Comparing Side Effects When Deciding On Treatment

Lung cancer patients are finding that a growing number of treatment options have become available. Sometimes, there are options even within the same basic umbrella. When I was diagnosed, I explored targeted drugs that worked with specific gene mutations, immunotherapy, and chemotherapy. Each type of therapy had multiple options available depending on how the oncologist wanted to approach the treatment. A longer life and a higher quality of life were balanced concerns. My first impulse was to get multiple opinions and compare the reasoning for each recommended treatment.

A Quickly Changing Treatment Landscape

Because targeted drugs and immunotherapy are being considered as first line treatments for some patients, it is important to understand how they differ from chemotherapy and, for early stage patients, surgery and radiation. Most oncologists are likely to recommend what they know works best for any particular type of cancer at any given stage -- there are more variables than most patients realize, with multiple types of cancers affecting the lungs that respond differently to the various drug options on the market. And even with broad similarities in a cancer type, there may be different driving mutations that will affect which drugs work best (or indicate those that are unlikely to work at all).

My lung cancer is a non-small cell lung cancer, commonly referred to as NSCLC, as opposed to the classification of small cell lung cancer, or SCLC. These are the two broad classifications of lung cancer (along with mesothelioma), but it gets more specific. The type of cancer I have is adenocarcinoma, which is rather common. Shortly following my diagnosis, my biopsy was analyzed for any actionable mutations that were known at that time. No mutations were revealed that would have indicated any of the targeted drugs available at that time, so I considered immunotherapy and chemotherapy as the two options worth exploring. Due to the then-current success rates of immunotherapy, it seemed very appealing if I could have gotten into a clinical trial. The upside of immunotherapy was that most patients experienced very light side effects and when it worked, it was highly effective. The downside was that there was the potential for serious organ damage in rare cases and, at least for my cancer, the potential success of chemotherapy was higher than that of the available immunotherapies. That sounded simple enough: go with the chemo.

Two Opinions, Two Options

The oncologist I consulted first wanted to try a relatively new chemotherapy drug called Pemetrexed, or Alimta. The oncologist I went to for a second opinion suggested Taxol, which seemed appealing because it was something of a "natural" chemotherapy, being derived from the bark of the Pacific yew tree. The main selling point of Taxol was that it had been around longer and had a proven track record. Also, it was decidedly cheaper and, therefore, was the preferred drug of my insurance company. On paper, the side effects seemed very similar. Neuropathy, fatigue, potential hair loss -- all of the usual suspects seemed present. So a closer look was required to determine whose advice to follow or which drug to push for. What I discovered was this: Taxol was very effective in the short-term, but it was also very difficult for patients to tolerate. On the other hand, Pemetrexed use could often continue for several years, with some patients able to maintain a stable cancer for five or more years. Because I knew that it was highly unlikely my cancer would go into remission, I weighed out the length of time I might expect to be on each chemotherapy drug before having to face a new treatment option.

The choice of drug is often a very personal one. I had two highly qualified oncologists with different opinions about two similar drugs. They agreed on the broad strokes of my treatment, but I had to really weigh out the pros and cons of the chemotherapy options. In the end, I feel that I made the right decision, but it has since run its course and I am looking at a new choice for a new therapy. Cancer research moves very quickly and new clinical trials are looking for patients, and new drugs are on the market (some even being used for "off-label" treatments in an attempt to offer more options for patients who may not have an approved or time-tested option available). The same questions are being raised for me as had been before. I have to weigh the pros and the cons. I have to decide which side effects I am ready to accept, or which treatment option is worth added side effects because of the likelihood of success.

In the end, of course, the side effect we all desire is being able to breathe.

Editor's Note: We are extremely saddened to say that on October 21, 2018, Jeffrey Poehlmann passed away. Jeffrey’s advocacy efforts and writing continue to reach many. He will be deeply missed.