Avastin After a TIA with or without Taxotere?

Portal Forums Lung/Thoracic Cancer Lung Cancer Complications General Lung Cancer Complications Avastin After a TIA with or without Taxotere?

This topic contains 7 replies, has 4 voices, and was last updated by  scohn 2 months, 1 week ago.

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September 7, 2017 at 8:42 am  #1291435    

kwieder

My 69 year-old wife (NSCLC adenocarcinoma, surgical resection of lower and middle lobs right lung six years ago followed by adjuvant Cisplatin and ???). Cancer returned one year later in both lungs). She’s been on Alimta with Avastin every four weeks for three years with no progression. During this time her blood pressure was always high, even with medication. Six months ago she decided to take a hiatus due to ‘chemo brain’. While on hiatus she had a TIA with no complications. She saw a hypertension specialist who changed medication which brought blood pressure down to normal and has kept it there.

Four months into the hiatus she started to have signs of progression and was put back on Alimta alone every three weeks with dose reduced by 20% but no Avastin due to TIA. After two infusions her symptoms (cough, wet rail sound on exhale,difficulty catching her breath and fatigue) grew worse and she is currently in hospital being treated for possible pneumonia (no fever) or other infection (waiting for cultures). CT shows ‘growth’ of something and Pulmonologist wants bronchoscopy to rule out cause other than cancer.

If growth is cancer, Oncologist opinion is that Alimta is no longer working and wants to switch her to Taxotere, bu veryt reluctant to return to Avastin. My question is since her blood pressure is now under control can she not go back to the Avastin? Since the doublet of Alimta and Avastin kept her progression free for three years we are reluctant to move onto something else.

Is it possible Avastin had a synergetic effect with Alimta – or – was the Avastin alone keeping her progression free? In any case Oncologist wants to go to Taxotere in order to ‘knock it down’ effectively but my wife is very reluctant due to hair loss and other more onerous side effects.

I’ve posted to Cancergrace several times in the past six years and am extremely grateful for the responses which helped enormously in charting a course of treatment. Thank you

September 7, 2017 at 9:53 am  #1291436    
catdander forum moderator
catdander forum moderator

Hi kwieder,

Welcome back, well I’d prefer you not have the need of course but I’m glad you’re wife has done so well for so long. It’s very possible she has an unusual strain of infection like c.diff. People with lung cancer have an elevated risk of developing odd strains of lung infections so it’s great she is being tested for other causes and not assuming it’s the cancer causing her symptoms. If she is found to have an infection it may be her onc will put her back on alimta.

I think most oncologists would be hesitant to move back to avasitin after a TIA even if she has no signs or symptoms. The consequences can be devastating. I even understand a bit the want to try, my husband had advanced squam nsclc so he wasn’t a candidate for avastin just because of an elevated risk of bleeding. I’m sorry for this complication.

If the symptoms are determined to be caused by cancer, (or her onc may want to move forward now with treatment) it’s probably important to use the best studied option to knock out her symptoms. Then if that chemo turns out to be too toxic (including hair loss) she has the opportunity to look at other options.

Abraxane may be an alternative chemo. It’s nanoparticle albumin bound paclitaxel a taxane similar to taxotere and has fewer side effects. It’s explained here, http://cancergrace.org/lung/2010/03/20/prelim-abraxane-vs-taxol-rr-results/

When your wife gets over this bump you might want to look at getting new genetic testing if it’s been 6 years. But that’s for another conversation but retesting in a situation like hers’ is becoming pretty standard for lung cancer specialists.

Keep us posted and best of luck,
Janine

September 8, 2017 at 8:25 am  #1291440    
JimC Forum Moderator
JimC Forum Moderator

Hi kwieder,

Just to add to the good information Janine provided, I think the main concern in using Avastin, despite the lowered risk of stroke due to bringing the blood pressure under control, would be the risk that Avastin would cause bleeding in the areas damaged by the previous TIAs. Her doctors probably believe that there isn’t good enough evidence of the efficacy of Avastin as a single agent to justify the risk.

Anecdotally, when my wife used Abraxane, she had none of the typical symptoms associated with Taxol or Taxotere, so it might be a good option to discuss with your wife’s doctor.

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

September 8, 2017 at 9:06 am  #1291441    

kwieder

Janine, Jim –

Thanks for your responses.

The Bronchoscopy shows the new growth IS the cancer. As I noted above, our oncologist wants to move to Taxotere and this is indeed a serious problem for my wife who has discovered there is the risk of partial to complete permanent hair loss. The manufacturer’s own study shows that 3% of breast cancer patients suffer partial to complete permanent hair loss. Other studies show percentages as high as 6 to 9 percent! I’m assuming this could very well be dose dependent and the dose and frequency for NSCLC can be very different.

