Hello Dr. West and the Grace Community,
I am writing in order to get your opinion on my mother's treatment options after being on Iressa for 15 months with good response (since June 2013) only to find out today that her scans last week showed progression. Here are the results of the CT Scan:
- Small new sclerotic foci are now identified within the bodies of T1 and T2 veretebrae, T5 vertebral lesion remains unchanged
- multiple additional tiny new nodular pulmonary opacities are identified within the Right lower lobe and also within the Right upper lobe
- new nodular opacities are also identified left upper and lower lung fields
- this suggests new metastatic lesions
- the pleural-based nodular opacity in the left upper lung field is larger than previous measuring 7 x 4.5mm, previously 3.6 x 2.7mm
- an enlarging left celiac axis node is suspected, 1.3 x 0.9 cm
Given this information, the medical oncolgist suggested that these results are concerning and gave us 2 options:
1) continue on Iressa and follow up with CT scans in 2 months time. If continues to progress, then stop Iressa and start Cisplatin/Alimta.
2) stop Iressa now and start Chemo with Cisplatin/Alimta.
The medical oncologist told us that her personal recommendation would be #1, to continue Iressa to try to get out more benefit and check back in 2 months time.
My question is: given the results of the CT scan, do you think that my mom should opt for the Chemo route?
Given the possible option for AZD9291 or CO-1686, I asked the oncologist if these agents are an option, she said that these are experimental agents and she can not comment on whether my mom should try them out or not. She said chemo is standard care and she is comfortable giving my mom chemo after the 2 months wait, but if we want she would be okay with my mom enrolling in a Phase 3 trial, not a Phase 1 or 2.