Avastin maintenance for nsclc that metastasized to brain

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March 30, 2018 at 4:39 pm  #1294155    

ccccathyiam

My friend was diagnosed. nsclc 2008, had lung lobectomy and f/u radiation and 6 yrs on Avastin. Taken off I 2014 and mets to brain 2016. Surgical removal of lg tumor and radiation to small one. 3rd tumor 10 mos later w gamma knife w much swelling. 3 mos later 4th tumor treated w gamma knife left rad necrosis and increased swelling. Could not tolerate steroids so back on Avastin for 6 mos removed swelling. Now provider stopped Avastin. Would ongoing Avastin for maintenance be indicated or some other treatment at this point? She tolerates Avastin well.

March 31, 2018 at 7:35 am  #1294159    
JimC Forum Moderator
JimC Forum Moderator

Hi ccccathyiam,

Welcome to GRACE. There is doubt about the value of long-term Avastin maintenance. As Dr. West has stated:

“We really don’t know how much Avastin (bevacizumab) as a single agent adds…and many specialists think it’s relatively little. But there are no trials done that directly answer that question.

I think that Janine’s point about a treatment break is a fair one, as I think the most relevant question is whether your cancer would demonstrate the same pattern of very slight progression over a very long time if you’re on Avastin, chemotherapy, some other targeted therapy, or no treatment at all. These treatments have very real cumulative side effects, so it is very appropriate to at least question how much they’re really needed and not reflexively treating without end, just for the sake of doing more and more treatment.”http://cancergrace.org/topic/avastin-maintenance-when-to-stop#post-1263480

That’s not to say that it may not help a particular patient, but in general there is no solid evidence about the value of such maintenance. In your friend’s case it’s impossible to know if the swelling would have decreased on its own without treatment or if the Avastin actually helped. In the absence of any continued progression, your friend’s oncologist very reasonably recommend withholding further treatment until there is a demonstrated need for it.

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

March 31, 2018 at 7:54 pm  #1294163    

ccccathyiam

Thank you. We will ask the oncologist if there are any clinical trials for which my friend would be eligible. Cathrine

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