Stage !V NSCLC squamous lung cancer .Please help!

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This topic contains 17 replies, has 5 voices, and was last updated by  catdander forum moderator 1 year, 11 months ago.

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May 12, 2012 at 12:32 pm  #10179    

ilawise26

My dad was diagnosed with NSCLC stage !V with multiple brain mets in February 2012.
He was given WBR 15 sessions .After that 3 cycles of chemo with Gemzar/carboplatin.
After three cycles of chemo, the brain mets have gone but the lung has seen an increase in the metastasis.
Now he had another biopsy and we came to know its squamous cell NSCLC.What chemo helped you?


::::Dad (non -smoker/non-drinker, age 53 )diagnosed with NSCLC Stage IV with multiple brain mets in Feb 2012. WBR 15 sessions followed by 3 cycles of chemo with Gemzar/Carboplatin.CT scan May 6,2012 showed no brain mets! Lung metastasis progressed.Did another Biopsy found it to be Squamous NSCLC.May 14,2012 Took Chemo with Taxotere/Carboplatin for 3 cycles(each cycle, tri-weekly schedule).July 13- CT scans-progression observed.Tested positive for EGFR mutation.Erlotinib from Jul 20,once a day.

May 12, 2012 at 2:45 pm  #10184    

Dr West

Here is a discussion of the treatments with the best track record for patients who have received prior chemo for advanced NSCLC:

http://cancergrace.org/lung/2010/10/04/lung-cancer-faq-2nd-line-nsclc-option/

The three best studied treatments are Taxotere (docetaxel), Tarceva (erlotinib), or Alimta (pemetrexed), though Alimta has been shown to be effective only for non-squamous cancers. Topotecan (Hycamtin) has been shown to also be comparably effective to these other therapies, but it isn’t as commonly used or well studied in previously treated patients as the other ones I mentioned.

-Dr. West


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.

May 12, 2012 at 3:59 pm  #10188    

cards7up

Tarceva is now used to treat squamous cell? Take care, Judy


Stage IIIA adeno, dx 7/2010. SRS then chemo carbo/alimta 4x. NED as of 10/2011. Local recurrence, surgery to remove LRL 8/29/13. Chemo carbo/alimta x3.

May 12, 2012 at 5:29 pm  #10199    

Dr West

Yes, and in fact while many docs can be dismissive about the lack of benefit of Tarceva in patients with squamous NSCLC, there actually is evidence of a modest but not negligible benefit for patients with advanced squamous NSCLC overall, and it is FDA approved for such patients. See here:

http://cancergrace.org/lung/2009/09/25/tarceva-for-squamous-nsclc/

-Dr. West


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.

May 12, 2012 at 11:10 pm  #10213    

ilawise26

Thank you Dr.West.
We will discuss this with our doctor.
Does mutation test happen in Biopsy?
In recent biopsy we were expecting mutation testing but the report had no results.
Looks like we will have to inform the lab.


::::Dad (non -smoker/non-drinker, age 53 )diagnosed with NSCLC Stage IV with multiple brain mets in Feb 2012. WBR 15 sessions followed by 3 cycles of chemo with Gemzar/Carboplatin.CT scan May 6,2012 showed no brain mets! Lung metastasis progressed.Did another Biopsy found it to be Squamous NSCLC.May 14,2012 Took Chemo with Taxotere/Carboplatin for 3 cycles(each cycle, tri-weekly schedule).July 13- CT scans-progression observed.Tested positive for EGFR mutation.Erlotinib from Jul 20,once a day.

May 13, 2012 at 2:43 am  #10214    

certain spring

Hallo illawise26. I’ve a squamous tumour like your dad, and a similar diagnosis.
The Tarceva issue is confusing. Occasionally, mutation testing (yes, by biopsy) will throw up one of the mutations that make a patient responsive to “targeted” drugs like Tarceva (it was my good fortune that they found the EGFR mutation in my cancer). However, these mutations are far more commonly found in people with adenocarcinoma.
Dr West’s reply to you was based on the idea that, even in people with squamous tumours and without the mutation, Tarceva can help stabilise the cancer. Tarceva is also a pill, which means fewer hospital visits. If I hadn’t had the Tarceva, the oncologist was offering docetaxol. I didn’t want it because I was in a poor state of health at the time, but as Dr West says it can work for some people with squamous tumours.
Leaving the Tarceva issue aside for a moment, I definitely think it would be worth asking the lab for any more information they can provide about your father’s biopsy. Very best.


49-year-old non-smoker, dx stage IV NSCLC May 2010 (squamous tumour of the left lung with multiple brain metastases). Radiotherapy to chest and brain; progressed through two cycles carbo/gemcitabine. Repeated lung collapses; pneumonia in collapsed lung, Nov 2010; bronchial stent placed, Dec 2010. Declined second-line Taxotere. Mutation testing Feb 2011, surprise EGFR exon deletion 19. Started Tarceva (150mg), Feb 2011. Progression in liver and elsewhere, May 2013.

