Chemo #7 and #8 in first line?

[Starr13]

I saw my oncologist this morning; chemo #6 will be next week. Scans after #4 did not yet have me in remission - still a 1.0 cm lesion on liver, and still "residual treated disease" on lung. However, "excellent improvement" according to my doctor; I will have scans again after chemo #6.

After that, he may or may not recommend radiation; he wants to see the scans first. Regardless, even if the next scans show the cancer all gone as he expects, he is going to do chemo #7 and #8, in an effort to drive out any micromets (and therefore I would assume reduce relapse potential). I did not ask him if he intends to change the drugs, but, has anyone else had this as part of first line treatment?

I'm up for it; my blood counts are all normal, no side effects, no meds; keeping a normal work, travel and exercise schedule, and so I'm happy to do it but wonder what everyone else's experience has been and especially if it had a positive impact on the outcome. It seems like CindyRN had a full six months of chemo in first line but perhaps others have too...

Thank you for all responses and I hope everyone is having a nice holiday season.

[Wendy]

Hi Starr,

I can't really help out with your question, but I wanted to tell you how excited I am that you are feeling good through your treatments.

Its great to be reminded that not everyone has debilitating side effects from the treatments.

I have my fingers crossed that you continue to receive good results with your treatments.

Wendy

[Starr13]

Thanks Wendy but I am worried - I do see where several people came through first line just fine but then quickly relapsed, so...I am worried. But then I worry about EVERYTHING related to this.

On that note, I was looking over profiles to get a sense of treatment scenarios and see if I could wrap my mind around six straight months of chemo, and, noticed that a lot of patients have coughs, either consistently or on and off. I haven't had any coughing at all. I did have a smoker's cough prior to diagnosis, but that disappeared within a week. I also had a cough between chemo 3 and 4 that turned out to be an infection, but, haven't had any coughing since. Does this mean it's coming later? Is this a side effect of chemo? Or is it an impact of the cancer, or (???). It seems like coughing is a GOOD thing in that it's the body's way of clearing out gunk. So is the lack of a cough a bad thing????

Thanks in advance for any thoughts...

[recce101]

Hi, Starr:

It's good to hear you're still doing well. If you haven't already, I urge you to visit onctalk.com. There's a wealth of information there, primarily on lung cancer, constantly updated by a Seattle oncologist who is an internationally-recognized expert on lung cancer and who gives high priority to promptly answering questions from people like you and me. A lot of us have "dual citizenship" so to speak, and use the same usernames there as here.

One OncTalk article you may find of interest is here:

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

If you check the Subject Archives under SCLC, you may find other articles that are of interest. You can find a list of Q&A Discussion Forum posts by entering SCLC in the Search box on any page. If those items don't answer your question, I believe it would be useful to present your situation to Dr. West and see what he has to say. Of course he won't give you specific medical advice, but he will do a great job of explaining all the pros and cons of various approaches in situations like yours.

Best wishes and Aloha,

Ned

[Starr13]

Ned, thank you for that, you saved me some confusion, I specifically didn't post the question to Dr. West because I thought I remembered an article from him that said chemotherapy after six cycles has no benefit at all. After visiting the link you posted I now see that that is NOT what he said, at all. Duh. I am still not entirely sure what he is saying exactly in terms of how it might apply to my oncologist's strategy - I usually have to read his articles twice before my non-doctor brain comprehends. He seems to be saying that +6 is appropriate IF there is no progression and IF the patient has a defensible perforance status. I will go back to read it again.

On a similar note, I did learn something new today that might be useful to anyone who is exercising - in weightlifting, muscles are damaged and then repaired, and, I decided to do more weightlifting and less running/walking because the latter is so mind-numbingly boring, etc. Weight lifting is at least fun, and interesting. But then I read some information online about cancer and inflamation, and, using the same medical degree, I immediately made the quantum leap that weightlifting = inflamation in the muscles = might provoke sclc mets and progression to the muscles. I am pleased to report that my oncologist says um, no.

But, seriously, I wondered if recovery from strenous exercise might cause the body to have to try to prioritize its work of healing and repair, and it turns out that exercise should actually help dramatically, for a number of reasons that I will mistate if I try to remember them exactly, so I won't try.

