Article and Video CATEGORIES

Cancer Journey

Search By

Dr. Jack West is a medical oncologist and thoracic oncology specialist, and Executive Director of Employer Services at the City of Hope Comprehensive Cancer Center in Duarte, CA.

Why Don't We Routinely Give Combination Chemo for Previously Treated Advanced NSCLC?
Sun, 12/16/2012 - 13:30
Author
Howard (Jack) West, MD, Associate Clinical Professor, Medical Oncology, Executive Director, Employer Services, Founder, President and CEO of GRACE

I just did a brief video that appears on my The Swedish hospital website/blog, addressing the question of why it is standard to give single agent but not doublet or other combinations to patients who have already received first line therapy for advanced NSCLC. As I cover in the video, the basic premise is that as treatment continues for patients on therapy for advanced NSCLC, it becomes only more and more important to balance the anticipated side effects of treatments against the incremental benefit of a more aggressive treatment.  Overall, most patients with metastatic/advanced NSCLC can tolerate and benefit meaningfully from  a combination approach for initial therapy (though a targeted therapy will be preferred for the vast majority of patients with a "driver mutation" such as an EGFR mutation or ALK rearrangement).  But beyond that point, as patients are experiencing cumulative effects from both the treatment and often the underlying cancer, the evidence reveals that combinations confer greater side effects but no accompanying significant improvement in overall survival.  

Instead, the prevailing standard of care, with the evidence to support it, is a strategy sequential single agent treatments, which may lead to further tumor shrinkage in some patients and prolonged stable disease in many others; these results often lead to an improvement in survival with a manageable balance of often modest side effects.

I welcome any questions or comments you might have. 

Next Previous link

Previous PostNext Post

Related Content

Forum Discussions

Hi JW and welcome to Grace. I'm sorry you're going through this but hopefully and probably this isn't cancer. There is so much going on anatomically in that area that the...

Hi and welcome to Grace. I'm so sorry about your mom's situation, it's very complicated and not at all reasonable for us to comment on all that is being taken into...

Hi Scruboak, I will ask Dr. West to comment, it may be tomorrow. He's an expert in the field and will have thoughtful input. The fact that it was caught and...

I asked Dr. West and he said that this is a question he can't answer, we don't have studies that give details that specific. He said to his knowledge, that this...

Thank you so much, Janine. It helps me to just chill overall.

It's surprising how a little piece of intel can make everything else in life easier.

Hi Scrappy,


 


Below I've pasted my comment from facebook. Google is a double-edged sword, you can find anything but without some context, it can be tough to digest. We get...

Recent Comments

JOIN THE CONVERSATION
Hi JW and welcome to Grace. …
By JanineT Forum … on Mon, 05/16/2022 - 10:52
All's good
By JanineT Forum … on Sat, 05/14/2022 - 15:10
Can Pancoast affect both sides of the body?
By JanineT Forum … on Wed, 05/11/2022 - 19:49
Hi and welcome to Grace. I…
By JanineT Forum … on Sun, 04/24/2022 - 08:41