Should I continue chemo? - 1256314

Hi Nancy,

Congratulations on the great scan results!

As we discussed in your previous thread, if cancer cells were found in your effusion, it's very unlikely that you were misdiagnosed. So it is reasonable for your doctor to be concerned that there may be cancer elsewhere in your body. Although the PET scan didn't show any cancer, it doesn't effectively diagnose cancer in the brain, since the brain lights up on a PET scan and it's not possible to distinguish between normal brain activity and a lesion. An MRI or cat scan is preferred. In addition, when a patient has had a good response to Tarceva, if progression occurs it often appears first in the central nervous system. So it seems that your doctor wants to confirm that there is no cancer there before suggesting that you discontinue treatment. In addition, it's also difficult to know whether you are "NED" due to ongoing treatment controlling the cancer, or because the cancer is no longer active. Some patients elect to continue treatment because they fear "letting off the brakes", but others prefer to stop treatment, keep vigilant with scans and resume therapy at the first sign of recurrence/progression.

Good luck with the scan and continued NED!

JimC
Forum moderator

As Jim suggested, the question of whether you're without evidence of disease solely because of the treatment or perhaps because you have an extremely unusual lung cancer that doesn't even need treatment now is unknown, but it's probably the best problem you can have with a diagnosis of advanced lung cancer. My personal approach in advanced lung cancer is generally to pursue the least intensive treatment required to keep things under control for the foreseeable future, including holding treatment if it isn't clearly needed. There are definitely potential risks to ongoing therapy, as our experience in treating people with advanced lung cancer with 2+ years of the same treatment is virtually unknown and untested. If it's not clear if that treatment is definitely the reason things are going so well, I often favor pulling back and checking whether a person might do just as well without it for a while, thinking we can resume it if/when we see things progress and confirm it's needed.

There's a very small risk something bad could happen when the cancer isn't being treated -- perhaps progression in the brain that leads to an unforeseen serious complication. However, there are always risks in any course of action, and if the risk of continuing treatment exceeds the risk of holding it, I would argue that it's very reasonable to step back and see how things might go without ongoing treatment.

Good luck.

-Dr. West

I agree this is a good problem to have. If you are not having trouble with Tarceva alone, it seems reasonable to continue it.
Regarding your original diagnosis, it seems reasonable to believe it, if indeed there were cancer cells seen on the cytology of the collected pleural fluid. Hope this helps.