AVERAGE LIFESPAN FOR BAC PATIENT AFTER TARCEVA STOPS WORKING - 1259118

josephine3
Posts:12

I would be very interested in knowing the normal lifespan for a person with BAC after resistance to Tarceva occurs?

Can increasing the dosage help or once the resistance starts is an increase to any dosage no longer effective?

Also, what treatments are actually working that are available when you have built a resistance to Tarceva and how much can they extend your life or is it all a guessing game at this point?

What is considered a fast growing nodule. If a nodule showing resistance has gone from showing all BAC clear to a nodule showing up at next scan at 2mm and has grown over the last 11 months to 9mm and has not grown over the last three months consider slow growing or fast growing?

Thank you for your information.
JDW

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Reply # - September 9, 2013, 06:04 PM

catdander
Posts:

Hi Josephine, It sounds as if your BAC is still slow growing. While tarceva studies were done with the highest max dose increasing wouldn't be appropriate.

Dr. West will respond to your post in a while.

I hope you do well moving forward,
Janine

Reply # - September 9, 2013, 07:25 PM

Dr West
Posts: 4735

The survival after progression on Tarceva is so variable I don't think it's helpful to give a number. It depends exceptionally on the underlying pace of the cancer, so I think giving a number just blindly is not remotely helpful.

There is no evidence that increasing the dose of an EGFR inhibitor after progression leads to any improved outcomes. I don't know any lung cancer specialist who considers this to be a fruitful strategy.

You should do a search for "acquired resistance" here on the site to see discussion of the open questions around how best to manage progression after a good response to Tarceva (erlotinib) or Iressa (gefitinib) that ultimately is lost as the disease becomes resistant. However, the short answer is "we don't know". There is no consensus on any best approach.

"Fast" growth is entirely subjective, but I'd say that clinically significant progression entails a readily detectable change over a 3 month interval.

Good luck.

-Dr. West

Reply # - September 9, 2013, 08:56 PM

josephine3
Posts: 12

Dr. West,

Thank you for your reply but, two questions :

1.) Do you consider a nodular that goes from 2mm to 9 mm in 8 months a readily dectable change and would be consider fast grownimg or is that amount of growth considered slow growing?

2.). What would your approach to treatment be with a patient that has progression on Tarceva? I know that you treat numerous patients with this problem what approaches do you use?

Being a physician who has considersble knowledge in treating BAC your thoughts and suggestions would be greatly appreciated. If you or a family member had this form of cancer and had shown good response with Tarceva for over two years and now shows progression what would be the next form of treatment you would take and/or suggest?

It would be nice to know what an expert in this field would do.

Kindest regards,
J.

Reply # - September 9, 2013, 09:09 PM

Dr West
Posts: 4735

I think that growth from 2 to 9 mm is enough to warrant consideration of treatment, though I don't think it's so clear that it would be called "fast". By volume, it's a significant change.

My approach to acquired resistance to EGFR inhibitor therapy is described in this post:

http://cancergrace.org/lung/2013/01/23/acquired-resistance-algorithm/

Good luck.

-Dr. West

Reply # - September 9, 2013, 09:52 PM

josephine3
Posts: 12

Dr West,

Thank you so much for your very informative. Like all cancer patients I am attempting to compile as much information as possible to make wise and well informed decisions. Naturally, I was in hope that Tarceva would have lasted longer before progression began and a new and well tested treatment would have been on the market. Unfortunately, not the case at this time but, there are very interesting trials going on and my goal is to find the best possible current treatment to keep me going until a new trial drug is perfected.

Do you take new patients for a second opinion and if so what is the wait?

Your time and and experienced advice has been greatly appreciated. ( Do you ever sleep!)

Kindest regards

Reply # - September 12, 2013, 09:15 PM

letswatch
Posts: 3

I had joined a while back but have not been on the site and not familiar and decided to check the site out because next Tuesday I will be hearing the CEO of grace will be speaking.

My radiation doctor wrote that my T10 spinal cord had been 50% destructed in 30 days before radiation had been started which was started and stopped the growth and bone grew back. I read that squamous cancer is usually slow growing but my is fast which is what I have above.

I have not done my signature yet on this site but will and post to give you the information I have which I got from my pet scan report.

Patrick

Reply # - September 12, 2013, 10:24 PM

Dr West
Posts: 4735

Unfortunately, the general concepts like "squamous cell lung cancer is slow growing" are not very helpful for individual patients. That's because there's really so much variability in how cancers behave that we really just need to focus on what's happening for an individual patient, rather than rely on any preconceived notions based on the generalities, which are often not very accurate.

I'll be the one speaking next week, so I'll see you in SF.

-Dr. West

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