Follansbee
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No question, just a comment. We just found out that my husband, who we thought was “healthy”, other than having Stage IV NSCLC and COPD, also has heart disease. The report that we got over the phone was that part of the heart wall muscle is supressed or akinetic and that the heart is working at 25-30% capacity, opposed to 50-55%, which is normal. He will see a cardiologist soon. In the meantime, I’ve been online, trying to learn what I can. If anyone elese who has been in a similar situation would like to offer tips or share your experiences, I would apprecite it. Wish there were a site for heart disease as good as CancerGrace.
Follansbee 
Husband 74 y, 04/11: dx Stage IV adenoc, LUL, RUL, mediastinum. Neg for KRAS, EGFR. 05/11+ : Carbo/alimta/avastin, two cycles. CT 06/11: majority of bilateral pulmonary nodules and mediastinal lymph nodes decreased in size. 07/11: 4th Carbo/alimta/avastin, well tolerated, ps excellent. On alimta/avastin maintenance. 02/12 Switched to alimta only maintenance due to dx of congestive heart failure. 3/12 Back on Alimta/avastin.
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Dr Pennell
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I’m sorry to hear that he is having more problems, but seeing a cardiologist is a good idea to see what can be done and how significant this is. Many times some adjustment to a patient’s medications is all that is needed to manage heart disease, but there may be additional testing involved to determine what is causing the damage and what needs to be done to keep it from worsening.
I am sure that there are online communities for patients with heart disease, but I’m afraid I don’t know any specifics.
Medical Oncologist
Assistant Professor, Solid Tumor Oncology
Cleveland Clinic Taussig Cancer Center
Views expressed here represent my opinion, not those of GRACE or the Cleveland Clinic. This information does not constitute medical advice and is intended to supplement and not replace medical information provided by your doctor.
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Follansbee
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Thank you, Dr Pennell. Neither my husband nor I have had any experience with heart disease, so we’re just trying to figure it all out and learn what we can.
Husband 74 y, 04/11: dx Stage IV adenoc, LUL, RUL, mediastinum. Neg for KRAS, EGFR. 05/11+ : Carbo/alimta/avastin, two cycles. CT 06/11: majority of bilateral pulmonary nodules and mediastinal lymph nodes decreased in size. 07/11: 4th Carbo/alimta/avastin, well tolerated, ps excellent. On alimta/avastin maintenance. 02/12 Switched to alimta only maintenance due to dx of congestive heart failure. 3/12 Back on Alimta/avastin.
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catdander
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Hi Follansbee, I’m so sorry your husband is dealing with…more. Good luck and I hope it is easily managed.
Janine
husband: 8/25/09 thoracotomy biop dx stage 3a squam nsclc pancoast tumor, 9/16-11/4/09 chemorads cis/etop, 10/30 c3 met stage 4, 11/9-20 rads to c3 & t6, 11/9-1/18/2010 carbo/navelbine, Feb-Nov tarceva. First progression 11/29/2010. gemzar started 12/14/2010… still on gemzer 2/2012.
Most recent scan March 23 suggests NED continue Gemzar 3 months.
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fortmyr
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Yes, best wishes to your husband Follansbee.
Myriam
Sister (now 45 yo), non-smoker, diagnosed stage 4 NSCLC 12/2009.
12/09-03/10: 5 cycles of cisplatin+navelbine (stopped because of neuropathy).
04/10-06/11:Tarceva (has EGFR, exon 21 mutation).
02/11: 15Xrad. to right lung (bronchi blocked).
04/11: MRI shows 10 mets to brain. 05/11: 5 sessions of WBRT (20 Gy).
06/11-12/11: maintenance Alimta.
11/11 and 01/12: radiosurgery (15 Gy) to 2+3 brain mets.
12/11-03/12: re-Tarceva. 04/12: Afatinib/Keppra/decadron (convulsions)
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Follansbee
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Thank you, Myriam and Janine, for your support. He will be seeing a cardiologist today (that was quick!). I’ll post the outcome of this later. My husband is currently on alimta/avastin maintenance. I hope that the oncologist doesn’t decide to stop chemo. I have read online that one study showed that heart failure may be a side effect of avastin treatment. However, other studies have not shown this effect. Does anyone know what the current thinking is on this? (My husband and I both think his heart problem is probably due to COPD and coronary artery disease.)
