yuzhou05
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Posts:10
Please refer to signature for the history...
A recent development, to everyone's surprise, was that cancer spread so rapidly.
PET-CT a couple of days ago revealed that he has got abdominal and bone metastasis.
Given his general health condition, it will be too risky for him to endure another round of chemo.
EGFR Inhibitors seem to be the only option now.
Was wondering if you can give some advice on which one to choose, Tarceva or Iressa, or anything else?
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Reply # - September 4, 2014, 07:50 PM
Hello yuzhou05,
Hello yuzhou05,
I am sorry to hear of your father's progression.
Regarding the choice of Tarceva vs. Iressa for patients with activating EGFR mutations, Dr. West has said:
"The short answer is that there’s no real evidence that Iressa (gefitinib) or Tarceva (erlotinib) is a better choice than the other for an EGFR mutated patients. They show remarkably similar efficacy in EGFR mutation-positive NSCLC patients, and modestly greater side effects with Tarceva at 150 mg, probably really quite comparable in side effect profile with a dose reduction of Tarceva. I think just about every lung cancer specialist considers them to be interchangeable choices for EGFR mutation-positive patients, and I would say that many consider there to be a modest superiority for Tarceva over Iressa in the patients who are EGFR wild type (no mutation)." - http://cancergrace.org/topic/comparing-effectiveness-of-tarceva-and-ire…
Good luck with your father's next treatment regimen.
JimC
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Reply # - September 4, 2014, 07:50 PM
A bit of history here:
A bit of history here:
My father, age 69, non-smoker, diagnosed with stage IIIA lung adenocarcinoma (PT1bN2M0) in Dec 2013. EGFR 21 positive.
Dec 2013--May 2014, surgery followed by four rounds of cisplatin and Gemcitabine.
June 2014, radiation therapy, but was not able to finish due to severe fatigue.
June 2014 to Aug 2014, no treatment, still suffers from severe fatigue.
Some of the biomarker values are high. All CT/PET examination by Aug 2014 showed no sign of recurrence.
Sept 2014, PET-SCAN revealed abdominal and bone metastasizes.
Reply # - September 5, 2014, 06:59 AM
I'm sorry to hear of his
I'm sorry to hear of his recurrent disease. As Jim highlighted, I would summarize that in EGFR mutation-positive patients, there is no evidence of any meaningful difference among the EGFR TKIs in wide use -- they all do comparably well. Iressa has the most favorable side effect profile. In some places, cost differences or availability may be a bigger factor.
Good luck.
-Dr. West
Reply # - October 3, 2014, 09:39 AM
Jim and Dr. West,
Jim and Dr. West,
Thank you very much for your responses.
Just an update on my father's status. A recent MR scan actually ruled out bone metastasis, we are much relieved. My father started gefitinib in early Sept. We haven't done any exam yet, but he has noticeable improvement in the first several weeks, e.g. sitting longer, eating more. However, the improvement seems have plateaued. I am wondering what shall we expect of the effect of the therapy? More recovery in a couple month or just being stable?
Best,
Zhou
Reply # - October 3, 2014, 11:11 AM
Zhou, I'm glad to know your
Zhou, I'm glad to know your father is experiencing improvement since starting gefitnib. It's still quite early in his treatment with this drug so I'd not rule out expectation of more improvement. Since some improvements are a combination of things it takes time. The best thing is that he's felt and you've noticed a difference so quickly you should keep hopes up for more. I think excellent info on this subject comes from people who've been there and we have, I'm sure you know tons of personal experiences in threads on the EGFR Inhibitors forum found here, http://cancergrace.org/forum/cancer-treatments-symptom-management/egfr-… or a search of the site may help. If your father has access to a palliative care specialist he or she would be a good source of what to expect and how to help get your father there. I'll ask our faculty lung cancer specialist who has palliative care background to comment.
Set your expectations high and know that he can fit anywhere in the spectrum.
All best,
Janine
Reply # - October 3, 2014, 09:14 PM
You can see a steady
You can see a steady improvement over months, but it's common to see the biggest effect early on and then a diminishing effect over time. For EGFR inhibitors in patients with an EGFR mutation, the big benefit is often over days to weeks, followed by a much slower improvement or just stable disease after that. Chemotherapy tends to have a much more gradual pace of improvement, and immune-based therapies can exert beneficial effects stretched out over a much longer time line of months. However, the most common pattern for all treatments is to see the biggest effect up front, followed by impact tapering to stability after that.
Good luck.
-Dr. West