Chemotherapy is often the first line of treatment for many cancers. It involves using drugs to kill cancer cells and shrink tumors. Unfortunately, chemotherapy does not always work right away. If the first round of chemotherapy does not achieve the desired results, there are still options.
Why the first round of chemo may not work
There are a few reasons why the initial round of chemotherapy may not be effective:
- The chemotherapy drugs used were not the most appropriate for the type and stage of cancer.
- The dosage or treatment schedule was not optimized.
- The cancer cells are resistant to the drugs used.
- The cancer is aggressive or advanced stage.
Doctors choose chemotherapy drugs and regimens based on the type of cancer, its stage, and the patient’s overall health. However, cancers can exhibit resistance or respond differently than expected. The initial treatment plan may need to be reevaluated.
Tests to determine why chemo is not working
If chemotherapy is not working, doctors will run tests to determine why and identify the next steps:
- Medical imaging – CT, MRI, PET scans check for tumor size and spread after chemo.
- Biopsies – Sample tumor tissue to test for genetic mutations and drug resistance.
- Blood tests – Evaluate blood counts, organ function, and cancer markers.
These tests help doctors understand why the cancer is not responding so they can modify the treatment approach accordingly.
Changing the chemotherapy plan
If the first round of chemotherapy drugs and dosage does not reduce the cancer, doctors will typically change the treatment plan in one of these ways:
- Use different chemotherapy drugs
- Adjust the drug dosage
- Modify the treatment schedule
- Combine chemotherapy with radiation or surgery
Switching the chemo drugs used gives another option that may be more effective. Adjusting drug doses or frequency can overcome resistance. Combining approaches like chemotherapy and radiation can enhance anti-cancer effects.
Chemotherapy drugs
Examples of commonly used chemotherapy drugs for different cancer types:
| Cancer Type | Standard Chemo Drugs | Second-line Chemo Drugs |
|---|---|---|
| Breast cancer | Doxorubicin, cyclophosphamide | Docetaxel, carboplatin |
| Lung cancer | Cisplatin, etoposide | Gemcitabine, vinorelbine |
| Colon cancer | 5-fluorouracil, oxaliplatin | Irinotecan, capecitabine |
If standard first line drugs are not effective, second line options are available.
Increasing chemotherapy dosage
If the initial doses did not reach therapeutic levels, doctors may prescribe higher doses in the next rounds. Dosage increases are carefully monitored for side effects and tolerability.
Changing treatment schedule
Standard chemotherapy schedules involve cycles of treatment days followed by rest days. Accelerating the treatment by shortening rest periods or giving doses more frequently may help combat aggressive cancers.
Second round of different chemotherapy
After re-evaluating the cancer’s response and adjusting the regimen, the oncologist will prescribe a second round of chemotherapy using the new drugs or dosing. Receiving this revised second round gives the chemotherapy another chance to effectively treat the cancer.
Factors about second round chemotherapy:
- Typically involves 3-6 cycles over 3-6 months
- Drug choice, doses, and schedule determined by doctor
- Closely monitored for results and side effects
- May be given in combination with radiation or surgery
This second attempt with adjusted treatment has potential to slow or stop tumor growth if the cancer is still susceptible.
If second round of chemo is still ineffective
If the cancer continues growing after two rounds of chemotherapy, additional standard treatment options may not be beneficial. At this point, doctors will discuss third line treatment approaches which may include:
- Clinical trials – Experimental medications and therapies
- Stronger chemotherapy – Intensive regimens with stem cell transplant
- Targeted therapies – Drugs that attack cancer’s specific mutations
- Immunotherapy – Drugs prompting the immune system to fight cancer
- Palliative care – Focus on quality of life and symptom relief
Doctors determine if pursuing intensive third line treatment is appropriate based on the patient’s health, cancer status, and wishes. Palliative care can also reduce discomfort and improve quality of life at any stage.
Factors influencing next steps after two failed rounds of chemo
Key factors impacting decisions about further treatment when two chemotherapy attempts have not achieved remission:
- How advanced the cancer is
- How aggressive the cancer cells appear
- Presence of comorbidities and performance status
- Expected side effects and risks of further options
- Patient goals and priorities
Pursuing additional rounds of reconfigured chemotherapy, clinical trials, or radiation may not be recommended if the cancer is extensive and efforts are becoming futile. Quality of life considerations take priority.
Outlook with two ineffective chemo rounds
The prognosis after two failed trials of chemotherapy depends on the individual cancer characteristics:
- Earlier stage cancers have better prognosis than later stages.
- Slow growing cancers are less concerning than fast growing types.
- Younger, healthy patients have more treatment options.
- Outlook is worse if cancer is advancing despite chemo.
After two unsuccessful attempts, curative treatment is less likely. The goal may shift to slowing cancer, relieving symptoms, and providing comfort care.
5-year survival rates after multiple rounds of chemotherapy
| Cancer Type | Stage I | Stage II | Stage III | Stage IV |
|---|---|---|---|---|
| Breast Cancer | 95% | 80% | 55% | 10% |
| Lung Cancer | 60% | 35% | 15% | 2% |
| Colon Cancer | 90% | 70% | 55% | 10% |
Later stage cancers have markedly lower 5-year survival after multiple failed chemotherapy attempts compared to earlier stages.
Conclusion
When initial chemotherapy does not successfully treat cancer, the treatment plan undergoes reassessment. Doctors determine why chemo failed and design a second round using different drugs or doses. If two rounds are still ineffective, options like clinical trials, targeted therapy or palliative care are considered based on the cancer status and patient’s wishes. The prognosis depends on the cancer’s characteristics and stage. While early stage cancers still have hope with reconfigured treatment, late stage cancers have bleaker outlooks after multiple unsuccessful chemo attempts. In all cases, focusing on comfort and quality of life is a priority.