Risks to Stopping Tarceva to Change Treatments - 1261176

hubby
Posts:2

After 33 months, my wife's last CT scan showed new cancer growth in the same lung as the original cancer. Tarceva was her first and only treatment. She was instructed to stop taking the Tarceva and will begin her new treatment on January 13th. We are worried that stopping cold turkey might cause a Flair Up, as we have read about prior. Her next round may either be a PD1 trial or Carboplatin + Alimta.

We have great trust in our doctor, but are looking for questions that might help with the decision to stop the Tarceva cold turkey - OR - consider other trials, etc... Thanks.

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Reply # - December 23, 2013, 10:19 PM

Dr West
Posts: 4735

If you've looked into the questions about acquired resistance, you know that there is no clear answer about how best to address cancer that is progressing after a good, prolonged response to an EGFR inhibitor. I would say that the rebound progression or "flare" reaction is something that is possible but pretty uncommon, well under the 20-25% range reported in one paper from Memorial Sloan Kettering, and more like a 5% possibility.

Even among experts, some favor continuing an EGFR inhibitor after progression, while others don't. There isn't especially good evidence to direct us either way, I'd have to say.

Here's a summary post, really just describing the pros and cons of different approaches, though again, with no clear conclusion of how to proceed, because there isn't evidence to support one strategy over another right now.

http://cancergrace.org/lung/2012/08/05/acquired-resistance-faq/

-Dr. West

Reply # - December 24, 2013, 11:55 AM

Jazz
Posts: 279

hubby, most of the PD-1 trials only require a 7-day washout period for Tarceva (Merck is 7 days). You might check to see what each trial specifically requires, and maybe ask your doctor why he wants your wife to stop Tarceva for such a long period prior to next therapy? A flare is something one can't anticipate and even for the 7-day washout I was a bit nervous, so no harm in asking.

Best of luck, you have options since your wife has only had one line of treatment.

Jazz

Reply # - January 2, 2014, 07:50 PM

carrigallen
Posts: 194

I agree with Dr West - the so-called rebound progression or 'flare' after stopping Tarceva may actually be rather unusual. There seems to be little evidence to support continuing the Tarceva once it stops working. The problem is that tarceva does have definite side effects - fatigue, skin problems, etc. The other problem is that its activity hasn't been well-tested in this setting. There were trials done in the early 2000's with thousands of patients (TALENT, TRIBUTE) that showed that adding Tarceva to chemotherapy increases toxicity, but not survival.
Bottom line: I don't think the reported flare phenomenon warrants the degree of anxiety that is often observed in patient forums. Hope this helps.

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