Time between maintenance treatments - 1255159

sandi3322
Posts:3

I was wondering if there is a max time (or the most you'd want/suggest) between maintenance treatments with pemetrexed when the cancer has been stable for 6+ months? Even though I've done fairly well with treatment, after 1 1/2 years of it... I'm really ready to enjoy my summer at the lake without having to come home for treatment.

Thank you for any insight

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Reply # - March 26, 2013, 12:42 PM

catdander
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Hi Sandi! How good to hear you are stable and ready for a break. It is very reasonable to take a break from treatment when you're ready. Especially if you're stable, you feel well, you want it, and have a lake to enjoy.
My husband was on treatment for 3 years before he took a break, boy was he past ready plus he's been extremely lucky so far.

Another reason for a break if you need it is to find out about the biology of your cancer; is it indolent or ist t aggressive and very responsive to treatment. These are good things to know in making future treatment plans.

In Dr. West's words, " I think it is extremely reasonable for people to take a break from chemo for advanced lung cancer if they’re stable or have shown a very good response and could benefit from a break. And if someone hasn’t progressed on a prior treatment that is feasible to give longitudinally, and if they haven’t experienced prohibitive side effects with that treatment, it’s very reasonable to return to a previously used agent." from http://cancergrace.org/cancer-treatments/topic/moms-continuing-treatmen…

this discussing both the importance of treatment break and maintenance therapy obviously the maintenance part doesn't apply but the break sure does.
http://cancergrace.org/lung/2013/03/09/goldberg-maint-rx-vs-rx-break/

Enjoy!
Janine
forum moderator

Reply # - March 26, 2013, 09:48 PM

Dr West
Posts: 4735

I agree it's a great problem to have. I would say that many oncologists are comfortable with giving maintenance therapy every 4 weeks instead of every three, and some might go out to every 6 weeks. However, at some point it's not maintenance therapy and is just a treatment break if you're going 6 or more weeks off of therapy.

I personally don't hesitate to give a 4 week interval for the patients who need it for physiologic or psychological needs, and I think that's likely to be every bit as good as every 3 week treatment. But I think a reasonable alternative is to follow a patient clinically and re-check scans every 6-8 weeks or so, holding off on further treatment in the absence of evidence of progression, or else to go on treatment for a few months and then take a planned few weeks off entirely again if the cancer isn't progressing.

-Dr. West

Reply # - March 27, 2013, 10:23 AM

sandi3322
Posts: 3

Thank you Dr. West & Catdander for your responses.

My treatment is at 1 pm today and I've briefly discussed this with my oncologist not long ago. Because I progressed with 1st line treatment he believes I should not push it more than 4 weeks. I'm more inclined to push for 6-8 but would settle for 5 :wink:

My last treatment had to be cancelled due to low counts, and my last PET showed an enlarged liver and spleen. I think I've done pretty well with treatments considering, but it has taken it's toll especially on my bones (mostly lower back & hips) which hurt all the time now. Since there are no bone mets I'm assuming the increase in pain is from the neupogen.

Although I'd love to say "no more for x months" I'm not ready to play roulette with my life so I will yield to what I'm told is best by the ones who know best!

Thanks again for your time and input! You guys are truly a blessing to all of us fighting this evil battle!!!

Reply # - March 27, 2013, 11:33 AM

JimC
Posts: 2753

Hi Sandi,

Quite reasonably, you and your oncologist are trying to set a treatment schedule in advance. But one option would be to tentatively set the schedule, then see how your blood counts respond, how you are feeling, etc. and adjust the schedule accordingly.

Since no one really knows how beneficial maintenance therapy really is (is the cancer under control as a result of first-line therapy (at least for the present), or is it being controlled by the maintenance treatment?) there's no good sense of an optimal interval. Chemo tends to be given at 3 week intervals because blood counts tend to recover in that amount of time, not because that's known to be the optimal interval in terms of fighting the cancer cells. In other words, it's being administered as often as it can be, not necessarily as often as it's needed. Especially with first-line treatment, when you're hoping to knock out as much of the existing cancer as soon as you can, that makes sense. For maintenance, who knows?

Good luck with your treatment today.

JimC
Forum moderator

Reply # - March 27, 2013, 09:01 PM

Dr West
Posts: 4735

Jim put that point very well. Yes, chemo on a three week cycle tends to follow that pattern because that's the most frequent schedule that can be done for many of the chemo combinations, not necessarily that it's optimal that way...and it's likely that what is optimal is different for different patients with different cancers.

Good luck.

-Dr. West

Reply # - March 31, 2013, 03:35 AM

sandi3322
Posts: 3

Thanks again everyone for your replies.

We've decided to go with every 4 weeks for now, with a fifth week when I'm wanting a bit more of a break or my counts take a dive again. Since I've remained stable for the last 3 scans, I really don't want to guess at which treatment has held it at bay so far (Carbo/Alimta or Alimta Maintenance) since that one seems to still be in the air to some extent.

For me I guess it comes down to leaving well enough alone until I don't have the option. It's a lot to get your head around sometimes of which way to go and what risk you're willing to take. Since my cancer is still "alive" just not growing or going anywhere for now, is it wise to play with the possibilities? This is 2nd line treatment for me as I progressed with 1st line of Cisplatin/Etoposide...

As much as I'd love to stop treatment till it starts to progress again, I have to admit, I'm a whole lot of scared to try that one.

Reply # - March 31, 2013, 08:31 AM

JimC
Posts: 2753

Hi sandi,

That seems like a reasonable plan.

I can understand your reluctance to stop treatment. At the end of my wife's first-line chemo, to which she responded well, we faced that same kind of decision, at a time when the concept of maintenance was very new. We will never know whether we made the best choice, but even though a treatment break would have been welcome, we weren't comfortable doing nothing. There's just no right or wrong choice.

Good luck with your continued treatments.

JimC
Forum moderator

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