Nsclc squamous stage 4 possible 3 rd line therapies - 1262653

Hello,

Welcome to GRACE. I hope you are enjoying your treatment break.

As an example (although it may not apply to you in terms of availability where you are), the three drugs which are FDA-approved for second and later line therapy are Alimta (pemetrexed), Taxotere (docetaxel) and Tarceva (erlotinib). Alimta is not effective with squamous cell lung cancer, so it is not an option for you, but either of the other two would be appropriate choices. You can read about second line treatment in the GRACE FAQ here: http://cancergrace.org/lung/2010/10/04/lung-cancer-faq-2nd-line-nsclc-o…

JimC
Forum moderator

Hi Sarah,

Immunotherapies are alternate forms of treatment which seek to either stimulate or suppress the body's immune system in order to fight cancer. Various forms of immunotherapy are being tested in clinical trials. Such a trial might be an option instead of established chemotherapies.

JimC
Forum moderator

Hi Sarah,

You might want to watch Dr. Spigel's podcast on immunotherapy for squamous here: http://cancergrace.org/lung/2013/12/11/squamous-lung-cancer-immunothera…

It's true that the two mutations which have established treatments (EGFR - Tarceva or Iressa) and ALK - Xalkori) are rare in squamous. Usually testing for other mutations would be done in conjunction with a clinical trial addressing a particular target. If there are cancer cells present on the effusion, it may be possible to test them for a mutation, depending on trial policies.

Thank you for your good thoughts as well.

JimC
Forum moderator

I have little to add to Jim's thoughtful comments here. The most readily useful "driver mutations" of EGFR and ALK are rare enough in squamous NSCLC that they are not usually tested for in that setting.

Jim outlined the agents that have a track record in previously treated lung cancer, specifically Taxotere and Tarceva. Investigational immunotherapies have demonstrated impressive efficacy in some patients as well, though they aren't commercially available -- only through clinical trials.

Good luck.

-Dr. West

Hi Sarah,
The radiation could certainly be the cause. As Forum Moderator Janine (catdander) said in a previous post:

"If the radiation is close to the esophagus it can cause esophagitis, inflammation of the esophagus which in turn can cause difficulty swallowing. My husband didn’t get it when radiated to his primary but did when radiated to cervical spine. It was at its worst the week after the end of a 2 week treatment, lasted about a week and caused quite a bit of trouble swallowing.

If that is the case for your mom there are a couple of medications she can take. But I can only remember magic mouthwash; a combo of numbing and pain relief meds compounded at the drug store. It lasts a short period of time and is good just before eating.

Another FYI is to eat soft, non acidic, non salty food. Anything that can aggravate the esophagus because it is already tender. Pineapple juice may be a culprit since it’s acidic.

Of course the safe thing to do would be to give the radiation dept a call to see what they say. It may be something completely different.

Here’s a blog on the subject of esophagitis. http://cancergrace.org/radiation/2008/08/03/rad-esophagitis/ "

Dr. Weiss added:

"Some of my patients have found that swallowing a shot of olive oil right before the radiation every day helps (thank you, Dr. Harry Quon for that trick!). Also, there are variety of magic mouthwash rinses containing lidocaine that you can swish and swallow to numb the esophagus before eating."

As far as the nodes growing but shrinkage or stability in other areas, this could be what is known as a "mixed response", where some areas of cancer remain sensitive to treatment while others do not. Since the nodules in both lungs and pericardial effusion (if it contains cancer cells) indicate stage IV disease, unfortunately new mets are always a concern. But node growth doesn't necessarily mean the cancer is metastasizing elsewhere.

JimC
Forum moderator

Hi Sarah,

The anemia caused by cancer and cancer treatment is not the same as that caused by having low iron levels. As Dr. Weiss has described it:

"Blood cells are made in the bone marrow. B12, folate, and iron are some of the building blocks necessary to make blood. If they are not deficient, then adding more of them won't help. It's like asking a toddler to build a house out of blocks. He certainly needs the blocks to build the house. But, if he's more interested in something else, it doesn't help to add more blocks.

Procrit is a pharmaceutical version of the same chemical that your kidneys secrete to tell your bone marrow to make more blood cells. It is the equivalent of asking the toddler to please build a house out of the blocks sitting in front of him.

The hemoglobin at which we give blood varies by the health status of the patient. For a patient with coronary artery disease or symptoms from the anemia, I typically transfuse for Hgb<10. If the patient has no symptoms from the anemia and no reasons for anemia to be more dangerous (like coronary artery disease) I typically transfuse for Hgb < 7 or 8. Transfusion is something that really needs to be personalized to the individual patient, which is your doctor's job. I hope that this rough guide is helpful for understanding.

Hemoglobin goes low in the cancer patient because of 2 dominant factors--the cancer and the chemo (although other sources, such as bleeding are possible). Cancers secrete cytokines that decrease the amount of blood cells the bone marrow makes. Chemo can lower blood counts by further decreasing production. Counts do tend to improve with time off of chemo, such as between cycles or after finishing chemo." - http://cancergrace.org/forums/index.php?topic=11102.msg90879#msg90879

JimC
Forum moderator