Anything New at ASCO Re Lepto in Lung Cancer - 1257016

chebird
Posts:104

Good morning all,

I was wondering if the faculty heard anything new about treating/preventing lepto in a lc setting.

I recently was forwarded an abstract which I, as a layperson, was unable to access. It was published last month by DC Christoph and Karen Reckamp. The title is "Intraventricular Chemotherapy for Leptomeningeal Carcinomatosis from Lung Cancer: a Feasible and Beneficial Treatment Option?" PMID: 23584292

I don't like the question mark in the title, since that leads me to believe that the answer is still no.

Any insights?

Thanks again and God bless,

Holly

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Reply # - June 5, 2013, 10:24 AM

catdander
Posts:

I will try contacting Dr. Reckamp for input. Though from what I found she may be quite busy getting back to the the clinic today as it appears she did co author 4 abstracts presented at ASCO this year.

I didn't have any luck finding anything at the asco site and like you wasn't able access the abstract online.

I'd be interested in what the doctors have to say about the choices between Intraventricular Chemotherapy and pulsed tarceva since he's EGFR positive and has done so well on it.

Keeping you close,
Janine

Reply # - June 5, 2013, 10:35 AM

JimC
Posts: 2753

Holly,

I don't have access to this paper that was published last month in the Journal of Thoracic Oncology either, but until Dr. Reckamp or another of the faculty chimes in, I would just say that the wording of the title makes me think that there is some anecdotal evidence that the treatment described in the paper can be effective, even though it hasn't been verified in a full trial setting.

There was at least one presentation on LMC in lung cancer: http://meetinglibrary.asco.org/content/116103-132 It dealt with pulsed Tarceva as a treatment option.

JimC
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Reply # - June 5, 2013, 04:04 PM

chebird
Posts: 104

Jim,

Thank you again. I printed out two copies: one, I mailed to Vicente's oncologist who doesn't want to do anything with Tarceva, and I'm taking the other copy with me tomorrow for the 2nd opinion.

Holly

Reply # - June 5, 2013, 10:42 PM

Dr West
Posts: 4735

There's a little suggestive evidence that some patients may benefit from intrathecal chemotherapy. The reference is to an editorial that provides commentary on an accompanying report that describes a few dozen patients who received intrathecal chemo or radiation, some of whom did well enough to speculate that these treatments might play a role. The general conclusion was a tentative maybe...hence the question mark. I think most lung cancer specialists don't consider it to be consistently or convincingly beneficial enough to favor.

-Dr. West

Reply # - June 6, 2013, 06:14 AM

JimC
Posts: 2753

Holly,

The drug you're thinking of is methotrexate, but Dr. West or Dr. Reckamp will have to answer whether that was used in these cases since there isn't even an abstract of this paper available to the general public.

O, for the days when I worked at a university with a medical school, giving me access to all the medical journals!

JimC
Forum moderator

Reply # - June 6, 2013, 10:49 PM

Dr West
Posts: 4735

Yes, I believe it was, but I really wouldn't hold up this paper as the new paragon of LMC treatment. It was just a series from a place where they did random things they happened to decide to do and then wrote that they thought some people did OK, so maybe other people might try it as well. There's a good reason it didn't reverberate through the lung cancer community and redefine the standards of care for LMC.

-Dr. West

Reply # - June 7, 2013, 07:30 AM

chebird
Posts: 104

I don't have a question; this is just an update for all the kind people here who have been so encouraging.

Well, we saw a lung cancer specialist at Banner MD Anderson in Gilbert yesterday, and we now will be driving 2 1/2 hours to see him. Vicente whined about the drive; he had to put the seat all the way back to even stand the pain.

The oncologist put Vicente back on Tarceva and wants to aggressively treat the mets in the spine. He said there is no reason to blast Vicente with chemo right now as there is nothing to blast. So, he just had a power-port put in last week for no reason :(

Dang, I wish we had gone there before V had the radiation to the T9. It was external beam, probably palliative, and this guy says it should have been surgically removed or radiated with a more focused type of radiation. I'm just praying that the tumor responded to the radiation (PET next month). The Pancoast tumor responded very well.

Vicente told the Dr that he has been having Pancoast-type pain on the other side. His CT scan in April was clean. The Dr said it was probably due to a change in activity (laying down most of the time since the surgery at T12). He has been taking the Tarceva every other day to "stretch it out", so I'm praying this isn't flare.

He said not to be so concerned with lepto yet; those tumors have probably been there a long time. Vicente did have symptoms starting last Dec which were ignored by the two Drs we saw as old age.

My mom (lives with us) is getting two CT scans done soon. She had a 1a adenocarcinoma removed via VATS in the summer of 2010. She is losing weight (15 lbs) and doesn't have an appetite. :(

Anywho, that's where we are right now.

Love and blessings to all,

Holly

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