If the first round of chemotherapy showed no improvement for Stage IV NSCLC (lung cancer), what is next? Can other chemotherapy agents or combinations be tried?
Patients with stage IV NSCLC are first treated with platinum chemotherapy which is a platinum drug (either carboplatin or cisplatin) plus another drug (Gemcitabine, Paclitaxel, Docetaxel or Alimta). At some point, unfortunately, patients will progress and their tumor will grow after the first type of chemotherapy is given. Generally at that point, a second line drug is used and the platinum doublet is abandoned.
There are three approved second line drugs (Tarceva, Alimta, Docetaxel) for NSCLC but their use is dependent on what a patient got in the first line. For instance, if a patient received Carboplatin and Alimta as a first line regimen, then the second line possibilities would be Tarceva or Docetaxel. Sometimes the drug Gemcitabine is also offerred. Unlike first line therapy, second line therapy is generally just one drug, not two. Response rates (the percentage of patients whose tumors shrink) is lower in the second line (only 10 to 15% of patients' tumors will shrink) depending on the patient the drug used. While those numbers are small, there is ample data that patients who go on to receive a second line drug live longer than those that don't receive any second line drug.
There are three approved second line drugs (Tarceva, Alimta, Docetaxel) for NSCLC but their use is dependent on what a patient got in the first line. For instance, if a patient received Carboplatin and Alimta as a first line regimen, then the second line possibilities would be Tarceva or Docetaxel. Sometimes the drug Gemcitabine is also offerred. Unlike first line therapy, second line therapy is generally just one drug, not two. Response rates (the percentage of patients whose tumors shrink) is lower in the second line (only 10 to 15% of patients' tumors will shrink) depending on the patient the drug used. While those numbers are small, there is ample data that patients who go on to receive a second line drug live longer than those that don't receive any second line drug.
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