the first lap, but rather having enough left to continue for a longer run.

The clinical trial you speak of, Tom, is ECOG 5508, which is a very important and well thought out trial that will provide a better understanding of what is really a "best" approach. To our knowledge right now, none is clearly the right answer yet, so any arm would be fine. Here's a post written just about that trial:


-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