Stage IV adenocarcinoma finishing 2nd month of tarceva - 1266802

Many people would not favor starting Tarceva for such a minimal amount of cancer, barely enough to consider as stage IV, especially with all other areas of disease stable for years. The key question I think many would ask is if the progression is really enough to be considered clinically significant and why Tarceva (erlotinib) would be chosen over chemotherapy if systemic therapy is truly indicated.

Do you have specific questions?

-Dr. West

Also, I'm presuming that the "squamous adenocarcinoma" is a cancer with both squamous and adenocarcinoma features, because I don't know of anything otherwise known as scquamous adenocarcinoma.

-Dr. West

Hi terimax1,

If you get beyond Dr. West's question of whether there is sufficient evidence of progression to warrant treatment, and you want to change to a different regimen, there are a number of standard chemo combinations that tend to be used initially. These regimens usually include a platinum agent such as cisplatin or carboplatin plus another drug such as Paclitaxel (taxol). You can read a GRACE FAQ on first-line chemotherapy here.

JimC
Forum moderator

Besides it very clearly being a treatment choice that isn't the well-established standard of care for someone who doesn't have an EGFR mutation, Tarceva is clearly NOT serving the purpose of being a minimally toxic treatment for her. I find the choice as initial therapy a little befuddling and the continuation of it to be very questionable. While there is some debate from the available data about whether there is meaningful value in treating squamous NSCLC (EGFR wild type in nearly all cases) with Tarceva at all, there are no lung cancer experts who feel that it's a viable alternative to first line chemotherapy.

-Dr. West

People with stage IV lung cancer want to live as well as possible for as long as possible even though cure isn't on the table. So to treat someone with stage IV who has no symptoms (clinical) or isn't showing possibility of causing damage internally then there's no good reason to treat. Many oncologist and patients would prefer to wait for a better reason (like pain or obstruction) before treating since there are only so many treatments available and they all tend to last just so long.

Here is Dr. West's most recent explanation of the idea of significant, http://cancergrace.org/cancer-101/2014/08/10/8-factors-on-evidence-lead…

I hope this helps,
Janine

I don't think the number of nodules over that period of time would be the deciding factor on which treatment to use. Instead, unless there is an activating EGFR mutation, chemo would be preferred over Tarceva. And at whatever point chemo is first used, a typical first-line regimen of platinum plus another drug would be the leading choice, except where circumstances dictate otherwise, such as when a patient is deemed to frail to tolerate a platinum doublet.

JimC
Forum moderator

I really meant that if progression is very slow, there isn't a clear reason to initiate treatment -- though it's admittedly a judgment call. Even if the pace of the disease is accelerating, it may only be accelerating from extremely slow to pretty darn slow...still not necessarily enough to initiate treatment if our goal is to ensure that the treatment shouldn't be worse than the disease.

-Dr. West