complete treatment break for 3 months after 2nd line chemo? why? help! - 1294510

Thu, 05/31/2018 - 05:06

Hi there, Grace community!

I'm writing because I'm a bit desperate! My mom has BC/mets in her lower lung, some bone, but overall good shape and stable. She's done two types of chemo, after Faslodex started failing, the 2nd line chemo is Taxol. But after 8 sessions of Taxol, doc says the illness is stable, so he wants her to take a break from everything for 3 months, to recover. Then he wants to do a PET scan, to see how things are and decide for new treatment. Is this normal?! Won't the illness progress and do irreversible damage? Have you ever heard of this treatment option of not doing ANYTHING for 3 months? Is the doc giving up on us? I AM SCARED! Please share your thoughts!

Many thanks to you!

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Hi bravesocks,

Welcome to GRACE. It's great to hear that your mom's disease is stable. Although everyone would like treatment to make their cancer completely disappear, that's often not the case, and stable disease is a good result. You can read this post for a discussion of that issue.

There is also the very understandable fear that if you don't treat the cancer continuously it will progress to the point where it becomes untreatable. So talk of a treatment break is scary. But chemotherapy is very tough on the body, weakening its ability to rebound from lowered blood counts and other issues. If that happens, further chemotherapy may not be tolerable, making continuous treatment impossible. Dr. West likes to say that treating metastatic cancer is more like a marathon than a sprint. You want to be able to continue treatment for as long as possible. As a result, taking a treatment break to allow the body to recover can improve the chances of doing that, and such breaks are common.

As far as progression, with close follow-up using scans and clinical examinations, cancer very rarely progresses so fast that further treatment can't have a chance to bring it under control. Your mom already has experience with that - when Faslodex stopped working and the cancer progressed, that progression was not so rapid as to prevent Taxol from bringing it back under control. The clinical experience is that spotting progression a few weeks earlier or later doesn't have an impact on long-term survival. Your mom's doctor's recommendation of a three-month interval is certainly reasonable.

Finally, many patients enjoy some time off treatment, so that's a factor to be considered as well.

I hope that you and your mom can make a decision with which you are comfortable and confident.

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Hi Bravesocks,

To follow up what Jim wrote, it is a valid strategy to take a treatment break in managing metastatic colorectal cancer, so I don't think her doctor is giving up by scheduling a three month break with a followup scan.

One issue is that long term there are cumulative toxicities from chemotherapies that one would want to avoid for as long as possible. Another issue is that may be possible later to rechallenge with a previous treatment that a bowel cancer patient developed resistance to.

There is a 2013 publicly available paper that explains some of this but is a bit technical:

Rechallenge therapy and treatment holiday: different strategies in management of metastatic colorectal cancer

Overall this is a complicated situation and depends on the best judgement of the treating physician given the overall situation with the patient. I will try to find a more recent paper that addresses your situation.

Edited to add: I see that your Mom has breast cancer rather than bowel cancer. I"m not sure how different these situations are. Apologies for the error.