Hello.
My name is Sergiu, I am from Romania.
I have wrote a few times on this site regarding my mother (age 59), who was diagnosed almost two years ago with NSCLC.
- 2012 august; 5 cm brain tumor, removed by craniotomy
- 2012 sept; PET and histology indicated Large cell neuroendocrine carcinoma (3,5 cm tumor in lung)
- 2012 sept – 2013 feb; Docetaxel+ Carboplatin and concomitant radiotherapy; After treatment, CT showed REDUCTION in tumor volume (1.2 cm), no mets.
- 2013 august; CT showed regrowth 3 cm of lung tumor (no mets), started Tarceva (K-Ras positive).
- 2013 october; CT showed 3,9 cm (no mets).
- 2013 november; thoracothomy for lung removal (failed attempt). Tarceva again.
- 2014 feb; 3 brain mets treated with Gamma Knife.
- 2014 may; lung tumor 10 cm, 3 liver mets (max 2 cm). Transaminase 4 x normal value, low iron. The rest of the liver parameters are good. Curently on arginine. Tarceva stopped!
She sommetimes does extensive work around the house, however after a few hours she get really tired. Other days she just rests.
Our onc said we will give her either capecitabine or gemtitabine + platinim. He said to read up, think, and we will decide next week.
I know the outlook is bleak at best, but she is my moter so I wont give up trying. Hoever, she is tired, so wathewer we choose, it has to be a mild treatment, we dont want to torture her anymore so low toxicity is essential. We have to find a good cost/benefit balance.
So here is my dilemma:
We have to find a mild treatment with the best cance for a response in both the primary lung and the liver mets .
I have found no evidence for capecitabine as a monotherapy in NSCLC.
I have found evidence for gemcitabine as second and third line as a monotherapy in NSCLC (especially in patients who perviously had a good respnse to docetaxel + platina - like my mother). Is it worth to add platina to gemzar? Wont it be too harsh?
Any other good treatments to coseder?
Thank you in advance.
Reply # - May 31, 2014, 10:12 AM
Reply To: NSCLC – low toxicity for liver mets
Hello Sergiu,
Most commonly (although there are always exceptions in individual cases), platinum is not repeated in later lines of therapy. It decreases bone marrow function, which becomes progressively worse with each additional administration of a platinum agent.
Dr. West has described capecitabine as "not among the more active drugs for lung cancer". - http://cancergrace.org/general/2009/05/25/oncobiz/
Gemcitablne is a drug with proven activity in lung cancer in the first-line setting, and although it has not been tested thoroughly enough in a second-line context to be FDA-approved in the US, it can be used in that setting.
The other treatments commonly used in second-line therapy include Alimta (pemetrexed) (if the cancer is non-squamous), which is approved as second-line treatment by the FDA here in the US, and navelbine (vinorelbine) which like gemcitabine is not approved but can have activity in that setting.
JimC
Forum moderator
Reply # - May 31, 2014, 10:19 AM
Reply To: NSCLC – low toxicity for liver mets
Most of our faculty are in Chicago at ASCO conference and will be out of touch much of the next few days. I'm sure someone with check in from time to time.
Hi Sergiu, I'm so sorry to hear about your mom's progression. You're right and a strong son to want your mom to have the least harsh treatment. Platinum isn't usually given twice especially if you're looking for low toxicity. Comfort care without treatment should always be open to the person with extensive cancer. Though if she's up to it a try on a single agent is very appropriate.
Below are links on neuroendocrine cancer. The biggest problem has been having enough people in one place to research what the best drugs might be.
Here are the blog posts and videos by our faculty on the subject of treating people with these cancers.
http://cancergrace.org/lung/2010/01/28/interview-with-dr-matthew-horton…
and this link is to 4 posts, http://cancergrace.org/lung/tag/large-cell-neuroendocrine-carcinomas/
All the best,
Janine
Reply # - May 31, 2014, 07:46 PM
Reply To: NSCLC – low toxicity for liver mets
Sergiu,
I'm truly sorry about your mother's progression. Unfortunately, wanting more treatment doesn't make it likely that further treatment will be helpful, and I simply can't offer a therapy that I could honestly suggest has a meaningful probability of being helpful. I suspect that her oncologist is mostly trying to offer a therapy that is less likely to be harmful, given that no therapy is likely to help. I don't see a value in adding another agent that will just escalate the chance that she'll become more debilitated from the treatment while also having the cancer progress.
I wish I had a more constructive answer to suggest, but I simply don't believe that giving people a treatment more likely to harm than help them is a good idea, even if the patient doesn't appreciate that further treatment is very likely to be futile.
Good luck.
-Dr. West
Reply # - June 1, 2014, 12:55 PM
Reply To: NSCLC – low toxicity for liver mets
...I was afraid you will say that. I was hoping gecitabine could offer a slight chance of help without making her too sick, but on some level I guess I knew we have reached a poin of no return.
Thank you Dr. West for your honest opinon. It will certainly way heavy in our decision (fully knowing that it is a subjective opinion not to be taken as definite medical advice).
In any case, I dont know yet what will we do, but I do know that I will be radical against a combined or any kind of demanding chemo.
And thank you catdander and JimC for the good thoughts and usefull information.