There are a variety of different types of treatments offered to cancer patients these days. It can be confusing to navigate, even with the assistance of a doctor–especially in the Land of Clinical Trials, where each facility has its own unique subset of trials. Here’s some general information that will set up more specific posts about my experiences as I journey through these new lands.
There are two broad categories for how cancer treatments are approved for use with patients. First-line treatments are, as the name suggests, used when the cancer is first diagnosed and staged. They’re the “gold standard” treatments with many years of clinical studies proving they provide the best survival odds with an acceptable level of toxicity or side effects. For many stages and types of cancer, first-line treatments have curative intent and are considered “definitive”–intended to get rid of the cancer for good. The chemo-radiation treatments I had for both the head and neck cancer in 2012 and for lung cancer in 2015 were first-line, definitive treatments.
Second-line treatments are used when first-line treatments fail, or the patient can’t take or tolerate first-line treatments. They can have curative intent, but they’re generally less successful (or they would be chosen as the first-line treatments). Since I’ve been through first-line treatments, I’m now looking at second-line.
There are a bunch of non-drug related cancer treatments (including various types of radiation and surgery) but those aren’t relevant in my current situation so my focus here is on drug therapies. There are three basic types of drug-based cancer treatments: Chemotherapy, Targeted, and Immune.
Chemotherapy used to be a term applied to all types of anti-cancer drug treatments, but at this point it generally means cytotoxic treatments. Cytotoxic treatments work by poisoning cancer cells, usually in a broad-strokes way that also kills other types of cells in your body. Both my previous treatment regimens featured platinum cytotoxic agents (cisplatin the first time, and carboplatin the second). I also had the cytotoxic agent Taxol for the second round of treatments. Cytotoxic agents are still usually the drugs featured in first-line treatments, and they also generally have more severe side effects than other anti-cancer drug types.
Targeted therapy attempts to address specific genetic characteristics of the cancer to destroy it. While these drugs can be cytotoxic, they are more often cytostatic, meaning they stop the cancer from proliferating. In lung cancer, for example, the mutations EGFR and ALK both have targeted treatments available for them. In some cases, targeted treatments are so effective they’re being approved for first-line treatment. The only way to know if a targeted treatment will work for a specific patient is to do a genetic analysis on biopsied cancer tissue samples.
Immunotherapy is the newest wave in treatment techniques. It attempts to get your own body’s immune system to successfully destroy the cancer. There are many different approaches taken in immunotherapy: some drugs simply rev up your immune system while others try to block specific “tricks” the cancer can use to fool the immune system into ignoring it. The first wave of these drugs to get FDA approval included Opdivo and Keytruda.
The future of cancer treatment is individualized, personalized treatment based on the actual genetic makeup of each specific patient’s cancer. Targeted treatments are already steps along this path. Immunotherapy approaches personalized treatment in different ways, for example one approach takes the patient’s own immune system cells, genetically alters them to be more effective, then gives them back to the patient.
That’s all setup–in the next post I’ll talk about the treatment options available to me, clinical trials, and why I made specific choices.