First-line treatment is the one that, for most people, is expected to provide the best results with the fewest number of side effects. In contrast, second-line treatments are used when the first-line treatment failed to improve a cancer, or if it worked for a while and then the cancer progressed, and tend to be less effective.
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 “second-line treatment”?
A break with the primary treatment and an adoption of a new regimen signals “second-line treatment.” The first-line therapy may not have worked, may have had some limited efficacy, or may have produced unacceptable side effects, damaged organs in the body, or jeopardized the patient’s life.
What is the difference between first-line and second-line therapy for breast cancer?
For example, with metastatic breast cancer, second-line therapy tends not to control the cancer for as long a period of time as first-line therapy. In some cases, there are two treatments (or more) that may offer very similar results (and have similar side effects), and second-line treatment may be equally effective to first-line therapy.
What is a second cancer?
When a person who has already had cancer develops a new cancer, it is called a second cancer or second primary cancer. It is a completely new and different type of cancer than the first one. A second cancer is not the same as a cancer recurrence.
What is second line therapy?
Second-line therapies are those tried when the first ones do not work adequately. The management of a cancer case requires regular evaluation of treatment and adjustment as needed. A break with the primary treatment and an adoption of a new regimen signals “second-line treatment.”.
What is the intent of first line therapy?
The intent of first-line therapy is to cure the cancer if possible. Also called induction therapy, this primary therapy is the first assault of chemotherapy drugs on the malignancy.
What is the first line of treatment?
First line therapy is the treatment regimen or regimens that are generally accepted by the medical establishment for initial treatment of a given type and stage of cancer. It is also called primary treatment or therapy. The intent of first-line therapy is to cure the cancer if possible. Also called induction therapy, this primary therapy is the first assault of chemotherapy drugs on the malignancy.
Is salvage therapy considered third line therapy?
The terms “third-line therapy ” and even “fourth-line therapy” are occasionally used for subsequent treatment, but salvage therapy is also used. Written guidelines rarely specify anything beyond second-line therapy. The same treatments can be used for subsequent treatment.
Can a first line therapy be approved for second line therapy?
Sometimes first-line therapies show progress for a period of time followed by a stalling or continued growth of the cancer. Often the FDA will specifically approve a new drug for second-line therapy. This labeling is common for new drugs that treat cancers which already have accepted treatments.
Is there a law on first line therapy?
There is no law, or even a community of practice rule, that doctors must use the accepted first-line therapy for a patient, ...
Is there a law that states that doctors must use first line therapy?
There is no law, or even a community of practice rule, that doctors must use the accepted first-line therapy for a patient, although when they do they “cover their backsides” to some extent and reduce their exposure to malpractice suits. Second-line therapies are those tried when the first ones do not work adequately.
What is second line therapy?
Second-line therapy is a relatively newconcept for gastrointestinal oncologists. Although retreatment with fluorouracil. ABSTRACT: Second-line therapy is a relatively newconcept for gastrointestinal oncologists. Although retreatment with fluorouracil (5-FU) is common, offering colorectal cancer patients a differentchemotherapeutic agent as ...
What is the treatment for metastatic colon cancer?
With the exception of surgicallyresectable liver or lung metastases, the majority of patients with metastaticcolorectal cancer are treated primarily with systemic chemotherapy. It is nowcommon for many of these patients to not only receive one, but two or morechemotherapy regimens during the course of their illness.
How long does it take for irinotecan to respond to treatment?
Response rates were 10% to 11%, with stable disease seen in 24%to 42% of patients. Median time to progression was 4.5 to 6 months and mediansurvival was 8 to 9 months. These results are comparable to the results achievedwith irinotecan as second-line therapy. [4-6]
How many patients have been treated with chronomodulated5-FU?
[19] In total, 196 patients had been treated with chronomodulated5-FU and oxaliplatin. Of these, 60% had received only one previous chemotherapyregimen and 40% had received greater than or equal to two regimens. Medianprogression-free survival was 9 months and overall survival was 17 months.However, hepatic metastases were resected in 18% of patients.
Is irinotecan a second line?
However, investigators initially assessed irinotecan as second-line therapy for metastatic colorectal cancer. In that respect, data fromthose trials remain the best framework in which to evaluate second-lineoxaliplatin. Single-agent irinotecan as second-line therapy has yielded responserates of 10% to 22% and median survivals of 8 to 10 months. [4] In two randomizedtrials, irinotecan also established a survival benefit over both best supportivecare and second-line infusional 5-FU. [5,6] The trials had different eligibilitycriteria and, therefore, patient populations. [7-12]
Is fluorouracil a second line therapy?
ABSTRACT: Second-line therapy is a relatively newconcept for gastrointestinal oncologists. Although retreatment with fluorouracil (5-FU) is common, offering colorectal cancer patients a differentchemotherapeutic agent as second-line therapy is a fairly recent strategy. Thefocus of this article is on the use and efficacy of oxaliplatin (Eloxatin) assecond-line therapy for colorectal cancer. As such, this article will presentvery limited data on the toxicity of oxaliplatin regimens. [ONCOLOGY14 (Suppl 11):21-26, 2000]
Is oxaliplatin a second line?
