Chemo vs WBR

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March 11, 2015 at 10:31 am  #1268854    


My brother, 50 years old, has Stage IV NSCLC (adeno);diagnosed September 2013; inoperable; no relevant mutations. He had undergone radiation to lung and several rounds of chemo (Carboplatin, Taxotere, Cisplatin, Gemzar). He also had surgery to remove one brain met (January 2014) and one kidney (May 2014)… CT scan in December showed no mets outside lung and lymph nodes….

He started Tarceva this January but it seems it did not work as the cancer spread to brain…. 9 mets were identified in the initial MRI 2 weeks ago but the subsequent MRI right before yesterday’s gamma knife procedure (which removed 7 mets) evidenced numerous other tiny/small tumors spread all over the brain….He has been in relatively good condition (eating well, no weight loss) until these new mets emerged (which affected his walking and reading ability)…. He is fine now again…

My question is: under these circumstances what would be the preferred strategy? To first do WBR (knowing that meanwhile and several weeks after he won’t have chemo, thus new mets will likely occur) or start chemo for a few rounds (knowing that meanwhile the brain mets will likely grow in size; his cancer cell type is very aggressive)….

Thank you for any opinion/insight….


March 11, 2015 at 2:09 pm  #1268863    
catdander forum moderator
catdander forum moderator

Hi Aurora, I’m sorry about all your brother’s difficulties.

Like other systemic treatments tarceva isn’t expected to have efficacy in the brain. There is growing evidence suggesting some people do have efficacy from tarceva in the brain but it’s probably more typical for tarceva not to have efficacy in the brain. And it shouldn’t be assumed tarceva isn’t working outside the brain as was hoped.

It’s typical to treat brain mets, especially symptomatic brain mets as the first order of business since they can cause the most debilitating issues and as such are treated first. In the link that follows Dr. West gives a brief overview from an MDA study showing a group of people actually did fine while taking tarceva while having WBR. So perhaps there won’t be need to stop completely or at least long enough to make much or any difference.

Let us know what your brother decides,


March 11, 2015 at 5:06 pm  #1268868    


Dear Janine,

Thanks so much for your response and insight into my brother’s situation….

Unfortunately, his oncologist stopped Tarceva once she found out about the new brain mets (last Friday)… He is currently scheduled to have WBR starting March 23 for 5 sessions (the maximum he can have). But right now he has no systemic treatment, and he will be without any for a while – I understood there is a waiting period after WBR before chemo can be started (not sure how long)…..

So, I wonder whether he can be put back on Tarceva until he can start chemo again (he will have a CT scan for his chest and abdomen this Friday, which might tell us whether Tarceva worked at least outside the brain)….

Also, I wonder what other chemo options (after WBR) are still available in his situation…. His last chemo was 6 cycles of cisplatin and Gemzar (evey 3 weeks, followed by Gemzar alone in the fifth day of each cycle); he was stable from July to November, when he switched to Tarceva… is it still possible to go back on this combination? Or try something new – eg, Navelbine (he is adeno, and am not sure if Navelbine is generally recommended)?

Many thanks again (and I am happy to see that your husband remains NED!!).

March 12, 2015 at 4:54 am  #1268871    
JimC Forum Moderator
JimC Forum Moderator

Hi Aurora,

I am sorry to hear of your brother’s brain metastases. I hope that WBR is effective and that its side effects are manageable.

Navelbine would certainly be an option, although the best-tested drug in this situation is Alimta (pemetrexed). He could also consider a clinical trial of new agent, such as the immunotherapy drugs currently being tested. He may want to discuss this option with his doctor, and you can search for trials available in your area at the site. Many trials will require that his brain mets be controlled prior to entry into the trial.

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:

March 12, 2015 at 1:53 pm  #1268878    


Dear Jim,

Thank you so much for the information; I really appreciate it!

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