New Biological Insights and Recent Therapeutic Advances in the Management of Lung Cancer: A Clinical Investigator Think Tank
Factors affecting the decision to administer 4 versus 6 cycles of a platinum-based doublet for metastatic NSCLC
2:10 minutes.
TRANSCRIPTION:
DR LOVE: We found that there are a fair number of oncologists who, in the situation of metastatic disease, metastatic adenocarcinoma, will give 6 cycles of a platinum doublet, pretty much straightforward, before they go to maintenance. Now, in other situations like this patient, where you’re kind of looking to see if you can squeeze out a little bit more response, but typically, do you have a defined number of cycles, Anne, that you go to? DR TSAO: Yes. So, if had been able to give her full dose, I would have probably just done 4 and then gone right to maintenance, is my usual standard. But with her, I had to dose reduce. So that’s why extended her a little bit longer. DR LOVE: So again, like, is it the wrong answer, so to speak, or pathway-wise, Jeff, to preemptively just decide you’re going to give 6 cycles? DR OXNARD: I tell all my patients it’s going to be between 4 and 6 and we’re going to decide as we go. At what point are you having cumulative toxicity? I don’t think the fifth and sixth dose of platinum are as important as the maintenance pemetrexed. And so I don’t want to jeopardize a maintenance program by hitting them hard with the extra platinum. If patients are having more response and not cumulative toxicity, I’ll make it to 6. If they aren’t having much response and the toxicity is cumulating, I might stop at 4. DR LOVE: Globally, how often do you end up using 6 as opposed to 4? DR OXNARD: I commonly make it to 6. DR LANGER: Almost always make it to 6. Pretty much the same conversation as Jeff. DR LOVE: So you’re going to go at least 4 and then decide about whether to go to 6 on how the patient’s doing? DR LANGER: If we’re using a pem/carbo combination, it’s usually very well tolerated. It’s probably one of the best tolerated chemo combinations we’ve ever used. DR SPIGEL: Yes. I stopped a few years ago, going beyond 4. So I always stop at 4. DR LOVE: Mark? DR KRIS: I perform that exercise at every visit. If the drugs are working, I continue them, period. DR CARBONE: If there’s a clear continuing response between 2 and 4, I usually will go to 6. But I would say that happens in 10% of my patients. Ninety percent of the time, I stop at 4. |