Follansbee 
Husband 74 y, 04/11: dx Stage IV adenoc, LUL, RUL, mediastinum. Neg for KRAS, EGFR. 05/11+ : Carbo/alimta/avastin, two cycles. CT 06/11: majority of bilateral pulmonary nodules and mediastinal lymph nodes decreased in size. 07/11: 4th Carbo/alimta/avastin, well tolerated, ps excellent. On alimta/avastin maintenance. 02/12 Switched to alimta only maintenance due to dx of congestive heart failure. 3/12 Back on Alimta/avastin.
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catdander
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I know one of the reasons squamous patients can’t take avastin is of bleeding problems; maybe related. If so it would be simple to remove it from treatment options. I hope it’s as easy a fix as that.
husband: 8/25/09 thoracotomy biop dx stage 3a squam nsclc pancoast tumor, 9/16-11/4/09 chemorads cis/etop, 10/30 c3 met stage 4, 11/9-20 rads to c3 & t6, 11/9-1/18/2010 carbo/navelbine, Feb-Nov tarceva. First progression 11/29/2010. gemzar started 12/14/2010… still on gemzer 2/2012.
Most recent scan March 23 suggests NED continue Gemzar 3 months.
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Follansbee
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Now I do have a question. We saw the cardiologist today, and he scheduled a heart catheritization for next Monday. He also mentioned that my husband should probably not continue maintenance chemo, no matter the outcome of the cath. So, based on an echocardiogram in two days we’ve gone to what we thought was going well n maintenance alimta/avastin to no more chemo.  My question is: Is alimta normally not given to lung cancer patients with cardiomyopathy? What about avastin?
Husband 74 y, 04/11: dx Stage IV adenoc, LUL, RUL, mediastinum. Neg for KRAS, EGFR. 05/11+ : Carbo/alimta/avastin, two cycles. CT 06/11: majority of bilateral pulmonary nodules and mediastinal lymph nodes decreased in size. 07/11: 4th Carbo/alimta/avastin, well tolerated, ps excellent. On alimta/avastin maintenance. 02/12 Switched to alimta only maintenance due to dx of congestive heart failure. 3/12 Back on Alimta/avastin.
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cards7up
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Is your husband NED? Stable? If he’s either, he probably could go off maintenance and just do the wait and watch until progression. I’m sure the onc here will have an answer for you. Take care, Judy
Stage IIIA adeno, dx 7/2010. SRS then chemo carbo/alimta 4x. NED as of 10/2011.
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Follansbee
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Hi, Judy. His last CT was in December, and he was stable then. He will be due for another one in March. Going off maintenance would be OK, I guess, but he would really like to continue at least the alimta, if it would be possible.
Husband 74 y, 04/11: dx Stage IV adenoc, LUL, RUL, mediastinum. Neg for KRAS, EGFR. 05/11+ : Carbo/alimta/avastin, two cycles. CT 06/11: majority of bilateral pulmonary nodules and mediastinal lymph nodes decreased in size. 07/11: 4th Carbo/alimta/avastin, well tolerated, ps excellent. On alimta/avastin maintenance. 02/12 Switched to alimta only maintenance due to dx of congestive heart failure. 3/12 Back on Alimta/avastin.
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Dr Hensing
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I’m glad to hear that the cardiology work up is proceeding quickly. The key question at this time is whether or not anything has happened recently to the heart or if this is a more chronic condition, albeit one that may not have caused a lot of symptoms to this point. The list of potential causes for cardiomyopathy is quite long, however when an echo identifies a focal area of the heart that is not functioning normally, the possibility of coronary artery disease is raised. I’m sure his doctors will be looking at any old EKG’s and any prior echo’s that have been done to try to pin down if something has happened recently. Avastin is associated with a modest increase in the risk of thromboses (blood clots), which can occur in arteries or veins. In the setting of any suspected recent injury to the heart, Avastin may certainly need to be discontinued. On the other hand, I’m not aware that this is an issue with Alimta and as long as functional status is maintained, pemetrexed can usually be continued if otherwise indicated depending on the status of the cancer. As the work-up is ongoing, it will be important for him to maintain close contact with the Cardiology team, especially if he experiences any new symptoms or change in his overall condition.