However, my wife’s sense of self (like many, if not most women – and many men as well) is very dependent on her appearance. I’m really concerned about the impact that permanent loss of hair, eyebrows, eyelashes would have on her quality of life.

What would be the next best chemo? Is it a mistake to try one with a softer side-effect profile – and then go to Taxotere if necessary? A quick scan of the literature suggests Taxol or Abraxane (as Jim points out). Our first oncologist who unfortunately moved to another city had said that he would move her to Tarceva when Alimta pooped out but that was four years ago.

I’m fully aware that making a choice dependent on hair loss seems foolish to a large degree, but in my wife’s case I’m not sure it is.

  • This reply was modified 2 months, 1 week ago by  kwieder. Reason: Didn't see Jim's response before writing
  • This reply was modified 2 months, 1 week ago by  kwieder. Reason: Didn't see Jim's response before writing
September 8, 2017 at 3:01 pm  #1291444    
catdander forum moderator
catdander forum moderator

Kwieder,

I think you forgot to put the “if not most” between ‘many’ and ‘men’. ;) But seriously hair loss is devastating for most everyone who suffers it. My husband was of the larger group of people who were wrecked by the loss of his hair. He added that it was just another reminder that he had cancer. Her sentiments are the same as every other person who is looking at chemo. If it helps to hear, maybe again, the decision making process is so much more stressful than you realize until it’s over.

The beginning of the article sounds like this might be something your wife might find helpful. https://www.theguardian.com/commentisfree/2016/jan/06/chemotherapy-breast-cancer-victoria-derbyshire

if your wife doesn’t have an activating EGFR mutation tarceva isn’t likely to have better efficacy than a taxane but it has been shown to have efficacy and is often used by those who are frail or unwilling to use a standard chemo drug. There may be a reason your wife shouldn’t try tarceva but in general it could be an option.

It’s not a my fingertips but Dr. Weiss spoke about treatment decisions for his advanced stage nsclc patients being as much about the patients’ personal desires as it is data driven. This is in part because there aren’t always clear choices so making life style and quality of life as important as a few statistical points gathered from thousands of people a real option. Not going into the cancer center for IV infusions can be a huge incentive on its own.

I’m sorry we don’t have easy answers. I’ve asked Dr. West to provide comment if he has something to add.

Keeping you and your wife in my thoughts.
Janine

September 8, 2017 at 3:11 pm  #1291445    
catdander forum moderator
catdander forum moderator

Comments from Dr. West, “Gemcitabine or vinorelbine are agents with some activity sometimes used after first line for NSCLC that cause little or no hair loss. They don’t have a proven survival benefit but are a reasonable choice.”

My husband and others on Grace have taken these drugs with good efficacy. As the saying goes, ‘responders respond’, meaning if you respond to one treatment it’s much more likely your respond to another and vise vers. Your wife responded to alimta a very long time so she likely to respond to another chemo drug. Gemzar and vinorelbine are oldish drugs and are cheap compared to other newer anti cancer drugs including alimta so she shouldn’t have any problem with insurance or health system paying.

Janine

September 8, 2017 at 3:54 pm  #1291446    
catdander forum moderator
catdander forum moderator

To add to those who move on the something other than a taxane here is a link to a wonderful member, scohn whose wife is moving on to Gemzar. http://cancergrace.org/topic/onward-ever-onward-to-gemzar#post-1291439

September 8, 2017 at 9:38 pm  #1291448    

scohn

Kwieder,

I just wanted to wish you the best for whatever path you and your wife end up choosing. There is no one right way, and my wife and I have been amazed at the degree of freedom our oncologist has given us, both in terms of treatment options, and in terms of timing of treatments. It has become clear to us that there are no completely ideal treatments, and that the important thing is to maintain an open conversation with your oncologist of concerns and thoughts and reasonings behind different treatments and approaches.

Every path is unique, but I just wanted to lend my support and let you know that there are those of us out here who will be holding you in my thoughts and prayers.


Wife, lifelong non-smoker, dx 4/24/15 adeno NSCLC stage IV, poorly diff. 2 bone mets, 1 lymph node. HER2 Exon 20 mutation. 6x Carbo/Alimta – >50% reduction in primary tumor, lymph nodes, & bone. Alimta maint. not effective, tumor growth, new liver mets. 11/15 – Opdivo; Not effective-add’l growth. 4/16 – clinical trial drug, large reduction of tumor and mets. 11/16-main tumor growth, liver mets stable. 2/17-All Stable. 8/17- Add’l growth-off trial, 9/17 start Gemzar-large tumor reduction.

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