Stage IV lung adenocarcinoma - 1254161

hanty
Posts:6

Hello,

My mother never smoke but she was diagnosed with lung cancer last June. She felt hard to breathe and went to the hospital where doctors found that she had pericardial effusion, and adenocarcinoma cells were found in the sample. But CT scan showed no particular tumor in her lungs. Doctors said it's stage IV.

She then took centesis in the pericardium and six rounds of chemo therapy: first time using pemetrexed, the next three times pemetrexed and cisplatin/nedaplatin, and the last two times still pemetrexed only.

Things were getting better then : the pericardial and pleural effusion almost disappeared and all the related indicators like CA125, CEA, CYF all were back to normal range. She felt better and gained some weight. We were so happy then and the doctors asked her to take a three-month break.

But the recent review in January showed that the cancer indicators were high again. CT scanning shows more shadows in both lungs. Now she's taking chemotherapy of docetaxel and oxaliplatin. Doctors said she has to do three rounds and then re-check the cancer indicators.

I was so worried. This new chemo treatment seems to have worse side effect on here compared to pemetrexed. She has loose bowels often and is almost bald now.

What should we do next if the docetaxel and oxaliplatin failed to stop the cancer growing? Shall we consider using Irresa or are there any other options? Some doctors said that Irresa is the last resort and some patients could develop resistance quickly, in three to six months. Is it true?

Looking forward to any suggestions. Thank you!

Forums
Full Archive

Reply # - February 25, 2013, 11:09 AM

catdander
Posts:

Hello hanty, I'm very sorry to know your mother is having difficulty with treatments. Docetaxel is known to have possible difficult side effects such as loosing ones hair, fatigue, and peripheral neuropathy. It isn't common to treat lung cancer with oxaliplatin (It's been researched in India in treating colon cancer I believe) so I don't have any input on side effects that may come from that drug. Also more than 6 cycles of a platinum drug can cause hypersensitivity and isn't normally given after 4 or 6 cycles. However side effects usually subside when treatment with the offending drug is stopped. Our doctors are all very adamant on the idea that treatment for stage IV nsclc is to both lengthen life and to save or raise the quality of life. It's a delicate balance and you obviously have the right idea about making her feel well. here is a discussion with Palliative care expert Dr. Harman, don't miss the related post at the end. http://cancergrace.org/cancer-treatments/2012/07/26/what-is-palliative-…

I will contact a faculty to give expert input on your post. In the meantime I've pasted some links to expert discussion on 2nd and further lines of treatment. Also the first one discusses typical approaches for assessing response.

Thanks for your questions and I hope you mother feels better soon,
Janine

http://cancergrace.org/cancer-101/2010/09/16/cancer-101-faq-assessment-…

http://cancergrace.org/lung/2010/10/04/lung-cancer-faq-2nd-line-nsclc-o…

http://cancergrace.org/lung/2012/08/27/socinski-tailor-trial/

Reply # - February 25, 2013, 04:26 PM

Dr Laskin
Posts: 34

Dear Hanty

i'm sorry to hear about your mom, sounds like she's having a tough time with the latest chemo. As Janine says docetaxel and oxaliplatin are commonly associated with the side effects you've mentioned.

In terms of what chemo might come next, in part it depends on where you/she lives and what's available - are you in the USA? i ask because some of the chemos you've mentioned would not be the most commonly used for lung cancer and i don't think Iressa is available in the USA. in any case, i would say she's probably had enough drugs with platinum in them, and after 6 cycles of docetaxel that's probably enough too.

in general a third-line treatment with an EGFR inhibitor such as Iressa or Tarceva would be a very reasonable next choice. yes, sometimes it only works for a few months but there are relatively few side effects (compared to what she's on now it would be much easier to tolerate and therefore much better for her quality of life) and sometimes it can stabilize or shrink a cancer for many months and sometimes years. As she is a never smoker, she has an even greater chance of benefiting from an EGFR inhibitor (because never smokers have a higher chance of having an EGFR mutation which makes the cancers highly sensitive to these drugs). So i would say that would be a great option to consider.

I'm also always in favour of clinical trials, should one be available to her.

best of luck

Dr Laskin

Reply # - February 25, 2013, 07:37 PM

hanty
Posts: 6

Hi, Dr Laskin,

Thanks for the reply. I'm Chinese, my family all live in China. I understand clinical solutions here may be different from the US. And that's why I seek for suggestions on Grace, it's not that I don't trust my mother's doctor - he is professional and experienced in dealing with lung cancer - but I just want to be well informed of all possible ways to make my mother live a better and longer life. She's only 54 years old and has been very healthy before being diagnosed with cancer.

Perhaps we should stop chemo after the three rounds of docetaxel and oxaliplatin and consider the targeted therapy. Or can we just go back to the signle agent of pemetrexed? It had proved to be effective before.

