Does standard chemo treat bone metastasis?

Portal Forums Lung/Thoracic Cancer Lung Cancer Complications Bone Metastases Does standard chemo treat bone metastasis?

This topic contains 8 replies, has 3 voices, and was last updated by  masalovai 1 month ago.

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March 17, 2018 at 8:12 am  #1294101    

masalovai

I have stage 4 NSCLC adenocarcinoma with bone metastasis. I started carboplatin Alimta Avastin chemo treatment and wondering if this triplet is effectively treating bone metastasis as well….. I am also receiving zoledronic acid every three weeks , but it does treat bone mets.

There are very limited publications related to effectiveness of standard chemo on bone metastasis. I’ve found that targeted drugs such Erlotinib and gifatinib are very effective in treating bone metastasis.

I am afraid of bone mets progression and would like to find out if I can have any treatment for bone mets in parallel with my chemo treatment. Can I probably add gefitinib to my triplet….. ?? I’ve found one paper discussing this combo. They observed some improvement , but only 6 people were involved in the trial.

Thank you

Irina

March 17, 2018 at 8:17 am  #1294102    

masalovai

These are only references I’ve found which related somehow to the treatment of bone metastasis.

I would greatly appreciate if someone could send me more information on this subject .

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5511889/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4599040/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4998527/

Thank you
Irina

March 17, 2018 at 8:51 am  #1294104    
JimC Forum Moderator
JimC Forum Moderator

Hi Irina,

Standard chemotherapy tends to be as effective as any systemic therapy in treating bone metastases, as such therapies treat cancer wherever it is found in the body, with the possible exception of the brain due to the blood brain barrier, where response may be lessened. Adding an EGFR inhibitor would only be considered if your cancer has been found to have an activating EGFR mutation, but even in that situation most oncologists do not feel that there is enough evidence to justify adding an EGFR inhibitor to the chemotherapy regimen. One reason for this is that sequential use therapeutic agents tends to be preferred, allowing a patient to get the maximum benefit from each agent, rather than “using up” several at once.

Treatment of bone metastases may include the use of radiation in order to palliate symptoms such as pain, as well as to prevent fractures. You may want to discuss this option with your oncologist.

The papers you cite show interesting results, but as you indicate the small populations make it difficult to draw any firm conclusions from the data, and larger, randomized trials would be necessary before such approaches gain clinical acceptance. The evidence is especially weak in the case study of an herbal regimen in one patient, as quite unusual results can occur when looking at just a single patient.

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 17, 2018 at 9:58 am  #1294107    

masalovai

Many thanks, Jim , for your prompt reply. I so much appreciate your messages. I fully agree that results of those sources are not reliable enough , but as I’ve mentioned there are very limited literature describing direct effect of chemo treatment on bone mets.

How the combo of chemo therapy is chosen taking in account presence of bone mets? Probably one chemo agent is working better in this specific case than other one…….?

Or probably additional drug could be added to the chemo treatment to help with healing of bone metastasis…?

Can you recommend any publications discussing treatment of bone mets , but not management of pain or bone destruction associated with them.

March 18, 2018 at 10:49 am  #1294113    
catdander forum moderator
catdander forum moderator

masalovai,

It doesn’t matter if the lung cancer metastasized to bone or organ if the systemic treatment works it works where ever it is except the brain. As Jim said chemo doesn’t often make it into the brain because of the protective barrier known as the blood/brain barrier.

The treatment that targets bone mets are the Bisphosphonates such as zometa.

So when reading research about bone mets, metastatic lung cancer, etc., systemic treatment efficacy includes efficacy anywhere outside the brain including bone but there are no specific anticancer agents that target bone.

I hope you do well and are feeling alright.
Best hopes,
Janine

March 18, 2018 at 11:43 pm  #1294116    

masalovai

Thank you, Janine , for your answer. I’ve learned from the literature that Tarceva is very effective for bone metastasis and some oncologists use it together with chemo. I just wonder is it works for people with negative EGFR ……. Probably the choice of chemo combo needs to take in consideration present of bone metastasis…..?

The literature also says that the effect of chemo is quiet limited for bone mets , specifically in lung cancer cases , but I am sure that some chemo agents could be more effective than others.

Unfortunately there is very limited publications in this subject.

I’ve seen in this side that doctors participate to discussions. Is there any chance to have their opinion…….?

Another question: I found just a few recent communications on the subject of lung cancer in this side. All other discussions are quiet old ….. probably I don5 know where to look.

Thank you very much again for your very valuable comments, your time and wish to help people.

All the best

Irina

March 19, 2018 at 12:04 am  #1294117    

masalovai

What is about Disulfiram , which has been found very effective in bone mets….?

https://www.ncbi.nlm.nih.gov/pubmed/25777347

Some other publications are also available. I just wonder if it could be safe with my chemo combo, particularly with Avastin…. I am receiving Carbo,Alimta Avastin.

My second cycle is next week. I also receive Zometa ones in 3 weeks.

March 20, 2018 at 2:49 pm  #1294120    
catdander forum moderator
catdander forum moderator

Unfortunately, there hasn’t been any new developments in metastatic bone health since the advent of bisphosphonates. Even though they are 8-10 years old drugs like zometa are still the standard of care for bone mets plus systemic treatment. There are also orthopedist centered treatments such as vertebra strengthening procedures to help combat bone mets. http://cancergrace.org/cancer-101/category/cancer-101/general-lung-cancer-issues/management-of-bone-metastases/

The study you mention above seems to be the only clinical trial on nsclc and Disulfiram. This trial really only shows that it’s safe and worth studying more but much too small to say adding disulfiram raises survival rates. There are ongoing trials for other cancers so that’s better than nothing. If trials in breast cancer and prostate cancer turn out positive then it’s more likely to be considered to be studied in lung cancer. It’s difficult to get funded for this level of research and it doesn’t sound like there’s much monetary incentive to study disulfiram for the pharmaceutical cos. That’s why the wonderful organizations that raise money for breast cancer are so important. I used to be jealous that breast cancer got all the attention and funding but it’s paid for good research that benefits lung cancer as well.

Our faculty occasionally comments on the forums but not regularly like they used to. I know they can add a lot of reassurance and credence to the discussion and that’s why we use the blog and forum posts as resources. I hope we are still able to help you understand your options moving forward.

All best,
Janine

March 21, 2018 at 1:36 pm  #1294123    

masalovai

Dear Janine

Thank you very much for useful information and all support.

Wish you all the best with your journey.

Irina

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