First line treatment dilemma - 1271642

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First line treatment dilemma - 1271642

Hi There,

My dad has stage 4 lung cancer, mets to the brain and bones - he was diagnosed in mid August, and so far has only received gamma knife surgery for his brain mets. He is Egfr negative, although a chemo-sensitivity test confusingly suggests tarceva would be effective against his cancer. Nivolumab also suggested positive results. A third treatment option would be traditional chemo (carboplatin/pemetrexed).

I have been trying to build up his weight and immune system - since nivo essentially utilities the bodies own immune system, it seems to make sense it should precede chemotherapy, as chemo would whilst hopefully working against the cancer, would also work against the immune system. Does this make sense or am I missing something?

He has lost quite a lot of weight recently, 62kg/6 feet tall, my fear is chemo may exacerbate his weight loss, so I'd be keen for nivolumab to precede chemotherapy. Any suggestions as to the best treatment order would be greatly received.

Thank you,


Hi Jorge,

Hi Jorge,

I'm sorry about your dad's diagnosis. I hope we can be of help.

At this time nivo is approved (read insurance will pay) for treatment after platinum based treatment so that pretty much is self explanatory; platinum doublet first then nivo. It is thought by many that alimta works just as well if not better than taxol (for those with non-squamous) as the doublet companion to carbo. Alimta almost certainly has fewer side effects than taxol.

The tests that show what chemo will work best are far from 100% correct making them useless to lung cancer specialists. They may easily miss what may work while missing what will work. Using data from extensive research is much more likely to help in your father's type situation.

I hope you're dad does well for a very long time.