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SCLC Platinum Sensitive Treatments


MyWifeSCLC

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I was curious to know if anyone knew why platinum sensitive treatments (cisplatin + etoposide) are defined as greater than 3 months before progression of cancer versus NCCN guidelines use for 2nd line treatment is greater than 6 months.

My wife is well past 3 months since her last chemo treatment (5 months). We meet with her Onc on Tuesday to go over results of last week's brain MRI and chest CT. Obviously, we are hoping for zero progression. If the cancer has begin progressing then we have to discuss the next treatment plan (2nd line).

According to NCCN relapse less than 6 months for SCLC your treatments are Topotecan (yuk) and Lurbinectedin with a an "other" recommendation of Nivolumab. There are more recommendations in the "other" category but Nivolumab is the more typical.

For relapse greater than 6 months, the preferred treatment is the original platinum based treatment of cisplatin + etoposide with a recommended "other" treatment of Lurbinectedin.

I guess I haven't thought about re-treatment with cisplatin + etoposide as an option. My thought process has always been NO TOPOTECAN and those that have read my previous threads can see this theme. My wife's Onc is no longer talking about Topotecan (yea) and has mentioned monotherapy Nivolumab (Opdivo). He was not a fan of treating with both Nivolumab + Ipilimumab (Yervoy).

Since the timing of the CT seems to be off by a month do I even suggest original treatment? It will be a moot point if there is no progression.

The other "fly in the ointment" is my wife's health. I would consider her health as performance status 3 (PS3) which is capable of only limited self-care; confined to bed or chair more than 50 percent of waking hours. Unfortunately she is barely able to use a walker. I think her sedentary nature has weakened her legs and she does not seem to want to get leg strength back. For relapse less than 6 months and PS 3 or 4 NCCN does not recommend further treatment and suggests palliative treatment.  This sucks. If my wife's bloodwork is good and she has no organ problems why not treat? I guess there is a relationship between fatigue/weakness and the ability to withstand further treatment.

It may be a small thing but NCCN does not appear to include performance status for treatment after 6 months. Too many things to think about for the upcoming meeting with her Onc.

Thoughts are welcome!

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Some additional thoughts - my gut feel for ranking how rough various treatments are on the body are as follows: Topotecan (harsh), cisplatin + etoposide, nivolumab and then Lurbinectedin (easiest). I'm sure "it depends" in all cases above. Lurbinectedin by far seems to be easiest on the body but this is based on a single trial. Lurbinectedin is so new that perhaps we don't yet know "real world" issues with it.  The clinical trial data is all that is available right now. All the other treatments have tons of data from other than the trials such as hospitals, etc accumulated over years.

I'm leaning toward pushing for Lurbinectedin and NOT palliative care if my wife's Inc suggest that. Right now my wife is in agreement but I can see some wavering when we discuss the possibility of beginning treatments again. I realize that her view trumps mine all day long.

I realize that I've gotten ahead of myself as we do not even know what the scans say yet. With this particular Onc (see previous threads) I have to have my ducks in a row before we meet. Regardless of what is talked about, I will get a second opinion from Dr. Lovly at Vanderbilt.

Steve

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Steve,

I agree about consulting with Dr. Lovly. 

I've not done much research on performance status but would encourage (coach) your wife to become as mobile as possible. I do know how difficult that was. I've had to recover from several drastic thoracic surgeries and tended to want to stay glued to the chair as I recovered. My wife admirably performed her role as drill sergeant and her diligence was fruitful.

Stay the course.

Tom

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