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.

_________________
09/14/2007 - 48 years old, female, former smoker, sclc ext., mets to liver, svc syndrome

10/20/2007, five days of radiation, two rounds of chemo (carbp/v16), scans, 85% of cancer gone, liver mets gone.

11/24/2007 fourth chemo completed.

12/10/2007 full scans scheduled, will get radiation decision then. Also supposed to have chemo #5 this same week...

12/11/2007 chemo #5 completed; radiation decision will happen after chemo #6. Scans show continued improvement but still not in complete remission - still residual treated stuff (???).

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

_________________
3/2004 Stage 3a-adeno @ 39yrs
3/2004 Left Lung removed, 21 nodes +, paralyzed left vocal cord
3/2006 - New Mets - Spine T12 & Right ischium bone
1/2008 - New Met Spine t10, Possible thyroid

CHEMO
May-Jun 2004 Cisplatin/VP16, 6 days straight every 3 wks, 3 cycles
Jul-Aug 2004 Taxotere 1X every 3 wks, 3 cycles
Sep-April 05 Iressa trial daily
Jan 06-Jan 07 Avastin ev 3 weeks, tarceva daily, zometa ev 6 weeks
Feb 07-Jan 08 Tarceva daily
Jan 08-Present Avastin ev 3 wks + Tarceva Daily

Radiation May-Jun 04 chest 28 days
Feb 06 Spot radiation X 10 days to spine t12 and pelvis (ischium bone)

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...

_________________
09/14/2007 - 48 years old, female, former smoker, sclc ext., mets to liver, svc syndrome

10/20/2007, five days of radiation, two rounds of chemo (carbp/v16), scans, 85% of cancer gone, liver mets gone.

11/24/2007 fourth chemo completed.

12/10/2007 full scans scheduled, will get radiation decision then. Also supposed to have chemo #5 this same week...

12/11/2007 chemo #5 completed; radiation decision will happen after chemo #6. Scans show continued improvement but still not in complete remission - still residual treated stuff (???).

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

_________________
Ned is just my nickname, though it would be nice to merge it with the other meaning eventually...

Aloha means "Hello, goodbye, love, compassion, welcome, good wishes." It means belonging to others with a common humanity. It's defined better as a feeling in the heart than by words.

Dx NSCLC adenocarcinoma IIIb Sep 2006, now stage IV. Taxol+Carboplatin+Avastin 4 mo., Avastin 8 mo., Tarceva 16 mo., Alimta 12 mo. (sometimes combined with Cisplatin or Carboplatin), Navelbine since Feb 2010, 10 sessions of WBR in March 2011. See My Cancer Journey: viewtopic.php?p=351369#p351369 — UPDATED 03/05/2011.

Above left: Our golden retriever Rosie, who joined the family on 3/5/08 at the playful age of 2.

Below: Hannah, our golden companion 1994-2007.

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.

_________________
09/14/2007 - 48 years old, female, former smoker, sclc ext., mets to liver, svc syndrome

10/20/2007, five days of radiation, two rounds of chemo (carbp/v16), scans, 85% of cancer gone, liver mets gone.

11/24/2007 fourth chemo completed.

12/10/2007 full scans scheduled, will get radiation decision then. Also supposed to have chemo #5 this same week...

12/11/2007 chemo #5 completed; radiation decision will happen after chemo #6. Scans show continued improvement but still not in complete remission - still residual treated stuff (???).

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

_________________
Mother Stage I clinically, Stage IIIa pathologically. Large cell neuroendocrine carcinoma. Deceased March 2003
Please seek 2nd opinions and verify everything

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

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.

_________________
09/14/2007 - 48 years old, female, former smoker, sclc ext., mets to liver, svc syndrome

10/20/2007, five days of radiation, two rounds of chemo (carbp/v16), scans, 85% of cancer gone, liver mets gone.

11/24/2007 fourth chemo completed.

12/10/2007 full scans scheduled, will get radiation decision then. Also supposed to have chemo #5 this same week...

12/11/2007 chemo #5 completed; radiation decision will happen after chemo #6. Scans show continued improvement but still not in complete remission - still residual treated stuff (???).

