Lung Cancer - 1255622

I'm so sorry to hear your husband hasn't responded to chemo. As your doctor suggested if first line treatment especially with radiation isn't working it isn't likely other standard chemos will work.

There are promising research trials available in many parts of the world. Second opinions are very helpful for finding them if your doctor doesn't have the info. Often the original oncologists have recommendations for someone at a large research hospital. http://cancergrace.org/cancer-101/2011/11/13/an-insider%E2%80%99s-guide…

In the last few years targeted drugs on those who have specific mutations have extended the lives of many people. Has your husband been tested for any of them, EGFR and ALK?
this webinar discusses molecular markers what they are and such.
http://cancergrace.org/lung/2010/02/03/pennell-molecular-markers-webina…

"Here’s the growing list of videos done at the International Association for the Study of Lung Cancer (IASLC) 13th Annual Targeted Therapies in Lung Cancer meeting."
http://cancergrace.org/general/2013/02/20/iaslc-vids/

Finally I very much respect your wanting to keep your husband protected. Mine too lives better with a healthy dose of denial and I possessed the info he was stage IV before seeing the doctor. A very difficult place to be...shoot, we both have the same info today and it's still a struggle to know how much to discuss with him. I try to let him lead the discussion but as you can see I'm pretty immersed in the topic. I suppose we keep each other balanced on this tragic topic.
http://cancergrace.org/cancer-101/2009/05/07/discussing-px/
http://cancergrace.org/coping-with-cancer/2009/04/29/denial-coping-mech…
About hospice of which we have much written, http://cancergrace.org/cancer-treatments/2011/03/10/what-is-hospice-fac…

I know I haven't answered your question. A doctor will comment on that in a bit.

All best,
Janine
forum moderator

Hi dcareprovider,

(Janine got here first with her excellent comments, but I'll add my perspective as well)

I'm sorry to hear of your husband's latest scan results. I see from your earlier posts that he was diagnosed with poorly differentiated stage IIIa NSCLC in March 2012 and received radiation and chemo (carbo/taxol). It might be helpful if you could describe how much his tumor has grown since the previous scan. That may be a significant factor in your doctor's decision to halt further treatment.

Although the scan shows something suspicious on the adrenal gland, and that is a place that lung cancer typically metastasizes, there is no way to know whether that represents spread of his cancer without an actual biopsy of the cells there. If it is a metastasis from his lung cancer, then his cancer is now stage IV and is not curable. However, whether it is still stage IIIa or IV, it would still be treatable; it's just that the goal of treatment for stage IV lung cancer is not to cure but to increase the length and quality of life. Since your husband is feeling well it certainly seems as though he may be able to tolerate more chemo. There are three drugs that are generally approved as follow up treatment for NSCLC: Pemetrexed (Alimta), Docetaxel (Taxotere) and Erlotinib (Tarceva), each of which we be an option especially if he has not used them previously.

Trying to guess at his life expectancy would be just that - a guess. Progression after radiation and chemo is certainly a negative, but in such circumstances some patients respond to further treatment and others don't, so it's difficult to generalize.

If it were me in similar circumstances, I would want a second opinion from another oncologist to see what might be said about the potential benefit of further treatment. The decision to stop treatment is too important to leave it in the hands of one doctor's opinion.

I hope your husband continues to feel well.

JimC
Forum moderator

I wanted to add that it must be particularly difficult to hear this about your husband, when a few months ago you reported that he was still going to the gym every day.
I agree with Janine that mutation testing might be worth considering, or a clinical trial if you are anywhere near a big teaching hospital. Looking at your earlier posts I see that the main tumour is close to the aorta, which might be one reason why your husband's oncologist is pessimistic.
There is no question that if you go by the stats, the outlook is grim. My husband and I were where you are two years ago, and I had the clear impression that I was expected to live less than six months. However I had a very lucky break with my mutation status, and things improved to the point where I no longer expected the axe to fall each day.
I suppose what I am trying to say is that it is possible to be realistic without being in despair. Your husband may be stronger than you think, mentally as well as physically. I am glad my doctors made it clear how difficult my situation was. Although it was frightening, it gave me a chance to make the most of what could have been a very small sliver of time with my husband, friends and family. The knowledge that things might be ending soon brought us all closer together. Best wishes.

Just to clarify, I wasn't saying that he definitely should have a biopsy on the adrenal gland spot. If his doctors think chemo is the appropriate treatment regardless of whether there is a metastasis at the adrenal gland, then it's not necessary unless they wanted to get a sample for molecular testing. If for some reason they were considering surgery/radiation to the lung tumor, then the question of whether there is a distant metastasis would be important, since in that context local treatment such as surgery or radiation is not usually favored unless it is needed to alleviate pain or other symptoms.

As far as whether to tell your husband about the latest results, that's always a difficult question. Many people want to know everything about their situation, some don't. It might help to read this post, and my reply to it (and the links I quoted), here: http://cancergrace.org/forums/index.php?topic=5226.msg32534#msg32534

JimC
Forum moderator

I haven't chimed in before now because Janine & Jim really covered the key points, and I think that offering numbers beyond the most general ones would put too fine a point on it, implying that I have some real insight to offer beyond bare guesses based on population-based statistics. In truth, a good oncologist working with a particular patient has far more at their disposal than just raw stats for a population. Specifically, the factors I see as critical modifiers of the raw stats are these:

1) How healthy and fit is the patient? Obviously, someone who is not limited in their exercise capacity is much more likely to do well than someone quite debilitated.

2) How extensive is the cancer? A tiny amount of cancer in an adrenal gland or in pleural fluid can be stage IV, which is the same as the stage of someone with extensive, bulky cancer in the liver, adrenal glands, brain, and bones, but the prognosis is better for someone with less tumor bulk.

3) What is the general pace of the underlying cancer (it's "natural history")? I wrote a post about this back in January, I think, because I think this is a too often ignored but critical piece of information. With ongoing follow-up, cancers give clues about the engine that drives them (independent of treatment) -- some very fast-growing, and others very indolent. People with an indolent cancer, which is also typically less bulky, tend to do better no matter what treatment they receive or don't receive.

4) How responsive is the cancer to treatment? Briefly, one of the glib pieces of wisdom you sometimes hear in cancer care is "responders respond". This basically just means that some people have cancers that happen to respond well to many chemo agents, so it may not be critical whether they get combination A or combination B -- their cancer seems to respond to lots of things. Unfortunately, the converse is also true: resistant cancers usually don't respond, no matter what you give.

I hope that's helpful.

-Dr. West