Chemotherapy Treatments

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.

Mainly blood tests that look at the bone marrow function and kidney function and liver function.

Chemotherapy for lung cancer has currently undergone several changes. The standard chemotherapy for patients with stage IV non-small cell lung cancer (NSCLC) is called a platinum doublet. That is either Carboplatin or Cisplatin in combination with another drug (generally the chemotherapy drugs taxol, gemcitabine, or pemetrexed).

However, recently, it appears that certain chemotherapy works better based on the subtype or histology of non small cell lung cancer that you have. This is called histology based treatment. Basically the data published suggested that if you select the chemotherpay based on histology, that patients do better. The two types of histologies of non-small cell lung cancer are adenocarcinoma and sqaumous cell. Based on recent data, it is my practice to give adenocarcinoma (the most common type) the following chemotherapy -- Cisplatin or Carboplatin in combination with a drug called Pemetrexed (Alimta). In addition, if adenocarcinoma, I generally add another drug called Avastin (for a total of three drugs). If patients have sqaumous cell, I generally offer Cisplatin or Carboplatin in combination with Gemcitabine. In summary, adenocarcinoma generally gets three drugs -- 1. Platinum (cisplatin or carboplatin), 2. Alimta and 3. Avastin (if elgible) and patients with sqaumous gets another (Cisplatin or Carboplatin) + Gemcitabine. Other acceptable standards include Platinum (Carboplatin or Cisplatin) + Taxol

Recently, there has been renewed interest to look at other markers (ERCC1, RRM, TS) in lung cancer to help select chemotherapy but thus far, this has not been proven to be better than the standard (these studies are ongoing). In mutational testing has become routine for patients who have adenocarcinoma. The two mutations that are tested for are the EGFR mutation and the ELM-4 mutation. Patient who have this mutation are generally offered oral drugs and not chemotherpay as discussed above

I think asking what were the most difficult side effects is like asking someone to describe the level of pain they are feeling. Two people can be experiencing the same exact thing yet their perception of it is very different. For me I think I had built up this idea that going through chemo would be the most horrid thing anyone could EVER experience and that was the bar I had set for myself. I was lucky and experienced minimal nausea thanks to anti-nausea medications. I also expereincved some slight neuropathy in my right foot which did cause some long term residual effects. I also had no appetite for 2-3 days after each chemo cycle. I had the tinny taste in my mouth when I ate. I was very tired all the time and just when I felt some energy returning it was time for the next treatment. I think the most difficult side effect was the bone pain. The overall body pain & exhaustion which, the closest thing I can compare it too is how your body aches when you have the flu then multiply it by 10. Emotionally painful was loosing my hair at first but ironically once it was gone I didn't feel as bad as I thought I would. Maybe it was because I was feeling so crummy overall, otherwise I just didnt care. I don't quite know for sure. For me though they were far from easy but I personally felt the side effects were manageable and I knew I had to deal with them because at least for me I had no choice but to have the chemo.

The following are resources that provide free wigs as well as other items you may find of benefit:

Breast Cancer Network of Strength , formally known as Y-ME helps breast cancer patients and survivors regain their sense of well-being and self-confidence by providing bras, wigs, and/or prostheses at no cost to those with limited financial resources. www.y-me.org or 1-800-221-2141

CancerCare under their Women's Cancer Program, offers financial assistance and counseling, support groups, and patient education. They also provide free wigs and breast prostheses to women who have lost their hair or a breast as a result of their cancer treatment. 1-800-813-HOPE (4673)

Crickett's Answer for Cancer 1-301-935-4411 provides free wigs, mastectomy products, mastectomy and lymphedema massage, facials, and other pampering services, as a way to keep a woman feeling feminine and beautiful despite losing her hair and/or breasts.

I posted an answer before, but I don't see it...silly iphone! So please bear with me if the other post shows up and I repeat myself...

It is critical to ask others for help. Give them specific food tasks to do for you - running to the store, chopping veggies, bringing over a pot of soup. You've got to delegate. I found during my own treatment that people really do want to help - they just don't know how, and they're honestly relieved when you give them a specific role.

The other key item for me was to have a protein smoothie every single morning for breakfast - whether I felt like eating or not! I looked at it as medicine - part of my treatment. Cancer treatment does so much to our red and white blood cells, so it is critical to keep up strength as much as we are able.

There are many varieties and flavors of protein powder available from healthy grocery stores. For those who avoid soy, try rice protein powder. Here's a smoothie I made every morning:

2 tbsp. protein powder, 2 tbsp. flax seeds or chia seeds, a handful of spinach if you can tolerate veggies, milk of your choice, and an apple. Blend it all in a blender. And remember - delegate someone to pick up these things for you. Then all you have to do is chop the apple and throw it all in the blender. NOTE: Coconut milk can be very soothing to the stomach.

If you happen to have access to a juicer, try to juice veggies every day. This gets a little more complicated because you have to wash the veggies and then wash out the juicer. But if you live with someone else, perhaps you could delegate juicing to them.

Talking to Young Kids
About Your Cancer Diagnosis

I know. This isn’t a conversation anyone wants to have. But part of being a grown-up means that we have to do the hard things, especially when it comes to our children’s well-being. And because a cancer diagnosis effects everyone in the family, it’s important to reach out and communicate to your children. Hoping that they won’t notice really isn’t an option. Here are a few things to keep in mind.

• Cancer is not contagious. In an age when we constantly tell our children to wash their hands so as to not catch germs, we need to make sure they understand that cancer cannot be “given” to someone else. Thankfully. They can give kisses and hold hands and hug just like always. In fact, there’s no better time to be loving.

• Cancer didn’t happen because of something the child did.
Feeling guilty is a very real emotion that children can carry around after a diagnosis. Sometimes for years and years. Yelling at a sibling or not eating the peas on the plate cannot give someone cancer. Tell them straight out that nothing that they did, or said, caused you to get cancer. And then tell them again. And again.

• Cancer is mysterious, even to adults. For young children, the technical details of cell mutation and environmental toxins with fall into the realm of garble-de-gook. If they want to know why someone gets cancer, tell them that it’s hard to know exactly why it happens.

• Cancer is an illness, not a state of being. Even though cancer medicine makes you feel sick, nothing can change how you feel about your children. Let them know they are still loved as much as always.

• Children know what’s going on, even if you don’t tell them.
Oh, they have ears with dog-like hearing, and can pick up on conversations that you’re sure they can’t hear. And they have friends, who will tell them things and ask crazy questions. Even if they’re little. Children who hear the truth from their parents upfront will have less anxiety, and that is one less thing you have to worry about.

• Slow and steady wins the race. You don’t need to tell your kids everything all at once, especially if they are little. The sit-down serious discussion can ratchet up your emotions, which might not be helpful. Give them information in small doses. The more normalized you can make it seem, the more they will accept it and move on. Really.

• Cancer treatment is time consuming. Children who are used to unfettered mommy 24x7 access will have to deal with changes in daily life. That is hard for everyone. But it can show your children that asking for and receiving help is one of the best lessons to learn in life. Reassure them that this treatment phase shall pass.


Sue Glader is a writer, mother and breast cancer survivor living in Mill Valley, California. She is the author of Nowhere Hair, a children’s book that gently and also playfully explains life during chemo and addresses the biggest concerns of young children. www.NowhereHair.com.