Selecting a second-line therapy depends on the reason for treatment, which can vary from bleeding to implications for health-related quality of life (HRQoL) to likelihood of remission and patient preference with regard to adverse effects, route of administration, and cost.
Full Answer
What is the second line of treatment for cancer?
Overview of Second-Line Treatment for Cancer. Second-line treatment is treatment for a disease or condition after the initial treatment ( first-line treatment) has failed. Second-line treatment may be used for a few different reasons: The first-line treatment doesn't work The first-line treatment worked but has since stopped working.
What is the difference between first line and second line therapy?
For example, one clinical trial may require the treatment to be used as a first line therapy, whereas another may only be entered if a person has "failed" first line or second line treatment. For those who are considering second line treatments, the option of clinical trials should be considered.
What is the second-line therapy for hepatocellular carcinoma (HCC)?
Pembrolizumab as second-line therapy in patients with advanced hepatocellular carcinoma in KEYNOTE-240: a randomized, double-blind, phase III trial. J Clin Oncol. 2020;38(3):193–202. [PubMed] [Google Scholar]
How do second-line TKIs compare in clinical trials of sorafenib?
When comparing second-line TKIs, it should be noted that the patient populations studied in clinical trials differed. Patients could only be included in the regorafenib study if they had tolerated at least a 400-mg dose of sorafenib for at least 20 of the previous 28 days.
How I treat immune thrombocytopenia The choice between splenectomy or a medical therapy as a second line treatment?
The paradigm for managing primary immune thrombocytopenia (ITP) in adults has changed with the advent of rituximab and thrombopoietin receptor agonists (TPO-RAs) as options for second-line therapy. Splenectomy continues to provide the highest cure rate (60%-70% at 5+ years).
How I treat newly diagnosed multiple myeloma?
Standard first-line therapy in the US for newly diagnosed multiple myeloma in both transplant-eligible and non–transplant-eligible patients is RVd—the combination of lenalidomide (immunomodulatory drug), bortezomib (proteasome inhibitor), and steroids (dexamethasone).
How I treat multiple myeloma blood?
Ideally, regimens should include both, such as bortezomib, thalidomide, and dexamethasone (VTD) or cyclophosphamide, thalidomide, bortezomib, and dexamethasone, or CyBorD for 4-6 cycles, followed by ASCT, especially if maintenance strategies are not yet approved.
How do you treat ITP ash?
In adults with newly diagnosed ITP, the ASH guideline panel recommends against a prolonged course (>6 weeks) of prednisone in favor of a short course (≤6 weeks) and suggests either prednisone (0.5 - 2.0 mg/kg/day) or dexamethasone (40 mg/day for 4 days) as the type of corticosteroid for initial therapy1 .
What is the gold standard treatment for multiple myeloma?
In the United States, the gold standard of care today is then the combination of an immune modulator drug, such as lenalidomide, with a proteasome inhibitor, such as bortezomib, and corticosteroids. Patients who receive these drugs have almost 100% response rate, so their symptoms improve quickly.
What is crab in multiple myeloma?
The acronym CRAB summarizes the most typical clinical manifestations of multiple myeloma, these being hypercalcemia, renal failure, anemia, and bone disease.
What is the most common treatment for multiple myeloma?
Steroids. Corticosteroids help destroy myeloma cells and make chemotherapy more effective. The most common types used to treat myeloma are dexamethasone and prednisolone. Steroids are taken by mouth after eating.
What is the most effective treatment for myeloma?
Chemotherapy. Chemotherapy uses drugs to kill cancer cells. The drugs kill fast-growing cells, including myeloma cells. High doses of chemotherapy drugs are used before a bone marrow transplant.
How do you know when multiple myeloma is in remission?
When you're in remission, you won't have any symptoms of multiple myeloma, but a few abnormal plasma cells still remain in your body. Treatments can't kill every single cancer cell. There just may be too few abnormal cells for tests to spot.
How is secondary ITP treated?
Therapy with prednisone can be supplemented with IVIG (1.0 g/kg/d for 1-2 days), IV anti-D (50-75 μg/kg), or IV methylprednisolone (1 g) if platelet counts remain below 20 000 × 109/L or if there is another need for a more rapid response.
What is the first-line treatment for ITP?
