tarceva - brain mets - pulsing - 1256699

Hi daisy,

I'm sorry to hear about your Mom's progression. Pulsing tarceva to treat brain mets is still an unproven idea, as Dr. Weiss wrote:

"There is some evidence that tarceva gets into the brain, regardless of dose. The pulsed regimen has gained greater attention based on data showing that at these higher doses, it can penetrate the CSF. CSF or cerebrospinal fluid is the fluid that bathes the brain and involvement of it is even worse than regular brain mets. When CSF has cancer in it, this is called leptomeningeal disease. Pulsed tarceva seems to help with leptomeningeal disease in patients with EGFR mutation.

Pulsed-dose tarceva is also being tried, with less data thus far, for other conditions. It's being tried for regular brain mets and for patients with prior responsiveness to tarceva who are now resistant. These avenues of investigation are worthwhile, but pulsed-dose tarceva has not been proven for either of these situations.

Stereotactic radiation is an option for many patients with prior WBR and new brain mets. It tends to work best for a small number of lesions that are small in size. With <3 small lesions, we often consider it promising. For >5 lesions, any of which are large, it is often less helpful." - http://cancergrace.org/forums/index.php?topic=11055.msg90256#msg90256

As far as the progression in general, if she has not been treated with Tarceva previously, she may show a good response to it now. If she has, then perhaps her doctor can recommend a clinical trial for acquired resistance to tarceva, or a different chemo regimen.

JimC
Forum moderator

Hi leah,

Thank you. No, thankfully LMD is not the normal course of NSCLC brain mets. It is still a relatively uncommon complication although it is showing up more frequently as patients survive longer after diagnosis.

Good luck with Tarceva!

JimC
Forum moderator

I'm very sorry to hear about her diagnosis. I don't have anything significant to add to Jim's great explanation. We'd generally pursue radiation for brain mets, Tarceva (erlotinib) for disease outside of the brain in someone with a known activating EGFR mutation. The tarceva would generally be given at a standard daily dose...while "pulsed" Tarceva given as a big dose every few days might be a consideration for someone with LMC, that's definitely not a well studied or standard approach.

Good luck.

-Dr. West

Jim, you mentioned experimental pulsed Tarceva for acquired resistance - is this in clinical trials?
Daisy1963, hope Tarceva works well for your mother.

cs,

That was actually in a quote from Dr. Weiss: I don't know of such studies, and haven't found any reports thus far.

JimC
Forum moderator

Thanks Jim.

I'm not aware of clinical trials with pulsed Tarceva for acquired resistance. There's more interest in pulsed Tarceva as a treatment for leptomeningeal carcinomatosis than for acquired resistance.

-Dr. West