jdrn
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85 year old male path report indicates invasive adenocarcinoma an neuroendocrine carcinoma poorly differentiated i.e. a small cell carcinoma however some area difficult to exclude atypical carcinoid tumor. Is this Large cell carcinoma with small cell carcinoma? Are the chemo regimens for this chemo a platinum with etoposide? Is this considered first line therapy? Is there a difference in aggressive chemo and palliative chemo as to dosage and timeline?
thank you jdrn
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Reply # - August 24, 2013, 06:01 PM
Reply To: chemo regimen
A combination of cisplatin or carboplatin with etoposide is usually the kind of combination we favor for someone with a neuroendocrine carcinoma, including either small cell lung cancer, large cell neuroendocrine carcinoma, or a carcinoid tumor that appears to merit chemotherapy. Because these neuroendocrine carcinomas are essentially part of a spectrum of the same process, there can be confusion about where a cancer sits in this spectrum. Moreover, some lung cancers (about 5%) can show a mix of small cell lung cancer and non-small cell lung cancer components.
Here's a link to a podcast here that describes neuroendocrine carcinomas:
http://cancergrace.org/lung/2010/01/28/interview-with-dr-matthew-horton…
The platinum and etoposide combination would be considered first line therapy, and the main differences would just be whether the platinum is cisplatin or carboplatin, with cisplatin being perhaps marginally more effective but often considerably more challenging for patients to tolerate. It would likely be extraordinarily challenging if not completely infeasible to give cisplatin at the standard doses to an 85 year old without remarkably high risk for major side effects. A leading consideration would most often be carboplatin/etoposide, perhaps etoposide alone, possibly substitution of irinotecan for etoposide, and perhaps some serious discussion about whether the treatment may potentially pose greater risk than benefit in someone over 80. The question of how best to treat someone over 80 is always going to be an individualized discussion based on the health of that particular person, their priorities/aversion to side effects, family/home situation, etc.
Good luck.
-Dr. We
Reply # - August 28, 2013, 11:36 AM
Reply To: chemo regimen
I just wanted to make sure you've seen the section on elderly and frail people with lung cancer. There are remarkably varied options for treating people depending on how well they withstand treatments. This link is from our "Focused Cancer Info" tab at the top of the page, I used the drop down menu to choose "lung cancer" then used the drop down menu on the right column under "archives".
http://cancergrace.org/lung/category/lung-cancer/special-populations-in…
And this link will take you to the forum where I've filed this thread, http://cancergrace.org/forum/lung-thoracic-cancer/nsclc/poor-risk-elder…
Best to you.