May 13, 2012 at 3:02 am  #10217    

ilawise26

Thanks a lot for your guidance certain spring.
I had seen you posting actively on this site and thought i should join this.
People like you make a lot of difference.
Wish you all the best and I ‘ll make a note!


::::Dad (non -smoker/non-drinker, age 53 )diagnosed with NSCLC Stage IV with multiple brain mets in Feb 2012. WBR 15 sessions followed by 3 cycles of chemo with Gemzar/Carboplatin.CT scan May 6,2012 showed no brain mets! Lung metastasis progressed.Did another Biopsy found it to be Squamous NSCLC.May 14,2012 Took Chemo with Taxotere/Carboplatin for 3 cycles(each cycle, tri-weekly schedule).July 13- CT scans-progression observed.Tested positive for EGFR mutation.Erlotinib from Jul 20,once a day.

May 13, 2012 at 8:33 am  #10231    

catdander forum moderator

I just wanted to add my example. My husband has a squamous tumor and as far as I know doesn’t have the egfr mutation. He responded (tumor shrinkage) to tarceva a small amount then remained stable for a total of 10 months before progressing. I think that may be on the long side for tarceva on a non mutation tumor but there is good founded hope that tarceva can help.
Good Luck,

May 13, 2012 at 9:40 am  #10234    

Dr West

It’s absolutely a range of how people do, and catdander‘s husband’s results are quite good for someone with EGFR “wild type” (no mutation) but entirely believable.

It’s worth emphasizing that Tarceva is an appropriate option in previously treated NSCLC, even in squamous cell, and even in people whose tumors don’t show an EGFR mutation. In that sense, since it’s an appropriate treatment whether someone has or doesn’t have an EGFR mutation, testing isn’t clearly imperative, especially since seeing a negative result tends to lead some clinicians to recommend against it.

-Dr. West


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.

May 13, 2012 at 10:30 am  #10237    

ilawise26

@Catdander
Its really nice that you shared your husband’s case.
We are waiting for our doctor’s opinion.
Do you have an idea how much time a mutation test takes?

@Dr.West, I hope our doctor has something similar to say and then we may stick with Tarceva.Thanks a lot
for your response.


::::Dad (non -smoker/non-drinker, age 53 )diagnosed with NSCLC Stage IV with multiple brain mets in Feb 2012. WBR 15 sessions followed by 3 cycles of chemo with Gemzar/Carboplatin.CT scan May 6,2012 showed no brain mets! Lung metastasis progressed.Did another Biopsy found it to be Squamous NSCLC.May 14,2012 Took Chemo with Taxotere/Carboplatin for 3 cycles(each cycle, tri-weekly schedule).July 13- CT scans-progression observed.Tested positive for EGFR mutation.Erlotinib from Jul 20,once a day.

May 13, 2012 at 10:57 pm  #10264    

ilawise26

Dr.West, my dad had his biopsy 4 days back.And he has been coughing terribly since then and also has diffilculty breathing.
What could be the reason?
Is it something to worry about?


::::Dad (non -smoker/non-drinker, age 53 )diagnosed with NSCLC Stage IV with multiple brain mets in Feb 2012. WBR 15 sessions followed by 3 cycles of chemo with Gemzar/Carboplatin.CT scan May 6,2012 showed no brain mets! Lung metastasis progressed.Did another Biopsy found it to be Squamous NSCLC.May 14,2012 Took Chemo with Taxotere/Carboplatin for 3 cycles(each cycle, tri-weekly schedule).July 13- CT scans-progression observed.Tested positive for EGFR mutation.Erlotinib from Jul 20,once a day.

May 14, 2012 at 2:27 am  #10270    

catdander forum moderator

I think it warrants a call to his doctor asap to let him know these 2 new symptoms post biopsy just to be on the safe side. Lung collapse isn’t rare after biopsy. Below is a link to a blog post by Dr. Harman. She explains that coughs are from many different causes; cancer, treatment, and of course not related to cancer. She also suggests that it’s not always easy to know. She also explains treatments for cough.
http://cancergrace.org/cancer-treatments/2009/05/09/managing-cough/

Tarceva is a standard option for 2nd line treatment mutation or not. Since you don’t need to have the mutation to receive tarceva 2nd line it’s not necessary to have the testing. Testing requires an ok from insurance and it’s quite possible insurance will deny at least an initial request because he has squamous cell nsclc. The tests take time, a couple of week at best to get results. So while testing may be something he’ll want to do it’s not necessary for 2nd line tarceva.

May 14, 2012 at 2:59 am  #10272    

ilawise26

@catdander.
Thank you for the links.
He went with the biopsy report today and he has been recommended Taxotere/carboplatin chemo on a weekly schedule for 3 weeks.
They say it can be a strong drug so they will see for 3 weeks and if he responds well, then they may continue with it.
As of now, they havent prescribed the Tarceva treatment.
HI first chemo on Taxotere/carboplatin will begin today and he is going to get an xray done for his lungs.
I’m however, going to another doctor tomorrow for a second opinion.


