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Hello, it has been alittle while since I have posted anything. Mom had started cpt-11 but could not tolerate it and was hospitalized due to dehyrdation. Went back to onc and she started her on topotecan which she has had 2 rounds and was due for 3rd this past friday. All along her counts have been low and she has had procrit but friday both counts were low and she had procrit and luekine. Goes for blood work tomorrow and if all is good will do chemo friday. Mom told me today that after these cycles of chemo she didnt know if she would do anymore, said she was tired of being tired. They havent done any scans since they found mets to brain, which she had 18 rounds of radiation, and I want to also mention that she has improved greatly, still weak but is doing physical therapy so hopefully that will help. Anyways, my brother and I were talking today and was going to ask her onc if maybe after the next series of chemo could she take a break of a month or so regardless of if she does scans and what they would say. Would it hurt anything to take a breather from all the stuff and just have a break?

We went to her other doc(diabetes, etc) and she told mom that she is surprised and that had exceptional will and fight and she was an inspiration. Mom has made it past 1 year mark since dx. Which is a heck of a milestone.

I was just wanted to ask about how well topotecan works and if not what line of treatment would they do next. Now when we were told she had sclc ext. carbo-etoposide was the only thing they could do and now we are on another line of treatment. So how many lines of treatment do they have and when do they decide to quit treatment?

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My Husband got a break from the chemo.. He was too worn out and sick, so they said they would leave him alone for a bit.

He perked up pretty quickly! I hope your mom gets a little vacation too.

I sometimes think that the treatment is worse then the disease, at first, but what choice is there, if you're determined to fight it? Doesn't seem fair.

Prayers for you guys,


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It's always reasonable to take a break if a patient wants it. The wrinkle is that SCLC can progress pretty quickly, so often it doesn't allow prolonged breaks before recurring/progressing, particularly if a person has already been treated with several lines of prior treatment. But quality of life is a huge issue here, so I would definitely listen to a patient who needs some time off.

In terms of later options, there isn't anything that has any proven value, but some people would try various other chemo drugs that have some activity in lung cancers...it just becomes increasing likely with more and more treatment that it will end up more harmful than helpful. With more time and treatment, the cancer becomes more resistant and our drugs become less effective, while patients tend to get beaten up by both the cancer and all of our treatments. So it ends up a pretty individualized decision about when more treatment just doesn't make sense and is going to clearly be detrimental. But platinum/etoposide and then a drug like topotecan, or sometimes irinotecan, would be the leading drugs people would consider most valuable, and beyond that, it's not clear what the additional treatment provides. We're actively looking for additional effective treatments, but SCLC has been a ridiculously hard nut to crack. Most of our treatments for SCLC have been more or less the same for years and years, because newer treatments just haven't panned out.

-Dr. West

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