Results of Path after Surgery - 1259430

cards7up
Posts:636

I posted previously that I had a local recurrence in the lower right lobe. This lobe was radiated (SRS) back in 2010 along with chemo after. NED for 2.5 years. The path showed a 5.2cm tumor that had gone into the pleura. Again no lymph node involvement and clear margins. It's going before our local tumor board as I had my surgery in Boston and obviously doing my follow-up at home. Would you see this as being treated with a single or doublet chemo? If taxotere is suggested in a doublet with carbo, should this be avoided since I've already done a platin and taxotere has been shown to be more toxic in this situation? My guess is due to the size, it will require further treatment, but they continue to say it's a local recurrence. I'm sad because my onc took a leave of absence back in June and passed away this weekend. He's also the one that got IV Aloxi going for lung cancer patients as an anti-nausea drug. I will miss him. RIP Dr. Grunberg!
Take care, Judy

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Reply # - September 23, 2013, 02:49 PM

catdander
Posts:

I'm so sorry for your loss Judy.
How are you recouping from your surgery?
I'll ask a faculty to comment on your question.
All best,
Janine

Reply # - September 23, 2013, 03:47 PM

cards7up
Posts: 636

I'm doing very well as far as my surgery goes. Had a problem getting the one large stitch out from where the drain tube was, as it was embedded. Watching it to make sure no infection and so far so good. No real pain to speak of, just aching. Thanks for asking. Take care, Judy

Reply # - September 23, 2013, 07:48 PM

catdander
Posts:

That's great Judy, I worry so for anyone having that surgery. I think this is obvious but I've got to ask anyway cause the obvious sometimes eludes me. This surgery was for a cure correct? You'll hear from a doctor on this but I was thinking that since there was pleural involvement a platinum doublet would be given if possible. Since it's been over 2 years I would be surprised if your onc would want to try it. I'm sorry you've go to find a new oncologist.
Thanks for being here and being a part of our family, ;)
Take Care,
Janine

Reply # - September 23, 2013, 08:13 PM

Dr West
Posts: 4735

Is that Dr. Steve Grunberg? If so, that's so sad. I know him (though not well), met him and spent some time with him at a lung cancer meeting several years ago.

I would say that your situation is unique enough that I really couldn't speculate on what might be recommended. Of course, you know that your case doesn't have any precedent or clinical evidence to guide it, so I wouldn't want to make up a recommendation without being directly involved in your case.

Good luck.

-Dr. West

Reply # - September 23, 2013, 08:42 PM

drramchandran
Posts: 9

I am sorry to hear both about your recurrence and Dr. Grunberg's passing. I would agree with Dr. West that this situation does sound unique. I am glad your care will be presented to a tumor board, and if there is any conflict or concerns a 2nd opinion is always worthwhile.

Some thoughts I would have/ or questions I would ask

1. What would complete staging look like (ie do you need an MRI of the brain, staging of the lymph nodes)
2. What is the extent of the pleural involvement
3. What is the goal of therapy--> cure, or palliation?

Just some things to think about as you move forward.

I am sending good thoughts your way.

Dr. Ramchandran

Reply # - September 23, 2013, 09:56 PM

laya d.
Posts: 714

Hi Judy:

So happy to hear that you are recovering relatively well after surgery. . .BUT. . .again I feel like you are finding yourself in no-man's land (or, rather, a very sparsely traveled land). I wish you all my best, dear friend, and I'm so sorry about the passing of your Onc.

xoxo,
Laya

Reply # - September 24, 2013, 04:50 AM

JimC
Posts: 2753

Judy,

I'm glad to hear that you seem to be healing well after the surgery, and that the margins were clear and nothing showing in the lymph nodes. Since it has been a while since you had platinum, you could decide to repeat it while keeping it on a very short leash - if even the first cycle proves difficult, you could always drop the carbo. Whatever the choice, I hope you sail through it and it works well for you.

My wife and I had developed a close relationship with our oncologist, as I'm sure many people do, so I'm very sorry to hear of your doctor's passing.

JimC
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Reply # - September 24, 2013, 04:50 AM

cards7up
Posts: 636

More questions!!!!

Yes Dr. West, it is that Dr. Grunberg. I will post a link to his obit at the end. I will truly miss him. Before the surgery, I had a brain MRI and Mediastinoscopy, both came back negative. Lymph nodes were checked during the surgery. Dr. Sugarbaker in Boston did the surgery, so all is clear in the pleura as well. The idea is the tumor size and doing chemo as a mop up. I want to avoid the taxanes if possible and would like to know an alternative, maybe carbo/gemzar? If it were your patient, would you do the full 4 infusions or just 2-3? I did carbo/alimta in 2010, so don't think they want to repeat that. Thanks all for your support.
Take care, Judy

http://www.legacy.com/obituaries/burlingtonfreepress/obituary.aspx?n=st…

Reply # - September 24, 2013, 06:24 PM

Dr West
Posts: 4735

I think that any of the combinations of platinum with a common partner like Alimta (for a non-squamous NSCLC), gemcitabine, Navelbine (vinorelbine), or a taxane are all very comparable in activity. Though cisplatin-based regimens are more thoroughly studied and considered the standard of care when feasible, I'd say that carboplatin-based combinations have shown a very comparable degree of benefit (measured by the "hazard ratio" that measures the difference in survival outcomes for the adjuvant chemo vs. no chemo groups), just in underpowered studies that have failed to show a significant benefit largely because they weren't large enough.

In terms of duration, four cycles is the most I'd be inclined to recommend, but then it's just important to see how someone is tolerating it. I go in with a target of four cycles, but if people are having trouble after 2-3 cycles, there is a point of diminishing returns, and I'm fine with stopping earlier if patients need to.

Good luck.

-Dr. West

Reply # - September 25, 2013, 07:18 AM

marisa93
Posts: 215

Judy,

I am very glad to hear you are doing well after surgery! Clear lymph nodes, yay!

I am also sorry to hear of your onc's passing. Thinking of you...

Lisa

Reply # - September 30, 2013, 07:44 PM

aunttootsie001
Posts: 324

So here you are! I haven't been visiting Grace as much as I was busy enjoying my Summer! But I have wondered about you many times! So happy your Surgery went well! So very happy both zlymph nodes and Pleura are clear. I hope they come up with a plan soon so you can get the ball rolling! Miss hearing from you! Lorrie from Ohio

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