i am in the cross road - 1264763

gigy
Posts:27

Hi,
Happy 4th!

I have quietly finished 4 rounds of Carbo+alimta, had PET scan today. It shows very minimum decrease in tumor size (10% ish). The larger adrenal gland shrinks from 2.8x3 to 2.4x2.7. almost all lesions are under 1cm and spread around the pericaval region.
The news is somewhat disappointing to me.
i am in the cross road of continue chemo with different drug of take a break for few weeks?
Thank you for sharing your kind advises or opinions or experiences.....
Gigy

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Reply # - July 3, 2014, 04:58 PM

Dr West
Posts: 4735

I'm sorry that you didn't have a greater response, and I suppose it's reasonable to be disappointed, but I would reassure you that modest shrinkage after 4 cycles is still not a bad outcome. Any tumor shrinkage is perfectly welcome, and even just stable disease is far better than seeing disease progress by the time that 4 cycles of chemo have been administered, or earlier.

That said, the question of whether to do maintenance therapy, and if so, what maintenance therapy, is a very big question with no best answer. Here is are a couple of links to a general discussion of the issue:

http://cancergrace.org/lung/2014/04/13/what-is-the-value-of-maintenance…

http://cancergrace.org/lung/2010/09/24/lung-cancer-faq-im-coming-to-the…

In addition, if you search the site for "maintenance therapy", you will find dozens to hundreds of discussions of the topic. What you won't find is a clear suggestion of how best to proceed, because the decision depends on many different factors, including patient preference.

One point I would make is that continuing with Alimta (pemetrexed) as a single agent after completing several cycles of a platinum-based doublet with Alimta is another leading option for "continuation maintenance". This is a very viable, often well-tolerated option in patients who haven't demonstrated disease progression after first line doublet chemo -- including in those patients with relatively modest tumor shrinkage.

Good luck!

-Dr. West

Reply # - July 3, 2014, 06:11 PM

ssflxl
Posts: 204

Gigy,

I had PET scan after 3 cycles of Carbo/Alimta and it showed some decrease in SUV, and then I had repeat PET after 6 cycles of chemo and it was stable. However, my cancer symptoms have improved - not 100% yet, but my pain and breathing are both improved. I had expected my scan to show a lot more shrinkage because of how I feel. I will start my Alimta maintenance next Monday and hope I will be able to stay on this for years!! So don't be disappointed just because of the result of the scan. If you physically feel better, then it's also an improvement.

ssflxl

Reply # - July 8, 2014, 04:37 PM

cards7up
Posts: 636

Did they do a PET/CT or just a PET? Normal follow-up after tx is usually a CT scan, which gives actual size of tumors. How long after you finished tx was your scan done? Chemo keeps on working, so you're next scan may show more shrinkage. Take care, Judy

Reply # - July 11, 2014, 09:48 AM

gigy
Posts: 27

Hello Dr. West, ssflxl, Janine and Judy;

Thank you for all your advises.
ssflxl, you gave me so much inspiration and encouragement, thank you. Would you let us know how the Alimta do for you? Wish you the best!

Sorry i do not know how to reply to each post, i will just do a summary below:
In 2/14 pet scan found the lung cancer (2a) i had 2 years ago has gone to bone (scapula), brain (cyber it) and current MRI show clean and no new lesion found. they are several small lesions spread around my chest area, when do deep breathing, it makes the center tighter and sometimes pain occurs.
i had 4x carbo+alimta. CT+PET after 2 cycle, so i had the image twice in every 6 weeks, personally i think it is done too frequent and too fast. the final word from the radiologist is "stable".

Here are some suggestions from doctors for next step:
1. take a break for a month or so to strengthen my body. (all vital signs okay now)
2. change drug for chemo (has not mention any combination, may be just any standard ones)
3. go in to maintenance using Tarceva (only 10% effective), i do not like this. The doctors mentioned to use Alimta before, don't know what happened.
As Dr. West noted, above 2/3 itself is a topic to study, which way to go?
4. i also request to participate in clinical trail PD-L1, i think this may have better chance to survive.
My energy seems to be limited recently, this is all for today.
Thank you so much.
gigy

Reply # - July 11, 2014, 10:38 PM

Dr West
Posts: 4735

Gigy,

As you know, we can't tell people what to do among the many reasonable options that don't have a best choice. All of the options are reasonable ones. Our goal is to try to convey the choices and the factors that might help people choose among them, but every case has personal considerations, so it has to come down to each patient and their docs to select the best approach for them.

Good luck.

-Dr. West

Reply # - July 12, 2014, 06:34 AM

gigy
Posts: 27

Dr. West, Thank you.

This is why making one choice is so difficult to most patients.
At this point, may be continuing chemo of some kind or clinical trial.
Any opinion on using Hemp oil??
Thanks.

Gigy

Reply # - July 13, 2014, 08:45 PM

gigy
Posts: 27

Hi Dr. West,
Appreciate your response very much. If the choices are acceptable, then my map will be read like this:
1. enter the clinical trial, if not accepted, then
2. another standard chemo (changing drug) or just go direct to Tarceva maintenance?
i have done Carbo/alimta and failed in last month. 2 years ago i have Cisp/alimta. May be this is why my doctor do not want to use Alimta as maintenance, i will find out.
Thanks a lot!
gigy

Reply # - July 14, 2014, 07:46 AM

JimC
Posts: 2753

Hi gigy,

Either way it sounds like a reasonable plan. And I agree that your prior experience with Alimta may be the reason that your doctors are not recommending its use now.

JimC
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