The data regarding the use of oxaliplatin as second-line (orlater-line) chemotherapy will be highlighted herein. The article willdemonstrate that phase II data in this setting are mature and that the time hascome for randomized trials to establish the true role of oxaliplatin insecond-line chemotherapy.
Is there a second line for HCC?
There are a number of second-line treatment options that arrived after the introduction of sorafenib. Today, the preferred options in the second-line setting to optimize care in our patients with HCC should the disease progress past initial treatment include:
Is Sorafenib a second line drug?
Sorafenib or lenvatinib; could move to second-line treatment, although at this point in time, there isn' t enough data available to support either of those agents beyond their indication in first- line treatment.
Is sorafenib the standard of care for HCC?
These are becoming the standard of care. In 2008, the multikinase inhibitor sorafenib became available for late stages of HCC. Sorafenib improves overall survival and disease-free survival, and is the standard of care for advanced HCC. There are a number of second-line treatment options that arrived after the introduction of sorafenib.
Is cabozantinib safe for HCC?
In March 2019, cabozantinib was approved for use in patients with HCC who were previously treated with sorafen ib. The most common adverse reactions with cabozantinib include palmar-plantar erythrodysesthesia syndrome, hypertension, fatigue and diarrhea.
Is regorafenib a multikinase inhibitor?
Regorafenib; a once-daily, oral multikinase inhibitor. In April 2017, regorafenib was approved for use in patients with HCC who were previously treated with sorafenib. The most common adverse reactions with regorafenib are hand-foot skin reaction, hypertension, asthenia/fatigue and diarrhea.
What happens if you get a second cancer?
If you are diagnosed with a second cancer, it can bring up a lot of memories and strong emotions. But you now know much more about cancer, treatment, hospitals, and health care, and all of this can help you cope with a second cancer. Your previous experience with cancer can help you decide how to approach your treatment and emotional support this time around.
What are risk factors for a second cancer?
A risk factor is anything that increases a person's chance of developing cancer. Some people with several risk factors never develop a second cancer, while others with no known risk factors do. Knowing your risks and talking to your health care team may help you make lifestyle and health care choices.
What happens when cancer comes back?
A recurrence happens when the first cancer comes back. If you are a cancer survivor, you probably watch for recurrence. A recurrence is the same type you had before, even if it develops in a different area of the body. Second cancers are not uncommon.
How to reduce risk of cancer?
Not always. You cannot control some risk factors, such as having a specific cancer treatment in the past. But you can do some things to reduce your general cancer risk, such as: 1 Exercising regularly and eating a healthy diet 2 Not smoking 3 Limiting alcohol use (ask your doctor for specific guidelines)
What do you know about cancer?
What you know about cancer, hospitals, and health care can help you cope with a second cancer. But you might also have strong memories and emotions . Your previous experience with cancer can help you make decisions about a second cancer. For example, you might want treatment in the same hospital or cancer center.
How do you know if you have a second cancer?
Symptoms of a second cancer. Symptoms of a second cancer may include: Feeling tired. Having a sore that does not heal normally. Having a cough or hoarse voice that does not go away. Loss of appetite, difficulty digesting your food, or difficulty swallowing. A lump, discharge, bleeding, or thickening in a certain spot.
How important is finding and treating cancer?
Finding and treating the cancer early are important, just as with a first cancer. Make sure your doctor knows as much about your first cancer, its treatment, and your general health. If an earlier cancer treatment likely caused the second cancer, you might question or blame yourself.
What are the best sources for cancer treatment?
Two good sources are the National Comprehensive Cancer Network (NCCN) Treatment Guidelines ( www.nccn.org) and the National Cancer Institute’s (NCI) PDQ® Cancer Treatment Summaries ( www.cancer.gov ). Both are available in versions for health professionals (which use medical language and terminology) and patients (which use everyday language).
Do insurance companies ask for another opinion before treatment?
Your insurance company asks you to get another opinion before you start treatment.
Do cancer patients need a second opinion?
Although cancer patients seem to be asking for a second opinion more frequently, studies show the benefits of getting one are unclear . If the second opinion differs from the first, you may find the following tips helpful:
Can you tell a doctor you want a second opinion?
Some people find it hard to tell their doctors that they’d like a second opinion. Remember it is common for patients to get a second opinion, and doctors are comfortable with the request. If you are unsure of how to begin, here are a few ways to start the conversation:
Can you get a second opinion on cancer?
Even after you have given your doctor a chance to carefully explain your cancer to you, you still may decide getting a second opinion is right for you.
Is there enough time to wait for a second opinion?
Treatment decisions should be made after you have learned all you can about your diagnosis, prognosis, and available treatment options. This can take time, depending on the type of cancer you have. In a few cancers, there are some treatment decisions that have to be made right away. But usually, you can take some time to think about them, and you should think about them. If you are concerned about waiting to start treatment, you should talk to your doctor.
What is second cancer?
A second cancer is a new cancer that's unrelated to any previous cancer diagnosis. It's a completely different type of cancer.
