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chemo question


kaneohegirl

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so Pop has had now 3 rounds of Taxol/Carbo he just had a CT and the scans show the Cancer is responding to the Chemo and shrinking. he doesnt go to see the Dr for 2 more weeks.

I talked to the nurses and they told me that he would only get 1-3 more rounds depending on what the Dr thinks....

so my questions are...

if the Cancer is not gone by the time they decide hes had enough of those drugs then what?

and...

if Carbo/Taxol is working then why not continue with that way of treating it?

and...

so if its not gone wont it start growing back?

this is such a confusing disease.

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All I can tell you is our experience and that was that Mom was "scheduled" for 6 or 7 rounds of carbo/taxol and managed to get 3 full-strength rounds in and two reduced-strength before she and her oncologist decided it was time for a chemo break. She continued to have shrinking even after the chemo was done and eventually, the primary tumor in the lung was nothing but history.

Wishing you and your dad all the best!!!

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Glad to hear your Dad is responding to this treatment. Most Docs only give 4-6 rounds of first line therapy because they feel that the effectiveness is diminished while the side effects get worse. Fortunately, in my husband's situation, our oncologist didn't feel that way. He kept going until my husband had an allergic reaction to the carboplatin on his 7th dose. We went for 8, but only were able to get in the taxol and then he had another reaction to the carboplatin.

He still had a lot of cancer and went immediately onto second line treatment of taxotere/gemzar for twelve 21-day cycles. After that he still wasn't cancer free -- it was working, he just had a lot of cancer. Also he had an allergic reaction to the taxotere. (If there is a hole out there, Tony falls into it! :? ) He rested three months, then went to Tarceva. He had significant growth during those six months as he didn't respond to the Tarceva.

So, I guess the answer is up to your oncologist. Our's figures if it is still working, then keep going. Tony didn't have horrific side effects from the treatments until after the 20 in a row.

He has never been cancer free, but is at 27 mos. from diagnosis, so that is pretty good. Hopefully your Dad's cancer is pokey about growing back if he goes on a break. Maybe the doc will move to Tarceva. The worst part is no two cancers are the same -- no rules apply.

Regards,

Welthy

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Hi, kaneohegirl:

I believe Missy and Welthy pretty much answered your questions, but if you want any more details on why 4 to 6 cycles of taxol/carbo is about the limit, here's a good discussion on Dr. West's website:

http://onctalk.com/2007/01/17/duration- ... ng-cancer/

After first-line treatment is complete, what happens next depends on what the latest scans show along with the general condition of the patient after getting off the "hard" stuff. Some go directly into second-line treatment, while others take a break from chemo to recover some strength. A lucky few might be told their cancer is nowhere in sight and are scheduled for periodic scans to check for recurrence.

My best wishes and Aloha,

Ned

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Thanks for the answers guys!

question about these possible break periods to regain strength...

does it take awhile to start feelin "good"... I ask only because I know my dad is itchin to try to go to CA, an possibly try to rough it on some property of his an by rough it I mean no runnin water no plumbing only electricity.... so he is barely able to walk thru the stores now... he needs the cart to "lean on" to keep goin an he loves shopping... as well as he takes 3-5 step for every one of mine so I really have mooosey along to stay along walkin with him...slllllllllllooooooooooooooooowly

**sigh** this is sooo frustrating seeing so much weakness

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If his weakness and fatigue is from the chemo, he'll snap back pretty quickly. Give it a 2-3 weeks after he is done and see how he is doing. Make sure his blood work is looking good too. (Tony took about 1 1/2 mos to get back to form, but that was after 20 cycles of full-strength doublets.) I hope he is not going to "rough it" on his own though. Someone really should be with him regardless of how well he feels.

It will be a wonderful feeling for him to get a break!

Good luck to him. :D

Welthy

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Please realize that I am totally new at all this and basically only one step up from completely clueless! :) I am slightly clueless. :)

After reading your post, I thought "What an excellent question....I should ask that" So, the next time we were at the office I asked. The answer I got was: Your Mom will either be scanned after two or three rounds, if she's responding, then we will continue with this treatment. She can have four, six, or eight rounds of this depending on how well she is reacting to the drugs because everyone is different.

In short, the answer I got from our Dr. was 4,6,8, but every patient is different.

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To reiterate the main themes, it's true that individualizing for the patient always has a role. There are no hard and fast rules, but most of the evidence supports 4-6 cycles before you reach a point of diminishing returns and would be inclined to save strength and marrow reserves for a different treatment. If cancer cells are still alive after 6 cycles of chemo, it's pretty unlikely they'll give up the ghost only after a 7th cycle. Anything cancer cells still alive after 6 cycles of chemo is likely just resistant to that therapy. But you can read more about this issue in the post I wrote that Ned so kindly provided a link for, above.

I also wanted to provide a link to another post that has gotten us lung cancer specialists thinking. Our general practice (mine too) has been to stop chemo and then follow without treatment for a while, until the time of progression. However, one trial presented at ASCO, our biggest oncology meeting of the year, suggested that perhaps moving straight to a next line of treatment may be better than waiting until progression (suggestive, but this trial hasn't settled the issue). If interested, you can read more about this trial here:

http://onctalk.com/2007/06/10/maintenance-rx-for-adv-nsclc/

I hope that helps.

-Dr. West

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