Bottom line, exercise if you can, it just might help win the battle, but, use common sense as my oncologist put it.

Edited to say: Ned, I just read the Q & A section, and Dr. West explains it all clearly there. It appears that additional cycles may be used (not often) if there is no progression, if the patient can do it, if there is no danger of toxicity or rather if the benefit outweighs the potential for unacceptable toxicity etc.

What I don't see anywhere - and what I guess no one can really answer because it's such an individuated issue - is does it actually WORK.

[john]

It can't hurt to get a 2nd opinion.

I believe the link below does show a slight improvement with more cycles for those who had a good response. Though I don't have a med degree so ... take it for what it is worth

http://annonc.oxfordjournals.org/cgi/co ... 13/10/1519

[recce101]

"Starr13" What I don't see anywhere - and what I guess no one can really answer because it's such an individuated issue - is does it actually WORK.

A case could probably be made that as long as the malignancy isn't growing, the chemo is working -- "stable is good." If that's the situation at the end of 6 (or whatever) cycles, then the decision whether to continue the same treatment depends largely on the side effects issue, as you said, and the patient has an input there. Another question would be, what other treatments are available that have a decent track record as a second-line therapy? The answer to that would affect the decision to milk the current treatment for all it's worth or switch to something else. I don't know that much about small cell to offer an opinion -- that's where Dr. West comes in.

Concerning your exercise program, have you noticed that little muscle strains that previously resolved within a few days now take a lot longer to heal and tend to accumulate rather than work themselves out? If not, that's great, and I'll spare you a long discussion of my experience, which might be unique to the Avastin which I received every 3 weeks for a full year. That problem is slowly fading now that I've been off Avastin and on Tarceva for 2-1/2 months.

Aloha,

Ned

[Starr13]

Ned, I don't know that I would be comfortable jumping right into second line if the intent is adjunctive chemotherapy - would it make sense to fire that weapon before it's needed? Maybe it would, I don't know. I wasn't thinking fast enough to ask him yesterday; I was so happy that he brought this up because I have been very, very worried about micrometastasis and it seems that with small cell, nearly everyone gets to remission, then, it comes back right away. His plan sounded awesome so I stupidly didn't ask the details. I looked at CindyRN's profile again and it seems that she had something like nine straight months of chemotherapy in first line. That was almost certainly with a change of drugs along the way, because it's not supposed to continue to be effective after 6-ish cycles, right?

Regarding my exercise program, I do notice that it takes longer for me to recover from weight training. I am guessing this is a chemotherapy side effect that hopefully will go away.

[lc46]

Hi- My Mom had 6 rounds-her tumor had shrunk 90% after 4-but also had some left-the last 2 really didn't do anything to be honest-but they still did the radiation to treat what was left-and it worked!

I'm glad you are feeling good. Keep me posted

Dar

[john]

Your Dr may bring up PCI also so you might want to do research on this.

It is good your are getting such a great response to chemo and the side effects have not been too bad.

I think that is why your Dr wants a couple more cycles.

[Welthy]

Starr,

I know NSCLC and SCLC are like apples and oranges, but my husband did 20 cycles of two different doublets in a row with no break. As long as he was responding, the doctor kept going, and that lasted almost 14 months. He didn't need any blood boosters until the 13th cycle. Some people's bodies can handle this and some can't. Every person is a unique chemical factory. Although he never was NED, this bought him a lot of extra time.

Glad to hear you are doing so well!

Regards,

Welthy

[Beachmama]

My moms doc had her on cystplatin & Another one starts with an E. for the first 2 rounds, and it was harsh!!! Then changed to carbo/E for the former two rounds. She had 7 weeks of radiation already and is showing no cancer anywhere at this time. It was sc on the lung limited. The doc originally wanted to do 8 rounds of chemo, but we'll see. We may only do 6. And she will have the preventive brain radiation as a precaution. All the studies say it's really helping and I like the sound of that. And you also know about the the alternative treatments we have her on (I think we discussed it before). Anyway, she is doing really good, like you!! I am very happy to see how well you are doing. Keep up the good work!!

Connie