Dr. Hensing
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Medical Oncologist,
NorthShore University HealthSystem
Clinical Associate Professor, University of Chicago
Views expressed here represent my opinion, not those of GRACE, the NorthShore University HealthSystem or the University of Chicago. This information does not constitute medical advice and is intended to supplement and not replace medical information provided by your doctor.
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Dr West
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I agree with Dr. Hensing’s points about Alimta not being associated with any clear problems related to diminished cardiac function; I’d add, though, that most of the experts feel that maintenance chemotherapy is just an option and not a mandate. We don’t have good evidence that it improves survival compared with actually giving the same therapy later, at a time when we’re seeing the cancer progressing. So I just wouldn’t consider a break from treatment if it might be causing increased side effects to be a deprivation from something clearly hugely beneficial.
-Dr. West
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Howard (Jack) West, MD
Medical Oncologist
Views expressed here represent my opinion, not those of GRACE or Swedish Cancer Institute. This information does not constitute medical advice and is intended to supplement and not replace medical information provided by your doctor.
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Follansbee
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Thank you, Drs. Pennell, Hensing, and West for your helpful and prompt responses. They are a great comfort to us. We both were almost certain that what the cardiologist was saying yesterday was that my husband should not have chemo again, ever. Since his performance status is good, this shocked us. But we’ll see what the heart cath shows and what the heart treatment options are decide what to do after that. My husband has a regularly scheduled appointment with his oncologist today, and we’ll find out what his opinion is on permanently discontinuing chemo. Will keep you posted.
Husband 74 y, 04/11: dx Stage IV adenoc, LUL, RUL, mediastinum. Neg for KRAS, EGFR. 05/11+ : Carbo/alimta/avastin, two cycles. CT 06/11: majority of bilateral pulmonary nodules and mediastinal lymph nodes decreased in size. 07/11: 4th Carbo/alimta/avastin, well tolerated, ps excellent. On alimta/avastin maintenance. 02/12 Switched to alimta only maintenance due to dx of congestive heart failure. 3/12 Back on Alimta/avastin.
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Follansbee
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Update: My husband saw the oncologist yesterday and got his regularly scheduled maintenance chemo. Got alimta only. Dropped the avastin. Heart cath next Monday.
Husband 74 y, 04/11: dx Stage IV adenoc, LUL, RUL, mediastinum. Neg for KRAS, EGFR. 05/11+ : Carbo/alimta/avastin, two cycles. CT 06/11: majority of bilateral pulmonary nodules and mediastinal lymph nodes decreased in size. 07/11: 4th Carbo/alimta/avastin, well tolerated, ps excellent. On alimta/avastin maintenance. 02/12 Switched to alimta only maintenance due to dx of congestive heart failure. 3/12 Back on Alimta/avastin.
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Dr Pennell
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Thanks for keeping us updated. That sounds like a very reasonable plan of action that continues to treat the cancer while minimizing agents that could damage the heart.
Medical Oncologist
Assistant Professor, Solid Tumor Oncology
Cleveland Clinic Taussig Cancer Center
Views expressed here represent my opinion, not those of GRACE or the Cleveland Clinic. This information does not constitute medical advice and is intended to supplement and not replace medical information provided by your doctor.
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Follansbee
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Update on catherization: Had the heart cath done last Wednesday. Results were much better than the cardiologist had predicted. Artories are “perfectly clear”. There might be some heart muscle damage, but this may improve. The cardiologist started him on a beta blocker, even before the cath. He isn’t getting “out of breath” during physical activity as much as he was recently.
The cardiologist said that the heart damage might be due to chemo. As I mentioned above, the oncologist is continuing him on alimta maintenance, but dropping the avastin. Does anyone have any information, either anecdotal or from studies, as to the impact of dropping avastin on survival?
Follansbee
PS: I have all the medical history in my “signatures” section, but can’t get it to show up in some of my posts. I’ll try to figure it out when I have a few more minutes. My husband has been on avastin since 4/11, first with carbo/alimta/avastin, then alimta/avastin maintenance. No signs of progression.
