Help for 3rd line chemotherapy please - 1251796

wnderwo
Posts:9

Dad is 78 with NSCLC nonsquameous adenocarcinoma. He was diagnosed in April 2011 with stage 4 lung cancer with bone and brain metastasis. He had 6 cycles of carboplatin and alimta followed by just 1 maintenance alimta with severe peripheral edema (now controlled by massage and wrapping) between cycle 6 and 7...a side effect of alimta. The main lung tumor responded and was reduced by 1/3 and he took 10 months off. Then due to lung tumor growth he began 2nd line therapy in Aug of 2012 with 2 cycles abraxane (stabilized the tumor..no growth or reduction in size) and then 2 cycles of carboplatin with the abraxane...tumor decreased slightly from 2.6 to 2.2 but during the attempted 3rd cycle of carboplatin with abraxane dad had a severe anaphalactic reaction requiring ER admission. He is negative for EGFR, KRAS, and ALK mutations and awaits results of additional tests.

(Dad had radiation for the bone and gammaknife for the brain metastasis. )

Regarding the 3rd line therapy...we are confused?

Is there a desensitizing protocol for alimta so that his severe edema doesn't return?
IS there another type of chemo we didn't try yet? Tarceva?

Thank you for any suggestions that we can bring to his oncologist as he is not a lung specialist and appreciates any suggestions that we can find.

Forums

Dr West
Posts: 4735

The evidence-based choices that have been shown to improve survival in patients previously treated with chemo for advanced NSCLC include Taxotere (docetaxel), Alimta (pemetrexed), and Tarceva (erlotinib). There isn't any desensitizing protocol for Alimta's side effects, but I wonder if he might still do well for a while before that becomes a problem again. Otherwise, Taxotere and Tarceva are still options that haven't been pursued, and I'll note that we're also generally pretty happy to see stable disease on a well tolerated treatment, so perhaps returning to Abraxane alone would be an option to consider as well. In general, only a minority of patients will show much tumor shrinkage in second line or later. While it's great when you see much shrinkage, stable disease is still a relative victory if the cancer would otherwise be growing. There's evidence that plenty of people who experience stable disease end up living longer due to these treatments than they otherwise would, so I wouldn't conclude that it's necessary to add to a second line or later regimen that is well tolerated and achieving tumor stability.

-Dr. West