What are second-line therapies?
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 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.
Do people respond better to second line therapy?
While statistically a person is less likely to respond (or respond for as long) to a second line treatment, people aren't statistics. In some cases a person will have a better response to a second line therapy than they did to first line treatment.
What is “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. “Third-line therapy” and such are used mostly in academic writing.
What is 2nd line treatment?
Treatment that is given when initial treatment (first-line therapy) doesn't work, or stops working.
What is the difference between first-line and second-line drugs?
Your first-line treatment may not work, may start but then stop working, or may cause serious side effects. Your doctor may then suggest a second-line treatment, also called second-line therapy. It is a different treatment that is likely to be effective.
What is third line treatment?
Treatment that is given when both initial treatment (first-line therapy) and subsequent treatment (second-line therapy) don't work, or stop working.
What are the lines of treatment?
“Lines of therapy” is the term used to describe the order in which different therapies are given to people as their disease progresses.
What are 2nd line antibiotics?
Antibiotics were classified as “first-line” (amoxicillin, TMP-SMX, or erythromycin) or “second-line” (clarithromycin, azithromycin, amoxicillin-clavulanate, cephalosporin, or fluoroquinolone).
What is second line antibiotic?
The most commonly used second-line therapies include amoxicillin-clavulanate, second- or third-generation cephalosporins (eg, cefuroxime, cefpodoxime, cefdinir), macrolides (ie, clarithromycin), fluoroquinolones (eg, ciprofloxacin, levofloxacin, moxifloxacin), and clindamycin.
What happens after 2nd chemo treatment?
Nausea, vomiting, and taste changes You may experience nausea (feeling like you might throw up) and vomiting (throwing up) after your last chemotherapy treatment. It should go away in 2 to 3 weeks. Your appetite may continue to be affected due to taste changes you may have experienced during your treatment.
How many rounds of chemo is normal?
During a course of treatment, you usually have around 4 to 8 cycles of treatment. A cycle is the time between one round of treatment until the start of the next. After each round of treatment you have a break, to allow your body to recover.
What is first-line of treatment?
THAYR-uh-pee) The first treatment given for a disease. It is often part of a standard set of treatments, such as surgery followed by chemotherapy and radiation. When used by itself, first-line therapy is the one accepted as the best treatment.
Is second round of chemo worse than first?
Overall, my second round of chemo went much better than the first... thanks to an adjustment Dr. Soule made based on my round one experience (she extended my steroid to be taken for three days after chemo, instead of just one, though with smaller doses on each day).
What is a first-line antibiotic?
Amoxicillin and penicillin V remain first-line therapy due to their reliable antibiotic activity against GAS. For penicillin-allergic patients, cephalexin, cefadroxil, clindamycin, or macrolides are recommended. GAS antibiotic resistance to azithromycin and clindamycin are increasingly common.
Is chemo worse the second time around?
The effects of chemo are cumulative. They get worse with each cycle. My doctors warned me: Each infusion will get harder. Each cycle, expect to feel weaker.
What is clinical trial?
Clinical trials are studies that test out new drugs or combinations of drugs. These new treatments may work better for you than the ones currently available. Ask the doctor who treats your CLL if a clinical trial might be right for you.
What is the term for cancer cells left in the blood after first treatment?
This condition is called minimal residual disease ( MRD). Doctors sometimes use the chemotherapy drug Campath to treat people with MRD.
What to do if CLL doesn't work?
Takeaway. If the first treatment you get for CLL doesn’t work or stops working, your doctor will try a second-line therapy. Chemotherapy, monoclonal antibodies, and targeted therapies are all used as secondary treatments for CLL, either alone or in combinations. You may need to try out a few different treatments to find one that works for you.
What is the treatment for lymphocytic leukemia?
Chronic lymphocytic leukemia (CLL) treatment often starts with chemotherapy, a monoclonal antibody, or a targeted drug. The goal of these treatments is to put you into remission, meaning you no longer have any signs of cancer in your body. Sometimes the first drug you try doesn’t work, or your cancer comes back after the treatment.
Can you get cancer back after a second line?
Sometimes the first drug you try doesn’t work, or your cancer comes back after the treatment . If that happens, your doctor can try new drugs or combinations of drugs. This is called second-line treatment. It may work better than the first therapy you tried.
What is the best second line therapy for SCLC?
