Systemic therapy
Second-line and beyond
What happens when the first treatment stops working, and how to know when to stop.
What it is
Progression on first-line treatment is not the end of options, but each subsequent line typically works less well and for less time. Deciding what comes next, and whether there should be a next, is one of the hardest conversations in oncology.
Re-biopsy and re-profiling at progression matter here: the tumour that is growing now may not be the tumour that was sampled two years ago.
When it is used
- Progression on first-line systemic therapy
- Rising markers or new lesions on surveillance
- When performance status is declining
- When the question is whether to continue at all
How the decision is made
- Whether to re-biopsy and re-profile, the biology may have changed and with it the options.
- Realistic expected benefit of the next line, stated in months and in quality of life, not in hope.
- Whether best supportive care alone is the better choice, discussed honestly rather than avoided.
Decided at the board here; delivered at your existing unit or a partner unit.
Who does what
What we handle, and what happens elsewhere
KPCIRC handles
- Re-profiling decision and, where indicated, a repeat biopsy through
- A written statement of expected benefit for each remaining option
- A trial search at every progression
- An explicit best-supportive-care option, presented as a real choice
- Family conversation support
Performed and billed elsewhere
- Biopsy procedure
- Drug supply and administration
- Beware anyone who offers a further line of treatment without discussing what it is likely to achieve. More treatment is not automatically better treatment.
Questions to ask your own doctor
Take these with you. They work whether or not you are treated here.
- What is this next line realistically likely to give me?
- Should we re-biopsy before deciding?
- Is there a trial for me now?
- What would you do if you were me?
Support that goes with it
Where this is used
Cancers this commonly forms part of
Lung & thoracic cancer
Non-small cell and small cell lung cancer, mesothelioma, thymic tumours
Breast cancer
Including hormone-receptor positive, HER2-positive and triple-negative disease
Colorectal cancer
Colon and rectal cancer, bowel cancer
Pancreatic cancer
Pancreatic ductal adenocarcinoma
Stomach cancer
Gastric cancer
Ovarian cancer
Epithelial ovarian, fallopian tube and primary peritoneal cancer
Not sure this is the right option for you?
That is exactly what a second opinion is for. Bring what you have, we will tell you what is missing and what the alternatives actually are, in writing.