treat or not treat

Portal Forums Q&A, Ask Us New Questions treat or not treat

This topic contains 4 replies, has 3 voices, and was last updated by catdander forum moderator catdander forum moderator 1 month ago.

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September 18, 2017 at 5:56 am  #1292420    

kkh130

Hi,

My father-in-law just got admitted to ICU from ER due to heavy urine bleeding (the ER doctor couldn’t stop the bleeding). He is 97yo and diagnosed for advanced prostate cancer metastases to bladder/intestines (so far no pain) and DIC. His platelet is very low. He was also treated aspiration pneumonia (mild) when admitted to ER.

My questions are:
1. How to stop the bleeding? Can radiation work?
2. He is 97 yo. Is it worthy to actively treat with drugs? If yes, What kind of drugs we should consider? LHRH agonists, LHRH antagonist, antiandrogens, or androgen synthesis inhibitors? Which one is easier to tolerate/less side effects?
3. Will Sipuleucel-T work and relatively safe to use compared to other drugs?

Please help…

Thank you,

Kkh


Diagnosed in 2014 stage 4 nsclc. EGFR+ (also positive for t790m). 1 year on Tarceva, then 8 months on Rociletinib, then WBR following by 7 months on Tarcrva pulse/carboplatin/avastin/alimta, then 7 month on Tagrisso. Was diagnosed leptomeningeal metastasis Nov 2015. Now has 10cm big tumor and multiple nodules with different sizes. Most recent guardant test (Feb 2017): TP53 C277F 29.8  EGFR Exon 19 Deletion 20.1  EGFR AMP ++  MET H1112Y 0.1  MET AMP +  FGFR1 AMP ++  PIK3CA AMP +  CCNE1 AMP ++  BRAF AMP +  MYC AMP ++  Additional Alterations  BRCA1 R7C 0.3  MTOR K1197E 0.2  NF1 V1762V 0.2  MET E436K 0.1  JAK2 V617F ND  MAP2K2 E66K ND 

September 18, 2017 at 9:59 am  #1292422    
JimC Forum Moderator
JimC Forum Moderator

Hi Kkh,

I’m sorry to hear of your father-in-law’s diagnosis and recent symptoms. From what I’ve read, radiation can irritate the bladder and cause urinary bleeding, but I don’t know if it could be used to as a treatment for it. Unfortunately, we don’t currently have a prostate cancer specialist on our faculty to whom we could refer your questions. In any event, treatment options for a 97 year old man would involve individualized choices based carefully on an assessment of his overall well-being (“performance status”)vas well as any other medical conditions he may have. His own oncologist, and perhaps another oncologist providing a second opinion, would best be able to judge whether there is a treatment appropriate for him, which could be effective while not causing other problems.

I hope they can find a therapy for him, either to directly treat his cancer or alleviate his symptoms.

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

September 20, 2017 at 11:09 pm  #1293143    

kkh130

Hi JimC,

His blood test shows agranulocytosis (suspected possible leukemia). The doctor suggests to do bone narrow biopsy to confirm leukemia. He’s 97yo. I would like to know is there any high risk associated with bone narrow biopsy. Any pain?
Are there any oral target drugs or immunotherapy he can take? and also easy for him to tolerate based on his age? We hope the treatment can bring back up a little bit his white blood cell, so he is not constantly infected with pneumonia.

Thank you,

Kkh


Diagnosed in 2014 stage 4 nsclc. EGFR+ (also positive for t790m). 1 year on Tarceva, then 8 months on Rociletinib, then WBR following by 7 months on Tarcrva pulse/carboplatin/avastin/alimta, then 7 month on Tagrisso. Was diagnosed leptomeningeal metastasis Nov 2015. Now has 10cm big tumor and multiple nodules with different sizes. Most recent guardant test (Feb 2017): TP53 C277F 29.8  EGFR Exon 19 Deletion 20.1  EGFR AMP ++  MET H1112Y 0.1  MET AMP +  FGFR1 AMP ++  PIK3CA AMP +  CCNE1 AMP ++  BRAF AMP +  MYC AMP ++  Additional Alterations  BRCA1 R7C 0.3  MTOR K1197E 0.2  NF1 V1762V 0.2  MET E436K 0.1  JAK2 V617F ND  MAP2K2 E66K ND 

September 21, 2017 at 8:57 am  #1293150    
JimC Forum Moderator
JimC Forum Moderator

Hi Kkh,

The Mayo Clinic has a good page describing the bone marrow biopsy procedure and possible side effects, which you can find here.

There are different types of leukemia, with corresponding treatment regimens, so a consideration of possible therapies will need to be assessed after the results of the biopsy are in.

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

September 21, 2017 at 9:37 am  #1293151    
catdander forum moderator
catdander forum moderator

I really appreciate you asking the questions about whether this will add or take away quality of life for your father in law. At 97 with an advanced cancer I suspect he is pretty fragile already and probably has his own thoughts on the subject. There are quite a few palliative care specialists who specialize in geriatric and/or cancer care. It could be very helpful to consult with one of these doctors. Many doctors are hesitant to talk about whether it’s appropriate to consider not proceeding with a work up or treatment. It may be necessary to broach the subject with some information and specific questions of your own. These decisions are so individual that decisions can only be made in an individual basis.

Below are a couple of links to what to expect from a bone marrow biopsy. First one from a 50 yr old whose gotten several. With a focused mind she’s learned to take them in stride. The second from the Mayo Clinic.

http://www.myelomacrowd.org/diagnosing-multiple-myeloma-what-is-a-bone-marrow-biopsy-and-does-it-hurt/?gclid=EAIaIQobChMIp63wxtK21gIVSlmGCh3XXAhxEAAYASAAEgJKPfD_BwE

http://www.mayoclinic.org/tests-procedures/bone-marrow-biopsy/basics/what-you-can-expect/prc-20020282

Also from the mayo clinic link, “Bone marrow exams are generally safe procedures. Complications are rare but can include:
“Excessive bleeding, particularly in people with low numbers of a certain type of blood cell (platelets)
Infection, especially in people with weakened immune systems
Long-lasting discomfort at the biopsy site
Penetration of the breastbone (sternum) during sternal aspirations, which can cause heart or lung problems”

Like all cancers treatments depend on stage and mutation findings among others and include chemotherapy, immuno biologics, targeted treatments, radiation, and stem cell transplant.

I hope some of this info is helpful in decision making and hope you keep us posted.
All best,
Janine

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