I don't know Iressa is not available in the US, it is so widely used in China. Since you've mentioned Tarceva, which one do you think is more proper in the case of my mother, Iressa or Tarceva?

It's unrealistic for us to go to the US, but thank you for the kind offer.

Reply # - February 25, 2013, 08:52 PM

Dr West
Posts: 4735

One important question that is very critical is whether her cancer has an EGFR mutation. A Chinese woman who never smoked and develops a lung adenocarcinoma has an approximately 60-70% chance of having a tumor with an EGFR mutation, which would have a very high probability of responding very well and for a long time to Iressa (gefitinib). The available evidence strongly suggests that in people who have an EGFR mutation, Iressa is every bit as good as Tarceva (erlotinib), but in those without an EGFR mutation, Tarceva might be a more effective option. The data are stronger supporting a survival benefit in patients who receive Tarceva if they don't have an EGFR mutation.

One other possibility is that she might have an ALK rearrangement. If so, she would have a good chance of responding well to the ALK inhibitor crizotinib, which I believe should be commercially available in China for people who have advanced NSCLC if their tumor has an ALK rearrangement.

Good luck.

-Dr. West

Reply # - February 26, 2013, 07:32 PM

hanty
Posts: 6

Thank you, Dr West. We will talk to the doctors to see if my mother can have a EGFR mutation test. Sometimes the patients here just take Iressa for a one-month-trial without taking a EGFR test to see if it works.

Does tumor sample a necessity for the test or we can use serum instead?

Also, have you heard of the India-made Iressa or Tarceva, are they as effective as the more expensive versions?

Thanks again!

Reply # - February 26, 2013, 08:30 PM

Dr West
Posts: 4735

Serum testing is available here and there but is not as reliable as tissue testing. That can be from a prior biopsy.

I don't have enough familiarity with the Indian generic versions to know whether they are as effective as the far better studied Iressa (gefitinib) or Tarceva (erlotinib). I don't think any of us here could speak to that specific issue.

Good luck.

-Dr. West

Reply # - February 27, 2013, 07:19 AM

catdander
Posts:

It probably isn't necessary to have an EGFR testing done if it's not going to change her treatment plan. Tarceva is given to most people by 2nd or 3rd line treatment whether they have the EGFR mutation or not. So it may not be necessary to spend the money and take the time on testing at least not just yet. Like you say it's often given without testing.

Reply # - February 27, 2013, 09:26 AM

Dr Laskin
Posts: 34

I would have to agree with that, with all due respect to Dr West, i don't think i would bother with EGFR testing at this point i would just try 6 - 8 weeks of either Iressa or Tarceva. we want the test in the first line setting so we can decide what chemo to start with but at this point even if her EGFR mutation test was negative i would still give it a try.

i do agree that if you don't know if she's EGFR positive or negative it might be that Tarceva is a slightly better option. it probably won't make a big difference as long as she tries one of them if there is Iressa available easily she should try it.

i cannot comment on the quality of the Indian versions of these drugs, sorry.

finally, i do agree that especially if the Iressa or Tarceva does not work, it would be ideal to test her cancer for ELM4-ALK, it's not common but there are new drugs to consider if she does have that abnormality in her cancer.

Dr Laskin

Reply # - February 27, 2013, 09:21 PM

Dr West
Posts: 4735

That's a good point, and in fact, even though I mentioned it, neither result would change the recommendation to favor EGFR TKI therapy. Therefore, there's really no clear incentive to do a test that won't change management. I believe I was just thrown off by the question of why a never-smoking Asian woman with an advanced lung adenocarcinoma could go through a few cycles of treatment without seeing an EGFR inhibitor. I presumed that demonstrating an EGFR mutation would convince whoever is dragging their feet on offering an EGFR TKI to make that move.

That said, the point well taken that an EGFR TKI would be an appropriate option regardless of that test result: I stand corrected.

-Dr. West

Reply # - March 4, 2013, 12:11 AM

hanty
Posts: 6

Hi Janine, Dr Laskin and Dr West, sorry I didn't check my email for the last few days. Thank you for the input.

My mother just finished the second round of docetaxel. She is doing better compared to the last time despite more hair losses. She has better appetite, no diarrhea. So we're pretty much back to the normal life now.

She will have to do one more time of docetaxel before she gets the scanning and tests on cancer markers to see whether the disease is stable.

The doctors said that they will probably start targeted therapy after that, pending on the situation then.

Thanks again.

Reply # - March 4, 2013, 02:06 PM

catdander
Posts:

Good good luck on the your mom's following treatment and scans. I hope she does very well...or reasonably well with good care of side effects.
I look forward to hearing good news.
Janine

Previous PostNext Post