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February 18, 2018 at 12:57 pm  #1293991    


My brother diagnosed Mar 2013 NSCLC IV ALK+. Cis/ Alimta then Alimta maintainance. Xalkori. Ceritinib,. WBR October 2017 because of LMD, straight after Blood clot in lungs and started blood thinner and still on Oxygen, From last two months on Alectinib but not effective and now disease progress to liver and Pancreas. He got tumour in bike duct and bilirubin shoot up, started taking Steroids and bilirubin reduce but LFt shoot up to 600 and doctors are not doing ERCP because they are suggesting he is on 6 litre of oxygen and oxygen must drop to already 2 which seems impossible, normally what to expect and any way out? Any example of patient who has successfully have ERCP while on Oxygen or some one has used Nivolumab which has good effect on liver mets but heard not good for ALK+? Any example or suggestions to over come this situation?

Kind Regards

February 18, 2018 at 4:33 pm  #1293995    
JimC Forum Moderator
JimC Forum Moderator

Hi ikhlaq1,

I am sorry to hear of the progression of your brother’s cancer and the other issues he is facing. It sounds as though his doctors feel that because of his overall condition, he is not strong enough for the ERCP, and that such a procedure would only be treating one of the several problem areas without addressing the others. They are in the best position to make that determination, which is done on a patient by patient basis.

It’s true that immunotherapies such as nivolumab (Opdivo) do not tend to be very effective for patients with targetable mutations such as ALK or EGFR, although the response rate is not zero. Barring that, the next step would usually be another standard chemotherapy regimen.

Although it is difficult and often avoided by patients, loved ones and oncologists, what may be necessary at this point is a frank discussion with your brother’s doctor about the feasibility of further anti-cancer measures, and whether they are likely to help or hurt him. There are two goals addressed by treatment for stage IV lung cancer. The first is to prolong life, while the second is to improve quality of life. As my late wife’s oncologist put it, there comes a point at which the focus shifts from an emphasis on the first goal to a focus on making a patient as comfortable as possible.

My thoughts are with you and your family as you seek the best path for your brother.

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

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