help my Dad - 1261872

I'm sorry about your father's diangosis and recent progression. I'm afraid the Sulindac concept is based on a lab-based study but not clinical evidence in lung cancer patients, and that would not be a high priority to any lung cancer specialists I know.

Gemcitabine and Abraxane (albumin-bound paclitaxel) is a combination of two agents that are active in lung cancer, and likely far more tolerable than the MAID regimen, but Abraxane is essentially a modified version of the Taxol (paclitaxel), so I would be concerned about going on a drug very similar to one that his cancer already progressed on.

As for MAID, I've never seen or heard of a patient with lung cancer receiving this aggressive, challenging regimen usually used for sarcomas. It might possibly be an active combination, but I suspect this is extremely ambitious to give as a fourth line therapy, since the cancer tends to become more resistant over time and people typically lose strength as the cancer progresses and they experience the cumulative side effects of the treatments up to this point.

Good luck.

-Dr. West

Hi Esperanza,

Tarceva can provide a benefit in later line treatment for non-mutants, it's just that the benefit doesn't meet the strict definition of "response". It's more likely to provide a period of stability, which is a good result in fourth-line therapy. You can read about this in the GRACE Faq: http://cancergrace.org/lung/2010/09/21/benefit-from-egfr-tki-if-egfr-wt/

Beyond that, single agents such as Gemcitabine and Navelbine, while not well-studied in this context, can also provide some benefit.

JimC
Forum moderator

Thanks very much for your kind words, Esperanza.

I really agree with Jim. Tarceva could potentially be helpful, though I'm not sure of what to expect from Tarceva in someone with sarcomatoid/pleiomorphic histology. Beyond that, other chemo agents, such as the gemcitabine and/or Navelbine (vinorelbine) Jim mentioned are very reasonable options, but no chemotherapy has any established benefit after so many prior lines of treatment, so it's really just speculative.

Good luck.

-Dr. West

Oncologists often give these drugs sequentially instead of concurrently. One reason is as you fear the side effects are cumulative so concurrent treatment with several drugs can cause the patient to become unable to continue treatment.
When used one after the other (sequentially) the person doesn't suffer as much from side effects, in turn allows the person to live more comfortably. Also there are only a few options for treatment and will run out quickly when given all at once.

It's really a matter of how the person feels and how well the treatments work. I'd certainly let my husband understand the options so he could make an informed decision. There's so little control at this point.

I hope he does well for a long time what ever he decides,
Janine

Esperanza, one option you may want to ask your oncologist about is a genetic test done on the tumor tissue that looks beyond the common mutations found in lung cancer. One such test is through Foundation Medicine and is called Foundation One though there are several others. At UNC we often used tests like this when trying to assess additional drug options and it can also help direct patients onto clinical phase I trials.

A limiting factor is having tumor tissue available from a previous biopsy or able to get a new biopsy if not, so it is nit possible for all patients. Most of the time, these tests are paid for by insurance in the US (not sure about other countries).

Best wishes,
Dr. Walko

I just wanted to agree with Janine that, while someone somewhere has probably given the triplet of gemcitabine + navelbine + Tarceva, I would venture to say that it's not something that I think any lung cancer specialist has ever done or considered. We don't tend to favor adding every drug out there into the same combination just because we can, any more than we would just add spices to a recipe because we find them on the rack. Adding new drugs has a significant chance of adding more harmful effects than beneficial ones, so most thoughtful oncologists tend to be judicious about what drugs to add, rather than just combining everything and seeing how it goes.

-Dr. West

Esperanza, I didn't want to end this conversation without linking you to the other side of Grace just in case you've not seen it. I'm voracious for it and usually link to a blog post from one of our Grace faculty for further reading. So here's a link about second line treatment but it refers to 2nd, 3rd, 4th... Too, don't miss the links following the post.

Best hopes,
Janine

http://cancergrace.org/lung/2010/10/04/lung-cancer-faq-2nd-line-nsclc-o…

My thoughts and prayers are with you and your family. My father died at 51 from lung cancer and his spirit is still a part of my life every day. I pray that you will find the same comfort.

Dr. Walko

Esperanza,

Please accept my heartfelt condolences. Lung cancer is a terribly humbling disease for all of us, despite everything we as doctors, caregivers, and patients do. Your family's love is a lasting and deserving tribute for him.

-Dr. West

Esperanza, I'm so very sorry for your loss.
Hope is something I've thought a lot about in the last few years. I've decided it's one of the things that we as living beings don't live without; there's always something to be hopeful for. Today I imagine your hope is lost in grief. I hope the time ahead will fill less with grief and more with good memories of your dad.

Janine

Dear Esperanza

I just read that your father passed after putting up a brave fight. Please accept my sincerest condolences. I know how difficult it is to lose someone you love so much and I hope you and your family eventually find peace.

Bob