help on making treatment decisions - 1290492

kkh130
Posts:39

Hi All,

I've done 5-day palliative radiation on my primary lung tumor 2 weeks ago. Now lessen the pain. A new systemic treatment will be start next week (total 3 weeks from radiation). I am giving the following options to choose:
1. Opdivo
2. Irrinotecan/avastin
3. Docetaxel/cyramza
4. Docetaxel

Need help on making the decision

Thanks,

Kkh

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Reply # - April 2, 2017, 12:25 AM

kkh130
Posts: 39

The first 3 recommended by Stanford oncologist
The last recommended by my regular kaiser oncologist

Kkh

Reply # - April 2, 2017, 01:02 AM

kkh130
Posts: 39

If the Docetaxel doing once a week x3 weeks then 1 week off (claim to be less harsh), will it have the same efficacy as the once every 3 weeks?

Reply # - April 2, 2017, 07:45 AM

JimC
Posts: 2753

Hi kkh130,

The trial evidence suggests that the efficacy is the same. As Dr. West has stated:

"...in mid-2000, Taxotere at 75 mg/m2 every three weeks became the clear standard of care as a second-line treatment for patients with advanced non-small cell lung cancer and was approved by the FDA for this setting. Nevertheless, this is a challenging strategy for some patients, and one alternative approach is to give Taxotere on a weekly basis, generally with off weeks in between. Overall, the studies that compared weekly to every 3-week Taxotere have not demonstrated that either approach is clearly more effective" - http://cancergrace.org/lung/files/2009/03/second-line-chemo-for-advance…

Many patients prefer the convenience of going for an infusion just once every 3 weeks, but where side effects make that difficult, the weekly strategy can help a patients successfully complete a regimen that might not otherwise be possible to finish.

JimC
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Reply # - April 2, 2017, 08:51 PM

kkh130
Posts: 39

Hi JimC,

I would like to know how often docetaxel being used with cyramza. Compare to docetaxel alone, under what circumstance the combo is more preferable? Can cyramza cross blood brain barrier? Is cyramza somewhat similar to avastin (used as maintenance?)?
I know docetaxel approved by FDA as 2nd line agent. I am trying to find recent research articles that show the advantages of the combo of docetaxel and cyramza. Try to find out why the Stanford oncologist prefers the combo? if I have the research articles to back me up and support my request, I may be able to convince my kaiser oncologist to prescribe.

I am hoping I can find the answer here.

Thanks,

Kkh

Reply # - April 3, 2017, 09:06 AM

catdander
Posts:

Hi kkh130,

We have a couple of posts on the subject. The first is a video shot at ASCO after the trial results were presented and the 2nd one after cyramza was approved. The drug is shown to extend overall survival by 6 weeks. Since OS with added side effects falls short of what some feel is clinically exciting Dr. Nasser Hanna's take away was that he would probably first look for a trial that would be suitable. With that said there are trials combining immunotherapies with other drugs that appear to add efficacy to immunotherapies to those who don't have much or any PD-L1 marker. So that may be another choice you can add. The links below are describe cyramza very well.

http://cancergrace.org/lung/2014/07/18/asco_2014_cyramza_second_line_tr…
http://cancergrace.org/lung/2014/12/13/cyramza-fda-approval-2l-nsclc/#m…

I hope this is helpful in making your decisions. Keep us posted.
All best,
Janine

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