Mom: 59, never smoker
8/11-Dx NSCLC –Adeno, T3N2M0, EGFR+ (Ex. 18), Thoracoscopic left upper lobectomy.
9/11-12/11 Adjuvant chemo with 4 cycles GP
6/12 Diffuse small nodules in both lungs, new bone mets
6/12-2/13 Iressa+ Zometa
2/13 New brain mets, single, 0.3*0.4cm; lung nodules slightly bigger
2/13-3/13 2 cycles Avastin+ Alimta，stable
4/13-6/13 Iressa
6/13 Multiple brain mets; lung nodules progressed
6/13-8/13 Afatinib
7/13 Multiple brain mets shrinked
8/13 a new 4.2cm nodule in the left lung
9/13- 2 cycles of Abraxane
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Q1: Now is the time treat brain mets with WBR?
Q2: Could i treat with that 4.2cm nodule in the left lung using Cyberknife or other local threapy?
Q3: if Abraxane doesn't work, what's the next step ？
Iressa or Afatinib or Erlotinib combines cMet Inhibitors？
CO-1686?
Etoposide VP-16？
Making treatment choices:Stage IV NSCLC AdenoC Brain Mets, Bone Mets - 1259490
viviannan
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Reply # - September 26, 2013, 10:12 AM
Reply To: Making treatment choices:Stage IV NSCLC AdenoC Brain
Hello viviannan, I'm very sorry your mom is going through this terrible cancer. I've pasted 3 links below that I believe address your questions without being so specific to your mom's case. We really can't say what one should do; as you know treatment options vary for each individual.
The first explains standard of care both tested and not that give results commonly for nsclc http://cancergrace.org/lung/2010/10/04/lung-cancer-faq-2nd-line-nsclc-o…
Dr. Loiselle explains exceptions to the WBR rule that can help you better understand where your mom stands http://cancergrace.org/lung/2011/09/11/brain-metastases-in-lung-cancer-…
This video blog post explains one very notable groups management of acquired resistance and brain mets (there are many video blogs from noted oncologists such as this in the link below) http://cancergrace.org/lung/2013/08/13/doebele-manage-acquired-resistan…
I copied 2 of the links from the nsclc/brain metastasis tab "focused cancer info" above, http://cancergrace.org/lung/category/lung-cancer/general-lung-cancer-is…
Please take a look at these and follow up questions as you have them.
All best,
Janine
forum moderator
Reply # - September 26, 2013, 08:16 PM
Reply To: Making treatment choices:Stage IV NSCLC AdenoC Brain
WBR is appropriate whenever there are multiple brain metastases that aren't controlled by current systemic therapy, particularly when there are more than a handful of brain metastases to treat.
Except for treating a specific symptom related to a focal lesion, there is really no conceivable value for local treatment to a single lung lesion in the setting of metastatic lung cancer progressing in several sites. The issue isn't one location...but a more global pattern.
There are various clinical trials, but chemotherapy with an agent like Alimta (pemetrexed) or Taxotere (docetaxel) is still the evidence-based option that has a survival benefit in previously treated patients with advanced NSCLC.
Good luck.
-Dr. West