My wife who is 73 and I live in the state of Washington. She was originally diagnosed with adenocarcinoma NSCLC stage 1A, 3 months ago by means of a needle biopsy to a 1.5cm growth in URL. The growth had been monitored since 2009 by periodic CT and Pet Scans. Numerous Lymph node nodules (non larger than 5mm) on the last Pet scan indicated no problems.
She then had concurrent Bronchoscopy, Mediastinoscopy, and VATS wedge section surgery URL. She had four lymph nodes dissected during Mediastinoscopy of which 3 were benign, but the forth was diagnosed malignant. This was the 4R nodule defined as a N2 node. She was then up-staged to 111A (T2aN2) No physical problems with the surgery. The tumor board met and recommended a post surgery treatment of radiation and Tarceva(150mg) for an extended period of time. She is EGFR positive.
The problem is my wife is Anemic and has Blood Transfusions 3 or 4 times a year. She has quite low WBC,RBC, and platelet counts. I tried to address this with the oncologist's but got mostly blank stares.Our concern is that the Tarceva will have a negative impact on her vital blood cells. I can't seem to find any information which would address this.
Thank you: billy1
Reply # - August 7, 2013, 12:13 PM
Reply To: Tarceva And Blood Counts
Hi Billy1, it took me a few minutes but I found the video blog on the very subject. The short of it is the question isn't answered of whether this type of adjuvant treatment is better or worse than standard chemo for a stage III nsclc with EGFR mutation. Note the concern of pneumonitis with tarceva. http://cancergrace.org/lung/2013/02/24/wakelee-markers-in-early-stage-n…
Please don't hesitate to ask follow up questions for our doctors.
All the very best to you and your wife,
Janine
Reply # - August 7, 2013, 01:39 PM
Reply To: Tarceva And Blood Counts
Hi Billy1, these cases often have subtle but important details than can't be portrayed well in a short description. This is why I am not able to discuss the specifics of her case. There simply isn't irrefutable evidence to support one approach over another, so many reasonable treatment plans exist here.
However, I can speak to how a similiar patient might be managed. For patients who end up having an occult N2 lymph node during sublobar resection for T2 tumor, the current guidelines recommend adjuvant chemotherapy. This is Level 1 evidence, regardless of EGFR status. The addition of adjuvant radiation is not 'set in stone' but there is lower level evidence to support this (subgroup analysis from ANITA) and this is generally recommended in this setting.
Re: Tarceva. To make a long story short, there are no randomized studies yet that show survival benefit from pills like Tarceva in the adjuvant setting, and one trial suggested harm. Guidelines do not currently support adjuvant Tarceva.
So, many doctors would only use pills like Tarceva in this setting for a selective few: fit, motivated patients - not usually as a substitute for adjuvant chemotherapy. In such patients, many doctors would avoid starting Tarceva at the same time as adjuvant lung radiation, due to the overlapping side effect of pneumonitis, as mentioned by catdander.
The blood counts are certainly an issue that can interfere with treatment. If the cause of low blood counts has not been figured out, that may be a reasonable next step prior to starting systemic treatment.
Hope this helps.