::::Dad (non -smoker/non-drinker, age 53 )diagnosed with NSCLC Stage IV with multiple brain mets in Feb 2012. WBR 15 sessions followed by 3 cycles of chemo with Gemzar/Carboplatin.CT scan May 6,2012 showed no brain mets! Lung metastasis progressed.Did another Biopsy found it to be Squamous NSCLC.May 14,2012 Took Chemo with Taxotere/Carboplatin for 3 cycles(each cycle, tri-weekly schedule).July 13- CT scans-progression observed.Tested positive for EGFR mutation.Erlotinib from Jul 20,once a day.

May 14, 2012 at 3:56 am  #10275    

certain spring

Good for you, ilawise26 – I wish I’d had you around when I was diagnosed! Took me the best part of a year to work all this out.
How are your father’s cough and breathing problems?
It would be really helpful if you could do a forum signature giving details of his diagnosis and treatment so far. Go to “Profile” (via your avatar or at the top of the page) and fill in “Biographical Information”. Here’s a walk-through if you need one:
http://cancergrace.org/topic/grace-site-tips-profile-bio-forum-signature


49-year-old non-smoker, dx stage IV NSCLC May 2010 (squamous tumour of the left lung with multiple brain metastases). Radiotherapy to chest and brain; progressed through two cycles carbo/gemcitabine. Repeated lung collapses; pneumonia in collapsed lung, Nov 2010; bronchial stent placed, Dec 2010. Declined second-line Taxotere. Mutation testing Feb 2011, surprise EGFR exon deletion 19. Started Tarceva (150mg), Feb 2011. Progression in liver and elsewhere, May 2013.

May 14, 2012 at 5:59 pm  #10298    

Dr West

I agree that a possible partial lung collapse is something you’d be concerned about after a biopsy, particularly if someone is coughing a lot, for days afterward.

For people who don’t have an EGFR mutation (which is present in only a minority of people with NSCLC, and quite uncommon in patients with squamous cell NSCLC), starting with a platinum-based doublet like carboplatin/Taxotere (docetaxel) is the current standard. We’d most commonly do a repeat scan after 2-3 cycles (6-9 weeks) to assess the response to therapy accurately. A three-week interval is on the short side to expect to see what’s happening.

-Dr. West


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.

May 14, 2012 at 10:07 pm  #10310    

ilawise26

@Dr.West, I was not informed.
They are going to do two cycles of Taxotere//Carboplatin chemo.
EAch cycle is broken into 3 parts- weekly .
So after 6 weeks and a 15 days gap , they will assess the condition with a scan.

As for the coughing part, the doctor says that the disease which was only in the right lung previously has spread and scattered in the left lung which might be causing the cough and dryness in the throat.
Is there any way i can share the Lung CT scan slides with you Dr.West?


::::Dad (non -smoker/non-drinker, age 53 )diagnosed with NSCLC Stage IV with multiple brain mets in Feb 2012. WBR 15 sessions followed by 3 cycles of chemo with Gemzar/Carboplatin.CT scan May 6,2012 showed no brain mets! Lung metastasis progressed.Did another Biopsy found it to be Squamous NSCLC.May 14,2012 Took Chemo with Taxotere/Carboplatin for 3 cycles(each cycle, tri-weekly schedule).July 13- CT scans-progression observed.Tested positive for EGFR mutation.Erlotinib from Jul 20,once a day.

May 15, 2012 at 1:10 am  #10311    

certain spring

Thanks for doing the signature!
Sorry to hear the latest news. I’m afraid the doctors on GRACE can’t read people’s scans/test results. See the forum guidelines:
http://cancergrace.org/grace-discussion-forums#guidelines
They may be able to make more general comments, however.
All best.


49-year-old non-smoker, dx stage IV NSCLC May 2010 (squamous tumour of the left lung with multiple brain metastases). Radiotherapy to chest and brain; progressed through two cycles carbo/gemcitabine. Repeated lung collapses; pneumonia in collapsed lung, Nov 2010; bronchial stent placed, Dec 2010. Declined second-line Taxotere. Mutation testing Feb 2011, surprise EGFR exon deletion 19. Started Tarceva (150mg), Feb 2011. Progression in liver and elsewhere, May 2013.

May 15, 2012 at 1:17 am  #10312    

catdander forum moderator

ilawise, I’m going to paste #5 of the forum guidelines which can be found here: http://cancergrace.org/grace-discussion-forums#guidelines It will explain why the doctors can’t read and give feedback on scans and reports.

Dr. West states, “We want brief telegraphic highlights of treatments given and how they worked, a quick summary of staging and pathology, but we ask that people notcopy and paste or upload pathology reports, radiology reports, etc. It’s problematic from a confidentiality standpoint, and beyond that, we can’t practically get immersed in the extreme details of everyone’s care. We’re trying to serve a broad population by providing information that can be useful to many people. The more specific the questions get to an extremely unique situation, the more time we are asked to spend to help just a single person. That’s really more in the realm of a person’s own medical team

Related to this, we can answer short questions about terminology of a word or phrase, but we can’t provide very time-consuming, detailed, line by line translations of reports.”

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