There is no proven "standard" first line therapy which has been shown to be surperior to the many other choices which exist. The same situation exists in the setting of 2nd, 3rd, and 4th line therapy. The therapies are equivalent on a "population" basis, but not on an "individual" basis. Proven by the large number of patients who have progressive disease on 1st line therapy but who have good responses to 2nd or 3rd line therapy. These patients should have received the "correct" treatment in the 1st line setting.
From the people at ASCO.
If your first-line treatment does not work, starts but then stops working, or has side effects that you are unable to tolerate, your oncologist may recommend second-line treatment (if at first you don't succeed, keep on trying), which is a different treatment that may be another option for you. In some cases, you may be a candidate for third-line therapy or even additional rounds of treatment.
Of course, at any point in your treatment, ask 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 (in other words, you're a guinea pig). In some cases, participating in a clinical trial may be a better option for your second-line treatment than a standard treatment.
Oh! And one more thing. Don't worry, be happy! This is oncologist-approved cancer information from the American Society of Clinical Oncology.
http://www.cancer.net/patient/All+Ab...esn't+Work