why is first line treatment more effective than second line treatment

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 difference between first line and second line treatment?

Second-Line Treatment In contrast to first-line treatment, second-line treatment is usually a treatment which is chosen after first-line treatment has failed to achieve the goal (either it doesn't work or all, or it works for a period of time and then stops working), or has side effects requiring you to stop using that treatment.

What is the chance that second-line treatment will be successful?

The chance that second-line treatment will be successful depends on the type of cancer you have. Second-line treatment often works very well for certain types of cancer. People with other types of cancer may have only a small chance that second-line treatment will work. Other factors that affect whether second-line therapy may work include:

Is first-line treatment a choice?

First-Line Treatment Is a Choice. We are entering an era known as "participatory medicine" in which patients are much more involved in their health care. Decisions are made as a team, rather than the paternalistic relationship between physicians and patients of the past.

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.

Why is second line chemo important?

What is the best second line therapy for SCLC?

What is autologous SCT?

Does second line chemotherapy affect survival?

Can platinum be used for IV?

Is there a survival benefit for second line chemo?

Is paclitaxel a second line chemo?

See more

About this website

What is the difference between first-line and second-line treatment?

Doru Paul, MD, is board-certified in internal medicine, medical oncology, and hematology. 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.

How effective is second-line chemotherapy?

In any case, no combination of drugs received as first-line treatment was subsequently given at disease progression. A complete response to second-line chemotherapy was achieved in 3 patients and a partial response in 25 patients, for an overall response rate of 16.0% (95% CI, 10.6–21.4).

What is 1st line 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.

What is meant by choosing a first-line of treatment in cancer therapy?

The first drug or combination of drugs a patient takes is called “first-line” treatment, which may be followed by “second-line” and “third-line” treatment. No specific treatment or combination of treatments works for every patient.

Is second round of chemo worse than first?

For most people the side effects were worst in the first few days after treatment, then they gradually felt better until the next treatment. Some said the effects were worse with each successive treatment. Most side effects don't persist and disappear within a few weeks after the end of treatment.

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 the difference between adjuvant and first-line therapy?

What is adjuvant chemotherapy? Adjuvant therapy is any type of therapy that follows the primary treatment. So, adjuvant chemotherapy takes place after you've had first-line treatment, such as surgery to remove a cancerous tumor.

What is a second line medication?

Any therapeutic agent that is not the drug of choice, or the 1st normally used to treat a particular condition; in rheumatoid arthritis, 2nd-line agents are used when standard 'first-line' therapy–ie, anti-inflammatory agents and corticosteroids fail.

What is first second and third line of treatment?

Treatment that is given when both initial treatment (first-line therapy) and subsequent treatment (second-line therapy) don't work, or stop working.

Can cancer spread while on chemotherapy?

While chemotherapy is one of the oldest and most successful ways of treating cancer, it doesn't always work. So, yes, cancer can spread during chemotherapy. Spreading could mean the tumor keeps growing, or that the original tumor shrinks, but cancer metastasizes, forming tumors in other areas of the body.

What is the most effective treatment for lung cancer?

If surgery isn't an option, combined chemotherapy and radiation therapy may be your primary treatment. For advanced lung cancers and those that have spread to other areas of the body, radiation therapy may help relieve symptoms, such as pain.

Why is chemotherapy not effective?

There are several possible reasons for chemotherapy resistance: Some of the cells that are not killed by the chemotherapy mutate (change) and become resistant to the drug. Once they multiply, there may be more resistant cells than cells that are sensitive to the chemotherapy.

Overview of Second-Line Treatment for Cancer - Verywell Health

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.

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What makes a drug first line?

What makes a drug first-line? These are the medicines doctors first resort to for a given disease (the doctors first choice try). They are the most commonly prescribed medicines for a particular disease. These medicines are well accepted by the medical community. For asthma, they include systemic corticosteroids like Flovent, Asmanex, and Qvar.

Is corticosteroids a first line treatment for COPD?

So, it remains a first-line treatment for COPD. Likewise, because it may help some asthmatics, it remains a second-line option here. Researchers learn more. Back in the 1970s, doctors were leary that inhaled corticosteroids (ICS) may cause the same side effects as systemic corticosteroids.

Is Atrovent a first line asthma medicine?

Atrovent was once-upon-a-time considered a first-line asthma medicine. It fit all the qualifications of one. But, subsequent studies did not show it benefited most asthmatics. Studies do show, however, that it does help most COPDers. So, it remains a first-line treatment for COPD.

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.

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.

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 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 is second line therapy?

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. Depending on the type of cancer you have and the available drugs, you may be able to have third-line therapy or additional rounds of treatment after that.

What happens if a first line treatment does not work?

Learning your first-line treatment did not work can be scary. You may also feel a wide range of other emotions, such as anger, fear, shock, grief, and anxiety. You may wonder if you and your doctor should have chosen another option for your first treatment. You may worry about whether you have the strength to go through a new treatment. These are all normal reactions. But it is important to seek the support you need to get through this difficult time. Some strategies include: 1 Sharing your fears and anxieties with family, friends, clergy, or support groups, in-person or online 2 Connecting with someone else who has had second-line treatment and understands the emotions you are experiencing 3 Expressing your feelings in a journal or a blog 4 Practicing stress management and relaxation techniques 5 Spending time outside or around nature 6 Listening to music 7 Watching or listening to programs or shows that make you laugh

What is the treatment for cancer called?

This type of treatment is known as palliative care or supportive care .

Why is it important to talk to your health care team?

It is important to talk with your health care team about your care throughout the treatment process. Being an informed, involved patient, asking questions, and talking about your preferences will help you and your health care team work together better.

What to do before a second line?

Before second-line treatment starts, talk with your doctor about the goal of any suggested new treatments. Also talk about your chance of getting better. You and your doctor may decide that receiving a new treatment is not the best choice. This may happen if the treatment has unpleasant or serious side effects or if the chance for success is small. ...

Is it safe to take a clinical trial?

It proves that it is safe, effective, and possibly better than the standard treatment you may already have had. Many clinical trials require that you have few or no previous treatments. Because of this, it is best to ask about clinical trials early in the treatment process.

Is second line treatment better than first line?

But the chance that second-line treatment or more rounds of treatment will have good results is usually lower than with first-line treatment. The chance that second-line treatment will be successful depends on the type of cancer you have. Second-line treatment often works very well for certain types of cancer.

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 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

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 ).

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 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

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 ).

What Makes A Drug first-line?

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What Makes A Drug Second-Line?

What Causes A Drug to Change First-Line Or Second-Line Status?

What to Make of this?

Lines of Treatment

• These are your medicines that are less commonly prescribed for a particular disease. But, they are available as options when first-line treatments alone are not working.

See more on asthma.net

Significance

The Option of Clinical Trials

Questions to Ask About Second-Line Treatments

Example

• Since discussing second-line treatment usually means that first-line treatment failed, you are likely feeling a whole host of cancer emotions, similar to when you were first diagnosed. Some people say that it feels like starting all over—but with less energy this time. Usually, first-line treatments are chosen because they have the greatest benefit...

See more on verywellhealth.com

Coping