What a timely post…we were torn whether to add Avastin to my mom’s next chemo and decided against it. One oncologist recommended it because she didn’t have any of the high risk factors while the other did not, citing the reasons you mention for elderly patients. I feel better now about our decision. Thanks very much!

Betty

betty r.

Will this affect your recomendations regarding Tarceva/Avastin in those over 70?

Jeff

Jeff123

I find this timely for myself as well. I like to think ahead one step, so I’ve been researching my options if and when I fail Tarceva therapy. One issue will be monotherapy vs. a different platinum-based doublet than the one I failed on the first round (Carboplatin/docetaxel). I may try to talk my doctor into Cisplatin/Gemzar, as I’m young and still in pretty good shape.

The other issue will be whether to add Avastin to whatever treatment we choose (I didn’t take Avastin in the initial chemotherapy because I was in a Velcade trial). I’m not in a high-risk group for Avastin, but I’m on the border due to some cardiac issues. Considering that this study shows (indirectly) that the survival effect for Avastin is larger than previously thought in younger people, I will argue vigorously for Avastin. We’ll see what my doctor, one Suresh Ramalingam, thinks of this recent work. It’s a small world out there!

neilb

I’m glad people find this issue a timely one. We’re certainly learning some of the nuances of avastin as we go. While I do think that many of the principles of chemo +/- avastin apply across several chemo agents/regimens, I think the avastin/tarceva combination may be different enough, as a non-chemo approach, that I would reserve judgment and would not presume that the same trends apply. We will likely have the opportunity to learn more about nuances like age, performance status, and molecular correlates with all of these combinations, including avastin/tarceva, as ongoing trials are completed and analyzed.

Neil, please give Dr. Ramalingam my best when you see him. I’m sure he’ll always give you thoughtful counsel.

-Dr. West

Dr. West

I saw Dr. Rama today. He says hi. He also reported that my scans were stable (two enlarged lymph nodes in mediastinum, one in supraclavicualar area, all the same size as two months ago). No new growth, no tumor per se.

Easy call to stay on Tarceva for two more months, but your post on stable disease saved your colleague a couple of minutes of explaining why stable was OK.

neilb

Thanks for bringing this up. I hope there’s no question about why OncTalk should be very helpful to patients and family members, but it’s not as clear how or whether it might help other physicians. I think to corroborate what they’re recommending it should be a great reassurance, as well as to fill in blanks for the questions that didn’t get covered, either because they weren’t thought of at the time of the appointment or because sometimes the time can be scarce.

Of course, some oncologists will have recommendations that differ notably from what I write here. That’s fine, because I do emphasize that there is plenty of room for different styles, as long as they can express their rationale and it makes sense. On the other hand, if someone isn’t using Avastin in an appropriate patient because they don’t know it’s approved for lung cancer, that’s a problem.

So thanks, Neil, I hoped there were ways that this site could be helpful to and not just “challenge” the oncologists that members here are working with.

-Dr. West

Dr. West