Why do we know more about second cancers than others?
Because it can take many years for cancers to develop, second cancers have been studied in types of cancers for which successful treatments have been around the longest. That’s why we know more about certain second cancers than others.
What are the risk factors for a second cancer?
Risk factors for a second cancer include some of the same things that are a risk for a first cancer: a healthy lifestyle and environment, using tobacco products, family history and genetics, being overweight or obese, drinking too much alcohol, or the lack of good follow-up care or cancer screening after a first cancer.
Do you need to monitor for cancer?
Sometimes there are specific lifestyle recommendations and monitoring needed if a person has certain non-cancer health problems that might affect them after treatment. There might also be specific cancer screening guidelines based on a person's level of risk or if they have a family cancer syndrome. But, in general, the same cancer screening guidelines should be followed as for people who have not had cancer.
Can you get another cancer after surviving the first?
Often, a cancer survivor's greatest concern is facing cancer again . It's important for all cancer survivors to know it's possible to get another ( new) cancer, even after surviving the first. This is called a second cancer.
Is it possible to get second cancer?
It isn’t always clear what causes a second cancer or who is most at risk. Some second cancers seem to have the same or similar risk factors as a first cancer. But, the risk is known to be higher for people with certain types of cancer, who had certain types of cancer treatment, or if they have a family cancer syndrome. But for other people, the risk for a second cancer may be lower or simply isn't known.
What is the first line of therapy?
You know, the first line of therapy is just the first treatment that you end up getting. Now, traditionally, again, that’s been the best treatment that we’ve had, the ones that have had the most effectiveness in terms of shrinking cancer cells and in terms of improving survival.
How long does it take to get a cancer test back?
We don’t have to wait two weeks to four weeks to get the test results back. And but what that means is that let’s say the cancer, you know, testing comes back with an EGFR (epidermal growth factor receptor) mutation or an ALK rearrangement. Well, then that means that that will be your second line of treatment.
Is patient power a substitute for medical advice?
Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.
Is a second line better than a third line?
So that second line is just the second treatment you get. There are lines in the third treatment that you get. But, of course, there are patients who get second-line and third-line treatments that are better than their first-line treatments sometimes. A great example of this would be targeted therapy where, a patient may not have time ...
What is the first line of treatment for lung cancer?
First-line treatment is usually the standard treatment (the "gold standard") given when someone is diagnosed with a particular disease or condition , such as lung cancer. In other words, it is likely the treatment most oncologists would first choose in treating someone. That said, there are no general "rules" stating which treatment has to absolutely come first, and in addition to that, it's important to work with your oncologist to choose the treatment that is best for you as an individual. Only you can be your own advocate and select the treatments which offer you the best outcome while minimizing the side effects you are willing to tolerate.
What is the difference between first line and second line?
In contrast, second-line treatments are used when the first-line treatment failed to improve a cancer, or if it worked for a while and then the cancer progressed, and tend to be less effective.
What are complementary treatments for cancer?
In this setting, therapies such as acupuncture, meditation, massage, and yoga are used in an integrative fashion—that is, they are used along with traditional treatments such as chemotherapy. These complementary treatments may help some people cope with the side effects of cancer and cancer treatments.
What is alternative treatment?
In this setting, therapies such as acupuncture, meditation, massage, and yoga are used in an integrative fashion—that is, they are used along with traditional treatments such as chemotherapy. These complementary treatments may help some people cope with the side effects of cancer and cancer treatments.
What is first line treatment?
First-line treatment or therapy simply refers to the initial, or first treatment recommended for a disease or illness. This may also be referred to as primary treatment, initial treatment, or induction therapy. With many conditions, including cancer, there are many possible treatments that could be effective.
What to ask when you have advanced cancer?
Is there any further testing that should be done? (If you've been diagnosed with advanced cancer, ask about the molecular profile of your tumor , and if this hasn't been done, ask why not).
Is chemotherapy considered first line treatment?
For example, with some advanced non-small cell lung cancers (without mutations that can be targeted), chemotherapy was once considered the accepted first-line treatment by oncologists, but a 2018 study explains how Keytruda (pembrolizumab) is used with chemotherapy in this setting.
Lines of Treatment
The Option of Clinical Trials
- Understanding line of treatment becomes very important when looking at clinical trialsfor 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. For example, one clinical trial may require the treatment to be used as a first line therapy, whereas another may only be en…
Questions to Ask About Second-Line Treatments
- Since the failure of a first treatment can leave you feeling overwhelmed and anxious, having a list of questions to ask your healthcare provider (as well as a friend to attend the visit with you) can be very helpful. 1. How effective is the second-line treatment, and how does it compare to the treatment you had previously? 2. What are the possible side effects of the treatment? 3. What ha…
Example
- 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. For example, the second line chemotherapy drug Taxotere (docetax…
Coping
- Thinking about and making decisions about second-line treatment can be heartwrenching. It's hard enough the first time around, but at this point many people are exhausted and it's easy to get discouraged. Reach out to people in your support network, and don't be afraid to share your fears. Certainly, not every friend will be comfortable with this, but choose at least a friend or two with …