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Traditional vs. Standard Chemo: Minimizing Toxicity

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Published on September 2, 2015

Dr. Paul Paik and Dr. Malcolm DeCamp discuss the pros and cons of traditional and standard chemotherapy. Both doctors acknowledge the promising effects of immunotherapy in alleviating toxicity levels in the body. Tune in to learn more.



LUNGevity Foundation

Transcript | Traditional vs. Standard Chemo: Minimizing Toxicity

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Susan Leclair:

There are new oncologic drugs coming on the market pretty much every day, some for lung cancer, some not. But a lot of the ones that you use seem to have been around for a while. Are they—what—what’s the difference between the standard, traditional chemotherapy that you would use with vincristine sulfate (Vincristine) or vinblastine sulfate (Vinblastine) or something that’s been around for a while, and—and what do you expect to get out of those versus the newer, the buzz words are always immunotherapy and immunomodulators and all of that kinds of stuff. 

I’m going to give you platinum, and it’s going to make your blood rich, but not much more than that, all the way down to these targeted markers.

Dr. Paik:                


Dr. DeCamp:       

Nice, well defined, easy.

Susan Leclair:     

Are you sure you don’t want to jump in at any time? 

Dr. DeCamp:       

I’ll jump in briefly while he collects his thoughts. And I think that the goal of treating people with systemic therapy is always a balance between killing the cancer and not hurting the patient. So its risk and reward are, like almost all are medical decisions so that what I’ve seen as a bystander, as a surgeon seeing my patients go off and get chemotherapy is that, we’ve been able to preemptively use medications. And we know what the side effects are and stop those side effects before they happen. So I think my colleagues in medical oncology have gotten a lot better. Most lung cancer chemotherapy is an outpatient experience now.  That wasn’t always the case so that they’ve done a good job of mitigating toxicity to a point.

And I think these new precision drugs or the targeted are harnessing the immune system. As we do these things and have advances, you see the efficacy, the benefit of the therapy go up and the side effects go down.

And any time that can happen in any kind of therapy, whether it’s chemo, radiation, or surgery, that’s good for the patient. We call that the therapeutic, window or benefit is sort of efficacy minus toxicity. And I think a lot of the new—new ways of doing things, whether it’s using old drugs in a new way, or old drugs in a different combination, I think they’ve gotten a lot smarter about how to take care of people.

Dr. Paik:                

At the end of the day the use of these treatments is a little bit different depending on what stage you have. So how we approach I think therapy in the perioperative space for patients who have early stage disease is—is different than how we approach patients who have unfortunately stage IV lung cancer. And part of that is that—that risk-benefit platform.  How aggressive are you?  How much toxicity do you tolerate?

A good example of this, we tend to be very aggressive in patients who have early stage disease in terms of toxicity.  We like cisplatin (Platinol) in these patients because we think that it’s at least based on some analyses we’ve done at least a little bit better than carboplatin (Paraplatin), although, by and large, it’s also more toxic, right? The rates of nausea and vomiting are higher, hearing loss, neuropathy, right, numbness and tingling in hands and feet.  We accept this, because of the cure rate benefit that that has, right? Now, that’s not that great, right? 

Basically, what we’re saying is, you know, we want to be aggressive, but there is also a sacrifice that you’re going to have to pay, right? By and large, on average, is that sacrifice.  So for us, something of the Holy Grail is very effective but also very well tolerated, right, where we know it’s going to work well for your cancer, but you’re also going to be able to live your life, you know, however it is that you would like to live it. And that’s where the focus on targeted therapy and I think immunotherapy comes into play, because the ways that these things work are very different from the ways that chemo works.

Chemo interferes with processes that are happening all over your body in normal cells and in abnormal cells.  Targeted therapies, they—they do this also, but—but the idea is that these processes are highly, highly dysfunctional in the cancer cells only. And so the idea for the therapeutic window is that by using sort of doses that are lower for these drugs, right, we’ll hit the cancer specifically while sparing the rest of the body.  And so this is why things like Tarceva—erlotinib, Xalkori—crizotinib are better tolerated, because of the doses that we’re using.  They really tend to affect the cancer cells more than the normal cells in your body.

And this is certainly the case for immunotherapy where, again, the mechanism action is that it is really driving your immune system to be able to do what the immune system does.

And so the typical side effects we think about chemotherapy, they just don’t happen in immunotherapy. And probably the—the single—the most powerful number that encapsulate this was presented to ASCO, and that’s the rate of what are called serious adverse events or serious side effects, these are side effects that tend to land you into the hospital, it’s about three times less for immunotherapy than it is for chemotherapy.  And so you can imagine, well, if it’s that effective and well tolerated in patients who have stage IV disease, the great hope is that it’s going to be the same for early stage disease.

And so by importing these there, we’re going to be able to have really the best of—of both worlds in terms of managing care. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

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