Whic way to go - more chemo or radiation - 1257843

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Whic way to go - more chemo or radiation - 1257843

So I have a question. My husband was diagnosed with ext. SCLC, mets to bones picked up by PET after nothing showing on CT of bone, abdomen/pelvis,brain. Originally thought he was limited but the PET changed it all. First line chemo carbo/etoposide 6 cycles - handled beautifully with little, if any side effects. My husband didn't want chemo to end because he felt so good but onc said no. Has anyone had 8 cycles or stayed on etoposide after? There has to be some maintenance chemo for ext. SCLC just like for NSCLC.

Relapse within 90 days discovered after getting CT scan to qualify for a clinical trial. Question is - more chemo to keep cancer throughout system at bay or thoracic radiation on lung tumor? I never heard of anyone having only one line of chemo when there are others available so it seems like that is the better choice since chemo worked the first time. Everyone responds differently to chemo so topotecan or irinotecan or one of the drugs might work. Seems like radiation should be the last choice unless trying to relieve some specific current painful site.

I hate this disease and find it completely unacceptable that there isn't more research into it. If they can get such a great handle on HIV/AIDS in 25 years, why not lung cancer. Still believe there is bias in the medical community against smokers even though we have the tobacco companies to blame for that IMO.

Dr West
Reply To: Whic way to go – more chemo or radiation

If there's evidence of progression now, topotecan would be the most commonly used second line approach, though its cousin irinotecan is certainly an option that can be considered as well. As you say, radiation really doesn't have a role in such an often multifocal, relatively diffuse process, except to manage local problems/specific symptoms from a metastatic area.

I can certainly understand that maintenance therapy is an appealing concept in SCLC, but it isn't generally advocated because it clearly adds side effects but doesn't have evidence to show any improvement in survival. In fact, it's most appropriate to recognize that there isn't especially strong evidence showing a survival benefit for maintenance chemo in NSCLC compared with the same treatment at the time of progression. The trials that have shown a survival difference for maintenance NSCLC have all compared more treatment to less treatment in the non-maintenance arm, so it's not at all clear that the timing of treatment makes a real difference if everyone gets the same treatment over time. I and many other lung cancer experts are far from convinced that maintenance therapy is any kid of mandate in NSCLC.

Sorry to get too off track. There's no question SCLC is an underserved, understudied disease with a painful need for new effective therapies.

Good luck.

-Dr. West

Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education