The standard initial treatment for ITP is oral corticosteroids to increase platelet counts. Intravenous immunoglobulin or anti-D immunoglobulin can also increase platelet counts and are particularly useful for stimulating rapid platelet increases before planned procedures.
When is ITP transfuse platelets?
The 2010 international consensus guidelines on the diagnosis and management of ITP (Blood, 2010) recommends that platelet transfusions be reserved for use when an urgent restoration in platelet count is needed, such as for patients who are bleeding and those preparing for surgery.
What is second line treatment?
Second-line treatment is treatment for a disease or condition after the initial treatment ( first-line treatment) has failed, stopped working, or has side effects that aren't tolerated. It's important to understand "lines of treatment" and how they differ from first line treatment and can play a role in clinical trials.
Why do we use second line therapy?
Second-line or further lines of therapy (third-line, fourth-line, seventh-line, etc.) may be used for a few different reasons: The first-line treatment worked but has since stopped working. The first-line treatment has side effects that are not tolerated.
What is the importance of defining lines of treatment?
An example of the importance of defining lines of treatment is a 2019 study that compared different second-line treatments for lung cancer. Since there are a number of different options, and many studies look at the effectiveness of first line therapies, this can give important information to oncologists.
Why is understanding the line of treatment important?
Understanding line of treatment becomes very important when looking at clinical trials for cancer. Some clinical trials require that people have no previous treatments, whereas others are designed for people who have had inadequate results with a previous treatment.
Is first line treatment more effective than present treatment?
The first-line treatment has side effects that are not tolerated. A new treatment becomes available that appears to be more effective than the present treatment. With survival rates improving for many cancers, and the number of available treatments increase, some people receive many lines of therapy.
Is second line therapy better than first line?
In some cases a person will have a better response to a second line therapy than they did to first line treatment. Second-line treatments are available for most cancers, but the likelihood of effective options can vary with the type and stage of your cancer.
Is breast cancer a first line treatment?
First line treatment can include more than one treatment method. For example, if a woman has surgery followed by chemotherapy and radiation for breast cancer, the combination of therapies is still considered first line therapy.
What should a clinician do before initiating a second line therapy?
For those patients who respond poorly to an initial antidepressant, clinicians should confirm a diagnosis of MDD, assess for possible comorbidities, ensure that patients are adherent to the current medication regimen, and optimize the dosage. If patients continue to receive an insufficient benefit from the initial antidepressant, then a second-line strategy is warranted.
Can antidepressants increase blood pressure?
Depression in patients with cardiac problems should be treated aggressively, but to avoid exacerbating the cardiac illness, antidepressants that might increase blood pressure or negatively affect the heart rate should be avoided. Thus, MAOIs, TCAs, and possibly atypical antipsychotics, which have a black box warning for increased mortality in elderly patients, as well as T 3 augmentation should generally not be used in this population. SSRIs, particularly sertraline, which has been more intensively studied in this area, may be beneficial for depressed patients with cardiac complications. 17 SNRIs might be helpful, but some agents may raise blood pressure at certain doses, particularly higher doses of venlafaxine.
Introduction
More than 34 million adults, or 13% of the U.S. adult population, have diabetes ( 1 ), and 80% of those with diagnosed diabetes are taking glucose-lowering medications ( 2 ).
Research Design and Methods
We retrospectively analyzed deidentified administrative claims data from OptumLabs Data Warehouse (OLDW), which includes medical and pharmacy claims and enrollment records for commercial and Medicare Advantage enrollees ( 20, 21 ).
Results
We identified 75,395 adults with type 2 diabetes who had initiated a GLP-1RA, 58,234 who initiated a SGLT2i, and 91,884 who initiated a DPP-4i between 2016 and 2019 ( Supplementary Fig. 1 ).
Conclusions
High-quality, patient-centered diabetes care is predicated on treating each patient with the drugs that are most likely to benefit and least likely to harm them. Yet, in our study population, patients more likely to benefit from GLP-1RA and/or SGLT2i drug classes were less likely to start them.
Article Information
Funding. This effort was funded by the National Institutes of Health (NIH) National Institute of Diabetes and Digestive and Kidney Diseases grant K23DK114497 (R.G.M) and Agency for Healthcare Research and Quality’s (AHRQ) Comparative Health System Performance Initiative grants 1U19HS024075 (N.D.S.) and R01HS025164 (P.K.-M., N.D.S.).