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

_________________
My Mom
5/1/46-6/20/08

When you are sorrowful look again in your heart, and you shall see that in truth you are weeping for that which has been your delight

Jake

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.

_________________
Mother Stage I clinically, Stage IIIa pathologically. Large cell neuroendocrine carcinoma. Deceased March 2003
Please seek 2nd opinions and verify everything

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

_________________
Carepages.com for Tony's journey, Named: TeflonTony
Beloved Husband - 67 (at diagnosis - made it to 70 1/2) - non-smoker/23 years, night sweats, coughing up blood & very SOB. Oxygen 24/7. Lung capacity 50%, blood/ox levels 88%. TB Test, Broncoscopy, CT, PET Scan
- 3-28-05 Wedge section biopsy Dx'd NSCLC Adenocarcinoma Stage IV. Primary tumor 3 x 5 cm, extensive mets both lungs. Mediastinum, hilar, lymph node & supraclavicular involvement. Histologic grade: Poorly differentiated Emphysema also.
-4-05 PLAN A -Chemo TAXOL/CARBOPLATIN - 8 CYCLES(full strength dose)- 21 day cycle APRIL-AUGUST 2005
- PET & CAT in May & Aug. 2005 show marked reduction.
- Cycle 8 - Second severe carboplatin reaction - no more platinum based drugs
- PLAN B - New chemo - TAXOTERE/GEMZAR - 12 CYCLES (full strength dose)- 21 day cycle. SEPT 2005-MAY 2006 (22 actual chemo sessions in 12 cycles) Both drugs day 1 & Gemzar only day 7. Fatigue, high fevers, fingernail changes, & mouthsores. Procrit & Neulasta started during Cycle 3 (as needed).
-11-7-05 CAT & PET - more improvement. Large mass now 3.6 x 2.7 cm with less uptake. One small tumor in each lung.
-2-2-06 - PET & CAT scans show large mass down to 2.6 x 3.2 cm with lower SUV. R Lung clear. Areas of scarring in both lungs. Tumor in mid-left lung has grown.
-3-7-06 - 15 RADIATION TREATMENTS to nuke the tumor in mid-left lung while continuing chemo. (Chemo 9b skipped)
-5-16-06 - Cycle 12a finished. Trouble breathing, skipped 12b. Allergic reaction to long term use of taxotere. Severe fluid retention everywhere. Oxygen 24/7 continues.
-5-22-06 - CAT & PET Scans. Radiated tumor gone, primary mass unchanged. More scarring, thickening, etc.
***CHEMO HOLIDAY for 3 mos
-6-6-06 - 1-3-07 - PLEURAL EFFUSION ISSUES - 14 Thoracentesis done ranging from 500-1300 cc's on both sides. No cancer cells ever found in any of the taps.
-8-28-06 - PET & CAT scans."Significant progression." Primary tumor larger and seven new tumors found in both lungs. Higher SUV uptake levels then initially.
-9-1-06 - PLAN C - TARCEVA 150 mg daily begins.
-11-16-06 PET/CAT scans. Tarceva didn't do squat. Disease progression. Some lung tumors same size, growth in old tumors, many new tumors in both lungs (about 17). All are over 1+ to 3+ cm. SUV higher on all (high being 12.1). New uptake in R-iliac and L-Scapula. Increased adenopathy in L-hilum with corresponding uptake. First time cancer has left his lungs. Crap.
-11-29-06 - Port installed.
-11-30-06 - 4-2-07- PLAN D - 19 WEEKLY NAVELBINE INFUSIONS Neupogen/Procrit (as needed) Zometa for bones every 4th treatment. Night sweats & some fatigue.
-2-2-07-PET/CAT scans. Overall improvement with decreased number & SUV activity in most of the lung tumors. All but one are smaller. Bone mets are better. Empty head too. Effusion issues cleared up! Praise God for prayers answered.
-3-28-07 - TWO YEAR ANNIVERSARY SINCE DX and now 70 years old!
-4-5-07 PET/CAT scans - Mixed results w/progression. R-lung tumors are still shrinking, bone mets are gone, two large areas in L-lung are stable. Progression in a tumor in the L-lung has increased in size & intensity and a larger area of new growth (3.9 x 2.4 cm) w/SUV 11.9 in subcarinal region. Need new chemo plan.
