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When the First Treatment Does Not Work

Posted 7/7/2013

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    Especially for adjuvant treatment, this is not something anyone wants to consider. If you read yesterday's entry about understanding statistics--and even more if you read the other mentioned resource from Cancer Net about understanding cancer research, you are aware that no treatments work equally well on all people. The first choice, the so-called first line or standard treatment, will be the one that has been proven to be the most effective for the most people, but there will be exceptions. This is harder to know in adjuvant therapy until/unless the cancer recurs--then it is sadly clear that the first treatment was not completely effective. Sometimes when a woman is receiving neoadjuvant chemotherapy (chemo given before breast surgery), it will be obvious if the tumor is not shrinking. More often, it comes up in the treatment of advanced or metastatic cancer when tumor markers begin to rise or  scans show progression. Even though women/patients are told that no treatment is going to work forever, that the cancer cells will figure out how to become resistant, it is always shocking and very upsetting when the evidence is clear that it is time for a treatment change.

  When your doctor talks about second or third (or more) line treatments, it is painfully clear that the road has become more uncertain and more bumpy. No one can predict with certainty what treatment will or will not turn out to be really helpful for a particular individual, the odds diminish with each new set of drugs. This is not to say that there may not be big successes further down the road, but it is sobering

  Again, from Cancer Net (you can tell that I think this is a really helpful resource), is this article about understanding this situation. I give you the beginning and a link to read more:

When the First Treatment Doesn't Work
This section has been reviewed and approved by the Cancer.Net Editorial Board [1], June / 2013
When a person is diagnosed with cancer, the oncologist (a doctor who specializes in treating people with cancer) recommends a treatment plan that is most likely to have the greatest benefits and the fewest risks or side effects. That initial treatment, called first-line treatment or first-line therapy, is usually chosen based on what worked best in clinical trials for patients with the same type and stage of cancer.
However, every person responds differently to treatment. If your first-line treatment does not work, starts but then stops working, or causes serious side effects, your oncologist may recommend a second-line treatment (also called second-line therapy), which is a different treatment that is likely to be effective. In some cases, you may be a candidate for third-line therapy or additional rounds of treatment after that.

http://www.cancer.net/all-about-cancer/cancernet-feature-articles/treatments-tests-and-procedures/when-first-treatment-doesnt-work

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