Husband 74 y, 04/11: dx Stage IV adenoc, LUL, RUL, mediastinum. Neg for KRAS, EGFR. 05/11+ : Carbo/alimta/avastin, two cycles. CT 06/11: majority of bilateral pulmonary nodules and mediastinal lymph nodes decreased in size. 07/11: 4th Carbo/alimta/avastin, well tolerated, ps excellent. On alimta/avastin maintenance. 02/12 Switched to alimta only maintenance due to dx of congestive heart failure. 3/12 Back on Alimta/avastin.
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laya d.
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While waiting for the doc to respond to your question, Follansbee – - just wanted to drop in and say that I’m so happy that the results re the heart were much better than predicted. . .Yay!
Laya
1/10 – My Mom (58) dx w/ NSCLC-Adeno 3a; 1 cycle of neoadjuvent Carbo/Alimta before finding out EGFR+ (Ex. 19), then switched to 7 wks of neoadjuvent Tarceva/150 mg (major shrinkage); 4/10 – right pneumonectomy; 6/10 started 3 rounds of adjuvent Cis/Alimta w/ concurrent chest radiation (7 wks); 8/10 – NED; 11/10 – small nodule in left lung; 1/11 – 3 small nodules in left lung, start Tarceva/100 mg; 4/11 – suspected sclerotic met to hip, continue w/ Tarceva, add XGEVA, brain MRI clear; 9/11 – solitary 3 cm met (adeno w/ T790m mutation) to cerebellum, surgery and gamma knife, up Tarceva to 150 mg; 11/11 – 2 left lung nodules growing, biopsy on 1 shows mutation from adeno to squamous (shocker!), brain MRI clear, continue Tarceva & Xgeva; 2/12 – brain MRI clear, CT scan, remaining nodule slightly bigger – – monitor for now, Tarceva (reduced to 100 mg) & Xgeva continued; 4/12 progression and rebiopsy (confirmed adeno), stop Tarceva, switch to Carbo/Alimta.
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cards7up
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If you don’t mind my asking, how old is your husband? Does he have high blood pressure?
Wishing him the best. Take care, Judy
Stage IIIA adeno, dx 7/2010. SRS then chemo carbo/alimta 4x. NED as of 10/2011.
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Follansbee
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Thank you, Laya and Judy. We were really relieved…the cardiologist here was very pessimistic, so we got a referral to a major center and had the cath done there. (Thank you, Dr. Weiss.)
Judy, my husband is 74 and his blood pressure has always been normal – around 120/60, and his cholesterol and weight are also normal.
Follansbee
Husband 74 y, 04/11: dx Stage IV adenoc, LUL, RUL, mediastinum. Neg for KRAS, EGFR. 05/11+ : Carbo/alimta/avastin, two cycles. CT 06/11: majority of bilateral pulmonary nodules and mediastinal lymph nodes decreased in size. 07/11: 4th Carbo/alimta/avastin, well tolerated, ps excellent. On alimta/avastin maintenance. 02/12 Switched to alimta only maintenance due to dx of congestive heart failure. 3/12 Back on Alimta/avastin.
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Dr West
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Follansbee,
There isn’t really any evidence to see what the Avastin brings to the combination. There is a recent result from a study called AVAPERL that showed that the Alimta/Avastin combination was clearly superior to Avastin alone.
http://cancergrace.org/lung/2011/12/21/follow-up-on-avaperl-trial-of-maintenance-alimtaavastin-vs-avastin-alone/
The question that remains is whether Alimta alone might do just as well as the Alimta/Avastin combination. There’s a trial that will test this question:
http://cancergrace.org/lung/2009/07/28/ecog-maintenance-trial/
In the meantime, we don’t have a firm answer, but I personally think Alimta alone is a fine maintenance therapy.
-Dr. West
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Howard (Jack) West, MD
Medical Oncologist
Views expressed here represent my opinion, not those of GRACE or Swedish Cancer Institute. This information does not constitute medical advice and is intended to supplement and not replace medical information provided by your doctor.
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