recurring ext sclc within a month- Doctor advised against 2nd line chemo - 1250512


Hello Dr West
I previously posted about my dad- diagnosed ext sclc with lymph node & liver mets in June after developing hyponatremia. 6 cycles of carbo/etop.- CT scan on 8th Oct ( a wk before cycle 6 & the first he received- for some reason they didn't do one mid-cycle) showed 1 chest tumor disappeared/2 shrunk by 60%, barely detectable in liver.
Dad developed lower back pain 2 wks ago - we thought from a strained muscle from over- exerting himself carrying a heavy object, but a bone scan on 18th Nov revealed suspicious masses in pelvis and along spine. Docs say its bone mets. He has become alot weaker in the last 2 weeks, made worse by bad constipation; lethargic, weak on his legs & low appetite. Today he was finally able to go to wc ( apologies for tmi) and felt much better as a result.

Doc's said he can get radiotherapy to the spine for pain management, but 2nd line chemo would be of no real benefit due to his cancer coming back so soon. They said 2nd line chemo is a combo of 3 agents- called it 'Orca'- Cisplatin & don't recall the other 2- and quite strong. He would be risking his life for little or no benefit to undertake it. I asked if radiotherapy on spine would possibly shrink the tumors there, doc said possibly, but it wouldn't affect the outcome as it's a systemic cancer.

We have to decide whether to try 2nd line chemo or not. doc is not at all encouraging about it, but I am scared to give up at this point. I believe in fighting it out... Would there be any benefit to trying it even for 1 or 2 cycles, to see if it at least shocks the system and potentially benefits?

I would appreciate any advice you could give based on your exepriences.
Thank you


Dr West
Posts: 4735

I'm sorry he's in this situation. Unfortunately, I can't make that kind of recommendation. His oncologist is correct to note that the chance of a significant benefit is very low if the cancer is progressing so soon after first line chemo, and there is absolutely real risk that aggressive second line chemotherapy will give him a very real risk of significant side effects without being counterbalanced by much probability of benefit. While I understand the temptation to "fight it out", that doesn't make a lot of sense when it's like jumping into a cage with a hungry tiger while armed with a butter knife. It's not a fair fight, and there's a real chance that he's just being set up to be mauled.

-Dr. West

certain spring
Posts: 762

mayab8, I am so sorry to hear that this is happening to your father, especially when he was diagnosed so recently. It must all be very shocking. What does your father want to do?
I hope he is less uncomfortable now. Constipation is very common with painkillers, and can make someone really quite unwell. This post might be useful:…
best wishes,