Maintenance Therapy with Avastin Only - Stage IV NSCLC - 1255292

Hi follansbee,

I'm sorry to hear about your husband's repeated infections. I assume you meant to say that his counts had been good throughout prior treatment. Even if that's so, eliminating the possibility that alimta could be weakening him and allowing the pseudomonas infections to flare up seems reasonable.

As discussed here often, it is always difficult to say whether maintenance treatment is keeping the cancer at bay, or whether it has been well-controlled by first-line treatment or perhaps just an indolent cancer. In the maintenance setting, the decision to alter or stop treatment is not as critical as it would be when it is clear that the cancer is actively progressing. Also, once you get beyond first-line therapy, treatment decisions tend to become less evidence-based (unlikely you'd find a study which addressed the same set of circumstance as your husband's) and more driven by general principles and experience - the art of oncology, just as necessary as the science.

Good luck with the Avastin maintenance.

JimC
Forum moderator

I agree it's not studied, so this is one of the many, many decisions that needs to come down to good judgment. I think what he's suggested sounds very appropriate, trying to balance risks and benefits of all of the factors here.

Good luck.

-Dr. West

Dear Dr. West,

My relative had stage 2b NSCLC and had a surgery and her surgeon noted the cancer was involved in her bronchia.

Her daughter told me , who is a physician, her mother's chemo went thru 12 months. Every three months a cycle. The mother lived for 12 years with NED after.

Based on this individual case, could we have maintenance chemo, say, every two or even three months a cycle with one or two meds for one or two years in order to pass first two years.

I know I am talking strangely. But I am facing the issue- maintenance chemo or not? How to do it?

My oncologist would say no. A doctor at Memorial Sloan Kettering told me to follow up every three months. I did not mention this case to any above doctor yet.

The chances are after one years or so the cancer could come back and my stage could from 1b to 4 ! I have Kras mutation.

In terms of life quality and toxicity, having maintenance chemo every two or three months is not too bad.

We never ask a stupid question, don't we?

Thank you!

:)

Hi huiyuan49, I'm sorry you're in this situation. If I understand correctly you have been treated for stage Ib nsclc. Once treatment is complete, surgery/chemo or chemo/radiation there is no more treatment that will make the cancer less likely to return. If your cancer stays away for 1 year it's very likely it won't return at all. If it's been 5 years you are considered cured.

It sounds like the doctors at MSK have you on the right plan of follow up.

Good luck,
Janine
forum moderator

This is a link to our library section on early stage nsclc. I hope it helps, http://cancergrace.org/lung/category/lung-cancer/core-concepts/early-st…

Hi, Jenine,

Thank you for your comment. I understand more and clearer where I am now. My doctor treated me as 1b but my second onc convinced me to switch to Alimta/Cisplatin. Then he mentioned I could have 6 cycles...I felt more "comfortable" with his idea. I always doubt If i am truly 1b, that caused a problem. I should be relaxed a little bit more. Regards.

I don't know of any oncologist who would recommend ongoing maintenance chemotherapy in the post-operative setting. If there is a microscopic amount of cancer that can potentially be eradicated, it's very hard to imagine that ongoing indefinite chemo, or even chemo for 1-2 years, would kill it for good but the initial 4 cycles of chemo wouldn't do the job. If the cancer is truly metastatic, then this is maintenance therapy like what we'd do for advanced NSCLC, but even then, I'm very, very wary about having someone continue indefinitely on chemotherapy when there's no actual cancer to monitor. Chemotherapy can have very real side effects, both acute and chronic, and while it's justified in the settings in which it is studied, I have absolutely no enthusiasm for someone being on continuous chemotherapy primarily as a treatment for anxiety.

I don't mean to be too harsh, but I personally think it is not responsible medicine to give potentially dangerous chemotherapy in a setting in which there is no evidence and a rather weak rationale. I also think that doing something very unconventional because someone who could absolutely have been cured with surgery alone did something very unusual after their surgery and happened to do well is likely to mean that they did well despite their unusual treatment, not because of it.

-Dr. West