There is no best salvage regimen or drug for recurrent or resistant SCLC. 689 Topotecan is the only agent approved by the FDA for use as second-line chemotherapy in SCLC.690,691 It is associated with a modest prolongation of survival and quality-of-life benefit whether given intravenously or orally. 692 Other agents such as paclitaxel, 693,694 oral etoposide, 695 irinotecan, 696 amrubicin, 697 and temozolomide 698 are also useful in this setting. From a practical standpoint, the most important factors influencing the decision to administer second-line therapy are the patient's current PS, the level of sensitivity to induction therapy, and the interval since prior therapy. Patients with a good PS, sensitivity to prior therapy, and a progression-free period of more than 3 months are much more likely to respond to second-line treatment. Retreatment with the induction regimen or one of the aforementioned agents is appropriate for patients meeting these criteria. For all others, second-line therapy tends to be a process of trial and error with single agents or combinations. 689 Paclitaxel-containing regimens may be especially useful in patients without prior response or a very short treatment-free interval after initial first-line treatment, especially if nonplatinum therapy is employed as induction therapy. 693,694 RT can be an effective treatment for palliation of specific symptoms and isolated intrathoracic relapses. 689
Why is second line chemo important?
Because disease relapse is usually incurable, the principal aim is to prolong symptom-free survival and palliate symptoms. The benefit of second-line chemo is dependent on the disease-free interval from completion of treatment to relapse.
What is autologous SCT?
Autologous SCT was evaluated in patients with refractory or relapsing PTCL, chemosensitive to second-line chemotherapy, excluding patients with indolent histologies and those with anaplastic lymphoma kinase (ALK) expressing anaplastic large cell lymphoma. The results of 24 patients with PTCL were compared with those of 86 consecutive patients with chemosensitive relapsed or primary refractory diffuse large B-cell lymphoma (DLBCL). With a median follow-up time of 6 years for surviving patients with PTCL and DLBCL, the 5-year PFS rates for PTCL and DLBCL patients were 24% and 34%, respectively, and 33% and 39% overall survival rates were not significantly different. The age-adjusted IPI was the only variable prognostic for PFS and OS on multivariate analysis. The authors concluded that the outcome of SCT for patients with chemosensitive relapsed or primary refractory PTCL is similar to that seen in patients with DLBCL.54
Does second line chemotherapy affect survival?
Second line chemotherapy could have an impact on overall survival of mesothelioma patients, as already shown by Manegold and colleagues in the retrospective analysis of patients from the phase III study by Vogelzang in 2003.
Can platinum be used for IV?
Platinum responders who relapsed after a disease-free interval of six months may also be retreated by IV platinum regimens. Carboplatin is the preferred platinum compound for IV treatment since it is as active as cisplatin but significantly less nephrotoxic, neurotoxic, and ototoxic.
Is there a survival benefit for second line chemo?
Until recently, there were no large randomized studies to support a survival benefit for second-line chemotherapy in EGCs. There are now three randomized studies performed in patients with gastric cancer to support such a benefit.
Is paclitaxel a second line chemo?
Only a few other agents (in particular, paclitaxel, CPT-11, carboplatin, etoposide plus cisplatin) have been investigated for second-line chemotherapy in patients with AOD. Except for the small numbers investigated with cisplatin and etoposide, with 4 of 10 patients responding, the response rates are low (in the 10–15% range), with one-third of patients free from progression at 6 months and virtually all patients progressing at 12 months. A drawback of some of these agents (paclitaxel, CPT-11) is their metabolism through the cytochrome CYP3A4and UGT-1A1, which implies that their metabolism may have been induced by enzyme-inducing antiepileptic agents. This enzyme induction limits the role of these and other cytotoxic agents metabolized through the CYP 3A4 and other metabolic pathways in patients receiving concomitant medication that induce or inhibit metabolism of the antineoplastic agent administered, and may also have affected the observed activity in the above-mentioned trials. One trial of PCV chemotherapy followed by an autologous bone marrow transplantation after a myeloablative procedure with melphalan proved too toxic, without clearly producing superior results. Despite the upregulation of platelet-derived growth factor (PDGF) signaling pathways in most oligodendrogliomas, the PDGF receptor tyrosine kinase inhibitor imatinib did not show any activity in recurrent oligodendroglioma or AOD/AOA (Raymond et al., 2008 ).
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 …