Nsclc progression after Tarceva, Carbo/Alimta, what next? - 1255729

asperr
Posts:2

My mom is 63, never smoker, diagnosed in January 2012, with left lung tumor and pleural effusion. EFGR positive. She progressed on Tarceva after 8 mos. Taken off Tarceva and Started Carbo/Alimta 4 rounds (some progression to right lung and bone) She had scans Monday(4/15/13) after three Alimta maintenance. Found more bone progression, and multiple brain mets, with four being 4/5mm. Docs are now suggesting brain radiation and radiation on her back (where active and painful bone met is). Then they suggest Abraxane as third line after radiation. What are the chances that this will be effective? Are there any other treatments/clinical trials that could benefit her disease? I feel like Alimta was our biggest hope! devastated that it failed. Thanks for your help.

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Reply # - April 17, 2013, 10:49 AM

catdander
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asperr, I'm so sorry about your mom's progression. The wbr and palliative radiation to the spine sound like good next steps.

I don't know how much you know about acquired resistance (significant progression of EGFR mutant on tarceva) but it's worth mentioning the "bad brakes are better than no brakes" metaphor. Meaning if progression on tarceva was slight then it might be worth sticking with it because the other option is significant progression. Now the question is what's the difference between slight and significant. Here is a blog post on the subject including a flow chart, excellent for the visual learner ;) . At the end of the post is a further reading list on acquired resistance.

Here's a positive discussion on the subject of abraxane. http://cancergrace.org/topic/abraxane-update

Please let us know if you have more questions and of how your mom's doing,
Janine
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Reply # - April 17, 2013, 06:05 PM

Dr West
Posts: 4735

I'm sorry to hear of her progression. Abraxane is certainly a fine choice to consider, but it hasn't been studied well enough to say what can be expected. It is certainly an active agent for NSCLC, and I have given it to some of my own patients recently in a similar situation, but the best studied agents for previously treated patients with advanced NSCLC are Alimta (pemetrexed), Tarceva (erlotinib), and Taxotere (docetaxel), so these tend to be the most favored options if one or more hasn't been given previously. Beyond that, there are other agents that are reasonable to consider, though they don't have as much evidence to support them.

As Janine noted, we don't yet have an established best practice for acquired resistance to an EGFR inhibitor, though a clinical trial in this setting is also attractive if one is available.

-Dr. West

Reply # - April 17, 2013, 07:38 PM

asperr
Posts: 2

Thank you, Dr. West and Janine for your replies and information. This site has been a great help in our understanding of the best way to fight this awful disease.
I do have questions about Taxotere. Is this a chemo drug or targeted therapy? I have never heard it mentioned by mom's doctor. I'm wondering if this should be done possibly before the Abraxane. Or would it be appropriate to try after if Abrax doesn't work.
Sounds like we really are running out of options at this point.
Also, how do I find out if there is a clinical trial available that fits her situation?

Reply # - April 17, 2013, 07:56 PM

Dr West
Posts: 4735

His doctor could speak to the possibility of participating in a clinical trial, or a second opinion from someone at an academic or other large cancer center could address this.

As for Taxotere, it is a standard chemo that is sometimes disfavored because people are wary about side effects, but in truth, many people do very, very well with it, and the side effect profile in actual clinical trials is comparable to many other single agents. Some people do have a hard time with it, but it's variable, and I would say that much of the hesitation about it is not entirely rational fear when you actually look at the evidence when it's systematically, carefully compared with other agents.

-Dr. West

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