Stable disease is just fine, thank you.

Posted by Dr Laskin on May 10, 2008 at 2:36 pm

At the 1st ESMO-IASLC Lung Cancer Conference in Geneva last week I saw a presentation that I thought would interest this general readership. The study, presented by Dr Grossi, from Italy, is a retrospective review of 61 patients with advanced NSCLC of all subtypes treated with either Tarceva (erlotinib) or Iressa (gefitinib) in the 1st or 2nd line setting.

The groups were similar, remember this was not a randomized prospective study; the median age was 65 for those receiving Tarceva and 74 for those on Iressa. About 26% of the whole group were never/former smokers. They all were pretty physically fit (ECOG PS of 0 or 1), and most of them (55-58%) had adenocarcinoma.

There were no complete responses and the rate of partial response was 6% and stable disease of 26% for the people on Tarceva and 13% partial response and 29% stable disease for those on Iressa. These figures, although low, are entirely in keeping with previous study results for both drugs given to unselected patient populations.

What was interesting was that for the people who had a partial response the median survival was 9.7 months, but it was 9.1 months for those who had stable disease, and only 3.7 months for those who progressed on treatment. This was a trend noted in other studies and one I certainly see in my clinic, but it was reassuring to see it reproduced. And hopefully reassuring to anyone who might have “only” stable disease. Dare I say “size isn’t everything”?

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Posted in: Epidermal growth factor receptor (EGFR)-based therapies, Lung Cancer, Non-Small Cell Lung Cancer (NSCLC), Second-line treatment, Stage IV/Advanced/Metastatic NSCLC, Targeted therapies, Third-line therapy and beyond, Treatment

3 Comments  

recce101
 Posted on May 10, 2008 at 5:23 pm

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
toosje
 Posted on May 14, 2008 at 4:31 pm

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
Dr Laskin
 Posted on May 15, 2008 at 12:12 pm

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

Posted In

Epidermal growth factor receptor (EGFR)-based therapies • Lung Cancer • Non-Small Cell Lung Cancer (NSCLC) • Second-line treatment • Stage IV/Advanced/Metastatic NSCLC • Targeted therapies • Third-line therapy and beyond • Treatment