-4-18-07 - 7-9-07 PLAN E - 5 cycles ALIMTA - 21 day cycle (Zometa still every 4 weeks)
Alimta has proved to be more challenging then we hoped. Crud. Fatigue, increased SOB & cough (some blood). Counts are good. Fevers/sweating episodes. Still on Oxygen 24/7.
-6-15-07 - CAT/PET scan results -- mixed bag, but overall stable. Some tumors have grown, none have shrunk, some are somewhat higher uptake values, several are somewhat lower. Bone mets still gone & no liver involvement. Dealing with 7-8 lung & mediastinum tumors, 3+ cms on most. Doc says continue with Alimta as the cancer is not running totally amok.
7-18-07 - Week from hell. Crisis SOB, cough, on antibiotics, fevers/sweats, very bad. Pleural effusion tapped. Partial collapse of upper R-lung.
7-19-07 - X-ray -R-lung almost reinflated, bottom of L-lung is collapsing from pleural effusion. Wait to tap L-side until R-lung fully inflated. Coughing & SOB still bad. Hospital/Doctor visits are now in a wheelchair.
-7-24-07 - Onc. visit. Obvious symptomatic progression.
-7-30-07 - 8-27-07 PLAN F - 2 CYCLES salvage GEMZAR -21 day cycle days 1 & 8
-8-2-07 - CT scan shows L-pleural space loculation & tumor progression. One tumor is now encasing pulmonary artery. SOB worse.
-8-6-07 - Doc appt. Still very SOB, but tolerates Gemzar well. Onc does not want to do radiation. More harm than good. Pray it works.
-8-9-07 - Breathing issues escalate. Reluctantly went to hospital as both docs are out of town. Infection in L-lung. Re-confirmed tumor progression. Main bronchial tubes still open. Home on 8-12. That was a waste of time.
-8-15-07-Onc. visit. Continue Gemzar. Scans after next cycle. Weight & r-side fluid somewhat stable.
-9-4-07 - Wait on scans for another cycle. Hgb up to 11.1 Yay!
-9-10-07 - No chemo. Gemzar stopped, not working. Weight is plummeting.
-9-11-07 - Echo Doppler test on heart. Results normal. Pulmonary artery difficult to detect on this type of test.
7-18-07 - 10-2-07 - PLEURAL EFFUSION ISSUES AGAIN - 9 Thoracentesis done ranging from 600-1600 cc's on both sides. Loculation in upper half of L-pleural cavity. Lasix to try to reduce fluid & help breathing. Toward the end, fluid was bloody on L-side and contained poorly differentiated adenocarcinoma malignant cells.
-9-12-07 - Dr. appt. Discussed options, had "the talk." Tony chooses to continue treatment. On we go.
-9-17-07 PLAN G - IRINOTECAN (aka CAMPTOSAR, CPT-11) AS OF 10-9-07 - 2 CYCLES COMPLETE. - 21 day cycle.
-10-3-07 - (And now for something completely different...) Hgb down to 8.3. Need transfusion. Heart rate went nuts, 180 & into atrial fibrillation 1 1/4 units into transfusion. ER 5 hours - controlling with meds - home.
-10-9-07 - Chemo
-10-10-07 - 10-12-07 - Gasping for breath, falling down, refuses to go to hospital. Finally called ambulance against his wishes to get him morphine to calm breathing, meds to straighten out A-fib, antibiotics for lung infection & 15 liters of oxygen vs. the 4 at home. Walked down the stairs 2 hours before ambulance was called. Fought til the end...
-10-12-07 - 6:14 pm CDT - My beloved Tony is with God in Heaven.
FINAL TOTE BOARD:
CHEMOTHERAPY 60 infusions in 48 CYCLES, 23 THORACENTESIS, & 15 RADIATION SESSIONS.
Never cancer free since diagnosis, never missed a treatment -- Tony was a cancer Warrior.
"How do I live without you, I want to know --How do I breathe without you...." - LeAnn Rimes
"And I'll try, oh Lord, I'll try, to carry on..."- Styx

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