here we go...third line treatment - CAV

Well, my Dads scans were not good, all the tumors nearly doubled since he was off topotecan. He says he has no pain at all , but I was noticing balance issues and some memory lapses- so the doc ordered an MRI (brain Mets?) Crazy how fast things can change with this cancer, 2 weeks ago he seemed so good.... now he hardly seems like himself confused,weak,unsteady and he lost 15lbs. So the Oncologist recommends CAV for third line , anyone have any input on this as far as side effects?
So hard to watch my Dad today, I can't imagine how he feels...just sad

Report post

9 replies. Join the discussion

It truly is sad. I sure hope there are no mets to the brain when he gets scan results. IF it did have some, lots of people seem confident and have good results with gamma knife or WBR.
Take care of yourself and love on dad a little more.

Report post

Thanks Jaime, I have heard good things too about gamma knife. I just have to find the strength to be positive and strong for my dad

Report post

It seems there are a few alternatives.

1. Generally chemo works well initially and then resistance develops. One alternative is to try another chemo.

2. A second is to try to determine the source of resistance. We are getting more sophisticated and a choice is to try a major research institution or review the literature. You may want to monitor the ASCO conference, with many presentations available online.
Here is a recent article on the subject.

HER2 As Therapeutic Target for Overcoming ATP-Binding Cassette Transporter–Mediated Chemoresistance in Small Cell Lung Cancer


Small cell lung cancer (SCLC) easily acquires multidrug resistance after successful initial therapy. Overexpression of ATP-binding cassette (ABC) transporters is important for the multidrug resistance. Among them, ABCB1 and ABCG2 are known to be upregulated in chemoresistant SCLC cells. We found that human epidermal growth factor receptor 2 (HER2) expressions are also upregulated in chemoresistant SBC-3/ETP, SBC-3/SN-38, and SBC-3/CDDP cells, compared with chemosensitive SBC-3 cells. Lapatinib, a tyrosine kinase inhibitor of HER2, could not suppress proliferation of these HER2-positive SCLC cells alone but successfully restored chemosensitivity to etoposide and SN-38 with a clinically applicable concentration. The reversal effect of lapatinib was thought to be caused by inhibition of drug efflux pump functions of ABC transporters, although lapatinib itself has been reported to be a substrate for them. Moreover, knocking down of HER2 by an short interfering RNA weakened the effect of lapatinib on ABCB1, indicating the involvement of HER2 in the inhibitory mechanisms. Notably, we showed that caveolin-1 and Src play key roles in modulating ABCB1 function via HER2 inactivation. In SBC-3/ETP cells, dephosphorylation of HER2 by lapatinib activates Src and successively leads to increased caveolin-1 phosphorylation. Through this process, caveolin-1 dissociates from HER2 and strengthens association with ABCB1, and finally impairs the pump functions. Furthermore, we showed that treatment by lapatinib in combination with etoposide or irinotecan significantly suppresses the growth of subcutaneous SBC-3/ETP and SBC-3/SN-38 tumors in mice, respectively. Collectively, these results indicate that combination therapy with lapatinib and cytotoxic agents could conquer ABC transporter–mediated chemoresistance especially in HER2-positive SCLC. Mol Cancer Ther; 11(4); 830–41. ©2012 AACR.

Report post

Thanks howian1, will look into all I can ! Thank you also for all you do to help those on inspire with your researching.

Report post

So sorry to hear about your Dad and just a thought about the confusion and balance... Could he be dehydrated? Praying for you both and for great scan results!

Report post


My husband is on his 5th line of chemo, and has had only a few side affects until this last chemo, CAV, he is on his 4th round. I now that he has been on chemo now for 14 months, SCLC and it is a buildup over time but CAV has really hit him hard. The amazing thing is his CAT scan after 2 rounds was as good as his first Cat scan after his first treatment 12 months ago. CAV is one of the first drugs they came out with for SCLC 20/25 years ago. His tumors in his abdomen shrunk by half and the ones in his lung either shrunk some or stayed the same. ONOC. things that we might be dealing with kidney cancer in his abdomen because of his response to all the chemo's has always been mixed results. If or when this chemo fails she will do a kidney biopsy. Last week he was painting chairs and going to the store, right now I am looking at him sleeping with oxy. making horrible breathing sounds due to severe sleep apnea, his feet are swollen, his back is in pain, so weak he has to lean on me to walk, which he isn't doing much of. I haven't seen him like this before, but tomorrow he can wake up like nothing happened.
Stay brave, but I know it is so hard, I get up 3x a night to check on him( he has to sleep in chair right now), it wears you out but God keeps giving us strength to carry on or sends others to help.

Report post

Thanks sue, the Oncologist did say this chemo can be tough,and like your husband my Dads previous chemo has been ok. I'm hoping for the best.please let me know how things are going for your husband, and you are right God gives us strength or sends someone to help.

Report post

Hi Cheryl,

I'm fairly new to this website. My Momma was diagnosed with extensive small-cell 03/04/13. She has had 4 rounds of chemo now with Chromogranin A blood test showing "normal". PET & CT scan results come this upcoming Wednesday. We are very scared about the results. Before this journey with Momma began, I had no experience with cancer in the immediate family so I am basically "clueless" on most everything. Do you care to share with me how long your Dad took chemo the 1st time around and if any radiation and what his response was. Also, how the disease has progressed during this time.

Report post

Hi Calley, So sorry you and your mom are going through this journey, but you will learn alot and get great support here. My dad was diagnosed Feb '12, lung, Mets to liver,stomach and spine,brain clear
March-june '12:
first line chemo was carboplatin/etoposide a total of 6 treatments.showed all tumors greatly reduced 70%
He then had pci (preventative brain radiation) 15 treatments (Aug '12)
Follow-up ct scan in Sept. Showed progression, started 2nd. Line chemo - topotecan. 6 treatments.
Scan showed no progression but no shrinkage either. They decided to take a 2 month break, scanned again. -all tumors doubled in size and also had numerous brain Mets.
So he then had wbr (whole brain radiation) 10 treatments.
And has started 3rd line chemo CAV. He has had 2 treatments so far.
Overall my Dad has had a great quality of life while being treated. Fortunately his side effects have been minimal, fatigue being the worst of it. Hoping for great scan results for you mom, let me know how it goes and I will send prayers your way.

Report post

This discussion is closed to replies. We close all discussions after 90 days.

If there's something you'd like to discuss, click below to start a new discussion.

Photo of Dave Grant

The Lung Cancer Survivors Support Community has provided support for patients, caregivers, families and friends since 2006. We welcome over 600 new members every month in the fight against lung cancer.

ALK mutations and lung cancer

Join the discussion about ALK mutations and lung cancer

Things you can do

Discussion topics

Community leaders