When the First Treatment Doesn't Work

Approved by the Cancer.Net Editorial Board, 06/2013

When a person is diagnosed with cancer, the oncologist (a doctor who specializes in treating people with cancer) recommends a treatment plan that is most likely to have the greatest benefits and the fewest risks or side effects. That initial treatment, called first-line treatment or first-line therapy, is usually chosen based on what worked best in clinical trials for patients with the same type and stage of cancer.

However, every person responds differently to treatment. If your first-line treatment does not work, starts but then stops working, or causes serious side effects, your oncologist may recommend a second-line treatment (also called second-line therapy), which is a different treatment that is likely to be effective. In some cases, you may be a candidate for third-line therapy or additional rounds of treatment after that.

Considering a different treatment option

If you need a second-line treatment, it doesn’t necessarily mean that you did not get the right treatment the first time or that there aren’t more treatments to try. However, it is important to understand the likelihood that a second-line treatment, or additional rounds of treatment, will have good results is generally lower than with a first-line treatment.

The chances that a second-line treatment will be successful depend on the type of cancer being treated. People with certain types of cancer often respond very well to a second-line treatment, while people with other types of cancer may have only a small chance that the second-line treatment will help them recover.

Other factors that influence the potential success of a second-line treatment include:

  • The stage of the cancer (where it is located, if or where it has spread, and whether it is affecting other parts of the body)
  • How well and how long you responded to the first-line treatment
  • How long it has been since first-line treatment ended. In many cases, second-line treatment is more successful if a year or more has passed between the two treatments.
  • The side effects you experienced during the first-line treatment
  • Your age and overall health

It is important to talk with your doctor about the goal of any new treatments that have been recommended to you and your prognosis (chance of recovery) before second-line treatment begins. In some cases, you and your oncologist may reach the difficult conclusion that undergoing a new treatment is not the best choice, particularly if the treatment may have unpleasant or serious side effects or if the chance for success is small. This decision allows you and your oncologist to focus more on controlling the symptoms of your cancer, known as supportive or palliative care. Learn more about caring for the symptoms of cancer.

Talking with your health care team

It is important to continue to talk with your doctors and nurses about your care throughout the treatment process. Being an informed, involved patient, asking questions, and communicating your preferences will help you and your health care team create an effective partnership and will make you feel more confident about your treatment decisions.

Bringing a list of questions to your appointments can help guide the conversation and ensure the oncologist addresses all of your concerns. You may want to print this list and bring it to your next appointment or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your care.

Here are some examples of the types of questions you may want to ask your doctor:

  • What is the current status of the cancer?
  • Has the cancer grown and/or spread since my initial treatment?
  • Are other treatment options available?
  • Would you recommend starting a new treatment?
  • Would you recommend participating in a clinical trial?
  • Should I consider not undergoing any new type of treatment at this time?
  • What is my prognosis if I choose not to have second-line treatment?

If you and your oncologist decide to pursue a second-line treatment, you may consider asking the following questions:

  • How is this treatment different from the first-line treatment I had?
  • What is the goal of this treatment? Is it to eliminate the cancer, help me feel better, or both?
  • What are the potential risks and benefits of the treatment?
  • What are the possible side effects of this treatment, both in the short term and the long term?
  • What success rate does this second-line treatment have for my type of cancer?
  • What is the expected timeline for my treatment plan?
  • Do I need to start treatment right away?
  • What is the chance my cancer will recur (come back) after this treatment?
  • Will I need to receive this treatment in the hospital, or can it be done in a doctor’s office or clinic?
  • How much experience do you and your health care team have using this treatment for my type of cancer?
  • Where can I find more information about the treatment you are recommending?

Find more questions to ask the doctor.

Considering a clinical trial

At any point during your treatment, you may consider asking your oncologist whether a clinical trial is an option. A clinical trial is a research study that tests a new treatment to prove it is safe, effective, and possibly better than the standard treatment you may already have had. Because many clinical trials require that you have few or no previous treatments, it is best to ask about clinical trials early in the treatment process. In some cases, participating in a clinical trial may be a better option for your second-line treatment than a standard treatment. Your health care team can help you review all clinical trial options that are open to you.

Coping with a new treatment

Learning your first-line treatment did not work can be scary. You may also feel a wide range of other emotions, such as anger, fear, shock, grief, and anxiety. You may wonder if you and your oncologist should have chosen another option for your initial treatment. You may worry about whether you have the strength to go through a new treatment. These are all normal reactions, and it is important to seek the emotional support you need to get through this difficult time. Some strategies include:

If you continue to feel anxious or depressed or are unable to focus or make decisions, consider asking your doctor or another member of your health care team for help finding a counselor. Even if you don’t experience severe anxiety or depression, talking with a counselor or an oncology social worker can help you develop healthy ways to understand and respond to your emotional needs and concerns.

More Information

Treating Cancer

Making Decisions About Cancer Treatment

Emotional and Physical Matters

How an Oncology Social Worker Can Help

Managing the Cost of Cancer Care