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Second-, third-  and fourth-line treatments work!

I often hear people of moving onto their second or third line cancer treatment being told there’s a “low chance of success”. I can understand why the doctor thinks this but it seems to be the wrong approach and mindset to these treatments.

As we go through the lines of treatment the reported efficacy decreases, that’s true of almost all medicines, but they do still have positive effects in many patients – that should be the focus!

The actual data is something I find encouraging. At ESMO this year (October 2023) I heard a study being quoted (Tampellini et al 2017) which showed what proportion of patients gained a clinical benefit to each line of treatment for metastatic colorectal cancer (stage 4 bowel cancer):

Percentage of patients with clinical response by line of treatment:

First-line: 71.5%

Second-line: 48.6%

Third-line: 35.2%

Fourth-line: 25.0%

The reason I find this particularly positive is that even if you haven’t responded to earlier treatments there’s still a good chance you could respond to the next one you try. This study only went to fourth-line treatment but there’s no reason to believe benefits wouldn’t continue in fifth line and beyond.

There have been some significant advances since 2017 in terms of newer treatments being available and a better understanding of the profiles of the cancers (the biomarkers), so if this study was repeated today it’s likely the results would be even better!

Therefore, my big tip is to try to approach your second-, third-  and fourth-line options (and clinical trials) as you did for your first treatment – with a sense of cautious optimism and a determination to get all you can from it!

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