challenging case

Portal Forums Lung/Thoracic Cancer NSCLC Stage IV NSCLC challenging case

This topic contains 6 replies, has 4 voices, and was last updated by  sima 5 years, 11 months ago.

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July 8, 2012 at 11:04 am  #1244128    


My dad was diagnosed with lung cancer in october 2011 the tumor was in his upper right lobe and they took the tumor and the upper and middle right lobe.
the pathology report was peripheral adenocarcinoma mixed type
He then undergo chemotherapy for 4 month. upon complaining of stomach discomfort and CT scan they diagnosed him with Adrenal cancer.
They put him on Tarceva for 30 days in hope of shrinking the tumor it did not work he had a surgery 2 weeks ago and they removed 95 percent of the tumor and they did Adreanaloctomy and they blocked celiac nerves to reduce pain.
The pathology report was metastatic pulmonary moderately differentiated adenosquamous cell carcinoma The doctors don’t believe the cancer spread to any other organs at this point.
the next treatment they are suggesting is Almita
He lives overseas and I am desperately seeking more info and options
Can anybody help me and tell me if the treatment is right for him or if there is other treatments that he needs to go through.

Thank you so much for your attention and responses

July 8, 2012 at 11:18 am  #1244141    
Dr West
Dr West

I agree that his is a challenging case, as it appears that he has demonstrated progression through what are very appropriate therapies. I’m sorry to learn that his treatments up to now haven’t been effective. Alimta (pemetrexed) now seems reasonable, though we would expect it is far more likely to be effective against the non-squamous than the squamous portion of the cancer.

Here is some information on treatment options generally used for patients who have progressed after prior chemo for NSCLC:

Good luck.

-Dr. West

July 8, 2012 at 12:06 pm  #1244173    
catdander forum moderator
catdander forum moderator

Hello sima and welcome to Grace. I’m sorry to hear your dad is so sick and so far away. I know that must be very difficult. I’m not sure how much you understand about lung cancer but I think it will be very helpful for you to do some reading about lung cancer and standard and not so standard treatments. In reality there are very few “standard” cases, all stage IV lung cancers are challenging in their own way.

It sounds like your dad had curative surgery after dx and adjuvant treatment (chemo after surgery). But he progressed in the adrenal gland.

4 to 6 treatments with a platinum drug is considered about all a person can handle safely.

If he didn’t respond to tarceva he probably doesn’t have an egfr mutation and still may have an ALK or ROS1 rearrangement/mutation for which there is a targeted therapy.

Below are some links that may be a helpful starting point in your search for information.

the first link discusses the use of alimta in adenosquam nsclc.

July 8, 2012 at 12:22 pm  #1244174    
catdander forum moderator
catdander forum moderator

sima, I forgot to mention we are implementing a new forum setup that includes the way in which doctors reply to posts.

Anytime you have you have a question you can’t find an answer to through the search please create it in the link below so I can practice getting it to the proper doctor for an answer.

Thanks again

July 8, 2012 at 5:15 pm  #1244223    


Thank so much for all this info .

July 9, 2012 at 5:02 am  #1244757    



If it is a stage IV adenocarcinoma or adenosquamous lung cancer, can you name any mutation tests (molecular rearrangement) tests that have been done? For example, was it tested for EGFR before trying Tarceva, or was that just a guess that didn’t work? If it was not EGFR-driven (if it was EGFR negative or ‘wild type’), was it tested for ALK? If also negative for that, was it tested for the not-so-useful KRAS? If negative for that, for ROS1? (A person almost always has only one driving mutation initially, so they might be tested in a sequence like that until the right one is found.)

If I recall correctly, ALK is very rare in squamous and ROS1 hasn’t been found in squamous before, but either can occur in adenocarcinoma and theoretically could appear in either of those or adenosquamous. They are rare (4% and 1% chance), but the odds of what’s left go up as you rule out more common ones like EGFR and the not-so-useful KRAS. Being a never-smoker also improves the odds (since smoking makes KRAS more likely). ALK- and ROS1- driven cancers can usually (not always) be controlled for a number of months with Xalkori (crizotinib). Xalkori is not available in every country, so it might be useful to know where you and your father each are (which countries). Some countries allow a doctor to prescribe a drug for other uses once it’s approved there, although it might be difficult to get insurance to pay for an “off-label” use (at least until it’s proven to actually work on the patient). (In the USA this drug is only approved for ALK but the early results from the ROS1 trial here are just as good or better.) Without insurance or assistance from the drug company, Xalkori is crazy-expensive (about $100,000 per year).

Best hopes,


- Stage IV never-smoker ROS1-driven m-BAC indolent adenocarcinoma
– Dr. Alice Shaw’s Xalkori (crizotinib) for ROS1 trial @ MGH, Boston (5 yrs)
– carboplatin + pemetrexed (7 mo)
– TPX-0005 for ROS1 trial @ MGH (starting June 2017)

July 9, 2012 at 10:38 am  #1244769    


Craig, thank u so much for a very useful and detailed reply. I would definitely look into that .

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