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Stupid question(s) time..


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Hi. I didn't see your question until today, so in case you haven't received a response yet, I'll make a stab at it.

Yes, first line, second line, etc. refer to the first treatment regimen, second, etc. that a particular patient is given. Two different patients may have two different drug combinations given as first line for the same diagnosis. Some treatments do have specific FDA approval for use as first line or second line, but this does not prevent an oncologist from using an approved drug in a different manner — so-called "off label" use as described here:


Since you've been reading on the GRACE site, you've probably seen Dr. West's comparisons of various treatment combinations, many of which have been shown to provide essentially identical results. In some cases, about the only difference is the type and perhaps severity of side effects. Oncologists tend to use the drugs with which they have the most experience unless there is something else that has been proven to be more effective.

Definitely not a stupid question. Aloha,


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...besides, don't take it personal that there were 44 readers and no responders. Sometimes, people are reading to see if your questions are the same as theirs, and others of us that have been here a while may need to think about an answer. OR, we wait hoping someone with a better handle on the question answers.

I still don't have an answer for your question, I don't know HOW an oncologist decides on what protocol for which patient. Not one single clue... My oncologist is my first opinion, he sent me to MD Anderson for a second opinion. I didn't like the second opinion and I'm sticking with him. He decided on what course of action with some attention to my age and health and my (non) smoking history. I'm not sure what makes other doctors decide on the protocols they use with their patients.

Good luck to you, and keep posting. There are thousands of registered users on this website and not everyone is home all day and online. Give your questions some time and you'll get answers.

Take care,


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I was one of the people who did read your posting originally; however, as I have never has chemo (I don't even have an oncologist) I just don't have the information you are seeking. I typically only respond to someone if it is something that I can answer with some level of knowledge. I hope this explains why there are sometimes many views to a posting, but few replies.

Take care,


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