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Understanding First-Line vs. Second-Line Therapy in Lung Cancer

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Published on September 10, 2015

What is the difference between first-line and second-line therapy in lung cancer? Dr. Paul Paik explains how each line of therapy varies between patients and their case-specific stages. Tune in to learn more.

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Transcript | Understanding First-Line vs. Second-Line Therapy in Lung Cancer

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:

Every now and then, actually, more than that, you hear about well, this is first-line therapy versus second-line therapy versus third line.  What—what does that mean?

Dr. Paik:                

The lines I think are becoming blurrier and grayer, which is a good thing.  So you know, the—the hierarchy has existed, because we basically bring out the big guns at the beginning, right, things that we know work the best.

And then from there, things get a little bit worse in terms of the lines of therapy. At the end of the day, it sort of is just nomenclature.  You know, the first line of therapy is just the first treatment that you end up getting. Now, traditionally, again, that’s been the best treatment that we’ve had, the ones that have had the most effectiveness in terms of shrinking cancer cells and in terms of improving survival.  So that second line is just the second treatment you get.  There are lines in the third treatment that you get.  But, of course, there are patients who get second-line and third-line treatments that are better than their first-line treatments sometimes.

A great example of this would be targeted therapy where, a patient may not have time for genetic testing to come back of their tumor, because they’re having symptoms.  So we need to start treatment like yesterday, in which case, we go for chemo because that is one of the tried-and-true things.

We can get it, you know, approved very quickly. We don’t have to wait two weeks to four weeks to get the test results back. And but what that means is that let’s say the cancer, you know, testing comes back with an EGFR (epidermal growth factor receptor) mutation or an ALK rearrangement.  Well, then that means that that will be your second line of treatment. And we know from studies that that is better than chemo. It’s not that chemo is bad.  It’s just that it’s better than chemo. And so your second-line treatment ends up being a good thing actually. Right? It’s not this oh, no, I’m on second-line treatment now. 

It’s now, oh, I’m on second-line treatment. And immunotherapy also changes this paradigm a bit, in terms of the—the effectiveness that we’ve seen for that and the tolerability. And so, you know, the general idea I think is that—is that we are broadly getting more lines of therapy available for patients.  And so this notion of, you know, second line, third line, you know, we’re going to extend to fourth line, fifth line as well.

And, again, it’s just what number treatment you are on. I think that’s basically what it boils down to.

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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