Adenocarcinoma stage 4 no chemo recommended - 1257355

tr17
Posts:1

Hi,
Thanks for all the information on cutting edge research and treatment. My dad is diagnosed with stage 4 adenocarcinoma with spread to adrenal glands. His oncologist does not recommend chemo, and both ALK and EGFR came negative. He is 58 year old but lost more than 5 % weight, has COPD and was smoker until the diagnosis. His oncologist thinks he won't tolerate the chemo. I am sending him supplements to support his immune system (vitamin D, melatonin,fish oil, etc) hoping for the best. Is there anything else I can do?

Also, I live very far (11 hour flight) and am waiting for worse times to go and help. Should I go now instead and help him to get stronger while we have a chance if any?

Thanks,

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Reply # - June 17, 2013, 10:12 PM

JimC
Posts: 2753

Hello,

Only a doctor familiar with your dad's overall physical condition can determine whether or not he may be able to tolerate chemo. It's possible that another doctor might have a different recommendation, so a second opinion is one possibility. Another would be the use of Tarceva, despite the lack of an EGFR mutation. Tarceva might be more tolerable than chemo, and there is plenty of evidence that even mutation-negative patients can receive a more modest benefit from it. In addition, since it is a daily pill if he has trouble tolerating it he can stop it quickly, as opposed to a chemo infusion which has effects that can last longer.

Also, the typical first line chemo regimen would be a platinum agent such as cisplatin or carboplatin, plus another agent such as taxol or alimta. It might be worth discussing with your dad's oncologist whether he thinks your dad could instead tolerate a single agent such as alimta, which tends to be easier to handle than other drugs.

As far as whether coming in to help your dad build up his strength, it might be good to discuss with his doctors whether they believe that would be feasible and helpful.

JimC
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Reply # - June 18, 2013, 09:05 PM

Dr West
Posts: 4735

It might be helpful to get a second opinion on whether he's a good candidate for chemo before upending your life to care for him. If he's lost 10-20% of his baseline weight, that may well signify that he's too ill to tolerate the rigors of chemotherapy. Having lost >5% of his baseline weight isn't ideal, but I wouldn't consider that a deal breaker for chemo, especially in a 58 year old. That said, it's really a complex assessment that can only come from examining a patient directly, so there are likely to be intangibles here that matter, such as how active or inactive he's able to be.

If he has a second opinion that corroborates that chemo is really a poor idea, at least you've confirmed that the first opinion was appropriate. If you get a different opinion, he's got a new plan to pursue.

Good luck.

-Dr. West

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