When should I start next therapy of multi focal GGO?

Portal Forums Lung/Thoracic Cancer NSCLC Bronchioloalveolar Carcinoma (BAC) When should I start next therapy of multi focal GGO?

This topic contains 11 replies, has 4 voices, and was last updated by catdander forum moderator catdander forum moderator 2 months, 2 weeks ago.

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November 27, 2016 at 10:12 pm  #1289272    

homeofheart

Age 78 Japanese
2003   (photograph a very low contrast image (not diagnosed)  X-ray LUL S3)
2004 DX a GGO LUL S3
Feb 17 2005  progression to three GGOs RUL RLL
Feb 23 2005 partial resection a 1cm BAC RUL S3
lobectomy a 3.3cm AD mixed BAC LUL S3
Jan 25 2008 progression max 1 cm multi focal GGOs RLL S8 S9
development primary max 1 cm multi focal GGOs LLL S9
Feb 8 2008 partial resection two max 1 cm multi focal GGOs RLL S8 S9
Apr 25 2008 progression multi focal GGOs RLL
May 2 2008 progression LLL
development primary GGO RLL S9
May 11 2008 a round of Carboplatin Paclitaxel
Jul 11 2008 start Tarceva
Sep 26 2008 stable RL
stable or shrinkage LL
Nov 18 2008 NED
Jan 19 2015 development an 8mm primary GGO LLL
Apr 20 2015 development a 4mm primary GGO RLL
May 7 2015   progression to two GGOs (8mm) LLL
progression to two GGOs (4mm) RLL
Jun 8 2015 stop taking Tarceva
Jun 26 2015 partial resection a tumor (11mm) RLL S6  EX20 T790M+ EX21 L858R+
watch and wait a GGO LLL
Sep 28 29, Oct 1 2 2015 SBRT 48gray X ray a GGO (12mm) RLL S6
Dec 4 2015 Radio Frequency Ablation a GGO (16mm) LLL
Jan 5 2016 lung capacity 3.55L predicted vital capacity 3.27L
Mar 8 2016 progression to multi focal GGOs RLL watch and wait
Jun 7 2016 progression to two GGOs LLL
Sep 27 2016 progression to multi focal GGOs (13mm 5mm etc) LLL
Nov 22 2016 no growth multi focal GGOs (5mm) RLL
progression to three GGOs (20mm etc, slow growing) and multi focal GGOs (not growing) LLL
Jan 24 2017 next CT scan and consultation

My Dr. showed me two options, Watch and Wait or Radio Frequency Ablation (not right now) to three GGOs in LLL.
He thinks drug therapies are possible but not now.

I would like to ask to Cancer Grace.
What is the best timing, situation to start next therapy and option?

November 28, 2016 at 8:27 am  #1289273    
JimC Forum Moderator
JimC Forum Moderator

Hi homeofheart,

Welcome to GRACE. I’m sorry to hear of your diagnosis, and it certainly has led you on a long journey. The length of time since your initial diagnosis indicates that your cancer is quite slow-growing, as BAC often is. Dr. West, a leading authority on BAC, stresses that it should not be overtreated, since that can cause more harm than good. Though we can’t express an opinion on what you should do in your particular situation, Dr. West has created an algorithm to aid in decision-making in cases of indolent BAC, which you can find here. You will see that when progression is slow, watching and waiting can be a very appropriate strategy.

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

November 28, 2016 at 3:56 pm  #1289277    

cards7up

Jim, your forgot to post the link for the algorithm for BAC. Take care, Judy


Stage IIIA adeno, dx 7/2010. SRS then chemo carbo/alimta 4x. NED as of 10/2011.
Local recurrence, surgery to remove LRL 8/29/13. 5.2cm involved pleura. Chemo carbo/alimta x3. NED

November 28, 2016 at 4:10 pm  #1289279    
JimC Forum Moderator
JimC Forum Moderator

Thanks, Judy. I’ve fixed that now.

Best,

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

November 29, 2016 at 5:26 am  #1289285    

cards7up

Jim, sorry no way to contact the moderators. So wanted you to check out this advertisement.

Take care, Judy


Stage IIIA adeno, dx 7/2010. SRS then chemo carbo/alimta 4x. NED as of 10/2011.
Local recurrence, surgery to remove LRL 8/29/13. 5.2cm involved pleura. Chemo carbo/alimta x3. NED

November 29, 2016 at 6:24 am  #1289288    
JimC Forum Moderator
JimC Forum Moderator

Thanks, Judy. I took care of the post, and removed the link in your email.

I appreciate your help.

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

December 15, 2016 at 6:54 pm  #1289555    

homeofheart

JimC
Thank you for your quick response and advice.
I have read some of Dr. West’s pages.
While my Dr. team “radiologist, surgeon and oncologist” has reached to conclusion. 
My lesions are too many to treat with Radio Frequency Ablation.
And a vascular is closer to a lesion which can not be specified as tumor.
Also, I think progression speed is 3mm par 3months, which is faster than so-called indolent shown by Dr. West.
My oncologist showed me an option, new EGFR TKI. This is match to Dr. West’s algorithm.
I am going to talk with the oncologist more next year.
I appreciate your advice and information.
homeofheart

December 16, 2016 at 2:55 pm  #1289560    
JimC Forum Moderator
JimC Forum Moderator

Hi homeofheart,

That sounds like a reasonable plan. The only point I would add is that measuring small lung cancer lesions is by no means an exact science. Since those lesions don’t tend to be smooth and round, the radiologist must try to find spots which represent the largest extent of the lesion in each dimension. Plus, the appearance of a lesion may differ by a millimeter or two based on how the CT images from different scans “cut”. So when you’re dealing with an increase of 3mm, it’s good to have a discussion with your medical team about their overall sense of the growth rate. Medicine can be just as much an art as a science.

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

January 14, 2017 at 8:26 pm  #1289796    

homeofheart

JimC

Thank you for your advice.
What I have made sure to my onc.up to dated, growing rate is 5mm per 8 months and GGO size is 18mm.
He said I have enough time to check mets with PETCT, MRI and blood test.
He suggested Tagrisso for next therapy, but he is discreet in starting it because of interstitial lung disease.
I can understand him. A data shows 6.3% of people who on Tagrisso developed ILD.
I do not know how they avoid / prevent or overcame the life threatening ILD.
Best wishes

homeofheart

January 15, 2017 at 9:44 am  #1289799    
JimC Forum Moderator
JimC Forum Moderator

Unfortunately with TKI-induced ILD, the usual recommendation is to discontinue the TKI and not return to it, which would be considered extremely risky.

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

April 7, 2017 at 8:45 pm  #1290539    

homeofheart

My onc. recommended me to start Tagrisso, and explained the earlier start brings the better effect.
Then I have started Tagrisso on Mar. 8 2017.
After three weeks, at least three X ray tumor images got fade. I am waiting for a check with CT scan.
Side effects are blepharitis, fatigue, decreased liver function, diarrhea, hives and paronychia so far.
Thank you for all of advice.

homeofheart

April 8, 2017 at 11:08 am  #1290541    
catdander forum moderator
catdander forum moderator

homeofheart Hi,

I hope the CT scan proves tagrisso is working well and I hope you can find some relief from the side effects.

Janine

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