Carbo/Alimta vs. Alimta only

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April 27, 2016 at 9:51 am  #1273796    


Had we started chemo after the scan 1 1/2 months after chemo/rad., they would have given him CARBOPLATIN + ALIMTA. Now 5 months after chemo/rad. with scan showing the reduced size 4cm tumor stable with progression to one lymph node, dr. says she’d give ONLY ALIMTA.

I would think since now in a lymph node, I would think they would want to hit it with the stronger combo including Carboplatin with the Alimta, and if it gets a good response keep going for 4 – 6 rounds, and then go on maintenance with Alimta.

I think the dr. is trying to give him the least chemo possible to give him the most healthy feeling time, which I can understand, but do you think Alimta could really work as good as the Carbo/Alimta.

If he only had the 2 rounds with cisplatin/etoposide, is chemo he would get now already considered maintenance .. I don’t see how

8/16 ——— DX 8 cm tumor RUL abutting bronchial tube and pleura
9/16 – 10/16 Rad./Chemo (cisplatin/Etoposide)
12/16 — CT showed tumor shrank to 4cm Wait & Watch
4/16 —– 4 cm tumor shrank tiny bit more, one lymph node near the tumor lights up

April 27, 2016 at 5:46 pm  #1273802    
JimC Forum Moderator
JimC Forum Moderator

Hi healmymom,

Dr. West often states that treatment for advanced lung cancer is intended to be a marathon, not a sprint. I can’t know for certain his doctor’s thought process in originally planning carbo/alimta, as evidence tends to show that giving additional chemo after standard chemorads does not increase survival. But his doctor may have originally planned for carbo/alimta is chemorads had seemed ineffective, but when the tumor shrank that plan changed.

It’s also typical to drop the platinum agent when moving to second-line therapy, as the toxicity of the platinum drug can be difficult to tolerate, and can deplete bone marrow to the point that a patient has difficulty tolerating any standard chemo. With just one lymph node lighting up (and they can do so for reasons other than cancer) while the tumor continues to shrink or at least remain stable, the extent of progression is unclear. Although we lack the full information that his own doctors possess, it might even be reasonable to watch and wait at this point. But if a small amount of progression is suspected, treatment with a single agent would be pretty typical, not just to make side effects more tolerable, but to preserve the ability to tolerate further treatment. Alimta tends to be quite tolerable for many patients on a longitudinal basis, which is why it’s often chosen in this context.

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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:

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