Thanks for the post, Dr. Laskin. When I saw the figures 6% partial response, 26% stable disease for Tarceva, my first thought was “wow, so low!” But considering that in my 20 months of treatment (4 months Taxol/Carbo/Avastin, 8 months Avastin alone, Tarceva since October 2007), each month I’ve felt a little better and been a little more capable than the month before, in spite of never having enough tumor shrinkage to meet the high bar of partial response, then I heartily agree that tumor size isn’t everything. For me, “only” stable has meant a vast improvement, far better than anything I had reason to expect in September 2006. Aloha,

Ned

recce101

Hi Dr Laskin:
Nice to see you posting again. You had not been heard from for a while, or maybe it’s the way I don’t manouever around this new website.
I am 111B, since March 2007. Small increase in tumour size 4 weeks ago. No mets anywhere. My oncologist has agreed to CT scan me again in another 4 weeks. If there is further growth I will start Tarceva. Or Alimta. Which do you prefer? I am afraid of all the possible Tarceva side effects. My Oncologist also mentioned Taxotere, but I really don’t want to lose my hair again. I’ve only had 2 haircuts so far! and I like not looking “sick”.
What is your opinion? What do you think of waiting for another scan?
Foxy

toosje

Hi all
sorry it’s true i’ve be somewhat absent for a bit - i’m afraid i don’t have nearly the superhuman stamina of Dr West.

i recognize the response rates are very low and pretty scary statistics, but keep in mind that this means the cancer has had to shrink at least 30%, so if it’s only a 25% shrinkage it is called stable not response. all pretty arbitrary but the line has to be drawn somewhere i suppose. also - those rates are about the same as the rates for 2nd line chemo such as alimta or taxotere.

as for the choice between the two, as you know from previous posts it is so difficult to choose a 2nd line treatment. usually it’s a matter or sequence, i.e. at some point you will probably get both tarceva and alimta - so which do you want to start with? i wouldn’t be too worried about the tarceva side effects, most people tolerate it very well despite the rash. and alimta is a toxic drug with side effects too. so, hard to choose. in general, i look at any factors that might suggest a possible influence - never smokers with adeno i might try tarceva first. but if you had a fantastic response to 1st line chemo and were well for many months then i might try alimta first.

there is some emerging data that may suggest that for people with squamous tumours alimta isn’t so great, in which case i’m starting to lean towards taxotere for squams.

as for CT frequency - in the absense of symptoms i don’t scan very often, in fact i tend to follow with x-rays and scan only if i’m not sure about the x-ray or if there is a new symptom to investigate. so, i think a scan after 8 weeks is perfectly reasonable.

hope that helps!

Dr Laskin

Dr Laskin