What are my options? - 1262012

Hi Rizalito,

Congratulations on your good response to treatment. There is evidence that ALK positive patients do particularly well on Alimta, although it's unclear whether that is because of the mutation or their non-smoking status: http://cancergrace.org/lung/2011/02/26/alimta-for-alk-rearrangment/

Regarding the question of whether to stick with a conventional maintenance treatment or switch to a targeted therapy such as Xalkori, Dr. West has said:

"the general approach has been to ride the wave of whatever treatment is both effective and well tolerated, with the extra bonus that the commercial availability of XALKORI (crizotinib) provides one more extremely promising option." - http://cancergrace.org/topic/continued-response-to-alimtaavastin-mainte…

And Dr. Weiss agreed, saying:

"My general treatment philosophy is the same as Dr. West’s. I define, “working” as both cancer controlled, and not too much side effects. As long as both conditions are met, I typically “ride the wave” when something is working."

Good luck with whichever treatment you choose.

JimC
Forum moderator

I hate to discard a well tolerated treatment on which a patient is responding or at least demonstrating stable disease. The goal is really to get the opportunity to be treated with as many potentially beneficial treatments as possible while a person is doing well enough to tolerate these treatments well. Beyond that, there's really no evidence that there's a significant difference based on the order in which the treatments are given.

Also, for stage IV disease, as is indicated by the multiple lung nodules, surgery is not an appropriate treatment and would be extraordinarily unlikely to help at all and would most likely only be associated with the risks of surgery but no benefit.

Good luck.

-Dr. West

Rizalito:

I just wanted to wish you all the best with your treatment. Please keep us posted on how you are doing.

Laya

rizalito,

Thanks for sharing the good results! Some tumor shrinkage and otherwise stable is great! As long as you're tolerating your treatment pretty well, it meets both criteria described by Dr. West and Dr. Weiss for continuing a line of therapy - effective and well-tolerated.

Wishing you continued good luck.

JimC
Forum moderator

That's really great to hear. I hope you'll keep us informed.

-Dr. West

Hi Rizalito, Welcome to Grace and a Big Congratulations on the good scan.

From our FAQ section, "For most cancers, there is visible evidence of a cancer on scans such as CT scans that are done periodically during the course of a patient’s treatment." http://cancergrace.org/cancer-101/2010/09/16/cancer-101-faq-assessment-…

CT is the standard scan used to follow a person after diagnostic scans of the type you mentioned earlier. The timing depends on the biology of an individual's cancer. After a few scans you and your onc will get a feel for how often you'll need scans usually every 2 to 3 months.

This may be of interest, http://cancergrace.org/cancer-101/2012/08/29/treat-the-patient-not-the-…

I look forward to good news,
Janine

Yes, the most recommended approach is follow up CT imaging every 2-3 cycles, usually about every 6-9 weeks, and then sometimes less frequently after that, to assess areas of visible disease over the course of treatment. There is no standard recommendation for repeat PET, bone scan, or MRI imaging.

-Dr. West