Lung cancer spread to the through the peritoneum cavity - 1263368

odossani
Posts:8

My mother was diagnosed with Stage 4 EGFR Exon 19 positive Lung cancer 3 years ago and has been on Tarceva during this time with very good results. Her most recent CT scans showed a small tumor in the liver (8mm) and around the same time she recently became unwell (unable to eat or drink) and so we had a Pet Scan which showed fairly widespread cancer spread to the intestines causing a blockage. We are working on switching to Afatinib but are also considering if radiation can shrink these tumors to where her intestine can allow food and water to pass through. Does anybody know if radiation can help this condition.? Surgeons have said surgery is very risky

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Reply # - April 23, 2014, 06:15 PM

Dr West
Posts: 4735

I'm sorry she's facing this situation. Unfortunately, this is a very diffuse process, so I cannot imagine that either radiation or surgery would be helpful for it. It tends to be difficult to treat, but systemic therapy like conventional chemotherapy or possibly a targeted therapy would be the most feasible approach. I wish I could be more optimistic about afatinib, but its track record in the setting of acquired resistance to Tarceva is just not very good except in very unusual cases. Some investigational agents, such as CO1686 (being developed by Clovis) or AZD9291 (from AstraZeneca) have demonstrated more promising activity in patients with acquired resistance to EGFR inhibitors.

Good luck.

-Dr. West

Reply # - April 23, 2014, 10:27 PM

odossani
Posts: 8

Dear Dr. West,

Thanks for your reply. Your opinion on Afatinib is known to me but the choice is chemo or that and after my review of the different studies and your own consideration that she has done very well with TKIs in the past we choose Afatinib (oncologist offered both options). We have applied for the co 1686 trial but given her condition of not being able to eat it is unlikely they will accept her for the one open slot they have and it is hard to travel in these circumstances.

A different oncologist reading of the Pet Scan resulted in a very different perspective.
He finds no significant progression of the lung disease and is suspicious that this may be ovarian cancer or something else altogether.

So the question for you is "is it common for lung cancer to progress in this manner". i.e Be stable in the lungs and elsewhere but block off intestines and one of her ureters"

Reply # - April 24, 2014, 06:18 AM

JimC
Posts: 2753

The most common sites for lung cancer metastases are the liver, bones, brain and the adrenal glands, but less commonly it can spread elsewhere. And there are times when it is stable in the lungs but progressing elsewhere. With cancer, pretty much anything can happen.

JimC
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Reply # - April 24, 2014, 06:49 PM

Dr West
Posts: 4735

It's not a common form of progression, but it's definitely a pattern we see -- in fact, I saw that pattern of progression in a patient in my own clinic yesterday. It's possible it's something entirely different, but more often than being two separate, independent cancers, it's more likely to be the same process.

-Dr. West

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