Extensive SCLC Complete Response - 1251273

ghuber
Posts:7

Hi All,

So my dad, a 67 year old male, was diagnosed in early Oct with EX-SCLC. He has a 6cm mass in right lung, 'spot' on the pancreas, and 6cm mass in the gastrointestinal tract. He is being treated with the standard therapy of etoposide and cisplatin.

He received 2 treatments total since that time. The doc repeated CAT scan last week and has reported a good result -- near complete disapperance of 6cm gastro mass, and significant shrinking of lung and pancreas spot. The doc remarked that from the CAT scan the it appears the tumor in the lung has broken into two pieces and away from the lung.

He will be moving on to the next treatment next week. We are hoping and praying for further shrinkage and perhaps the total disappearance of all tumors.

My question is this response typical? If in fact he hits the milestone of complete rresponse are there any proven therapies to help keep any remaining SCLC cells from growing? Lately, I've been coming across a lot of promising research on curcumin. Out of all non-standard therapies, this seems to be generating the most buzz. Aside from that, green tea extract had looked interesting, but the research I've been reading as of late looks a little less promising. Thoughts?

Forums

Dr West
Posts: 4735

It's terrific that he's doing so well! This is a very good response, particularly for extensive stage SCLC, but it's not extremely unusual for SCLC, which is often quite responsive to initial treatment. Unfortunately, there is no intervention we know of as a maintenance strategy that has a significant impact on the overall course of the disease. Various maintenance chemotherapy approaches have been tried, most notably topotecan or etoposide, and these can modestly lengthen the time before the cancer progresses, but there is no significant impact on overall survival, and the maintenance approach is associated with more side effects. With such a modest/minimal beneficial effect and real negative impact, maintenance therapy is not a standard approach after 4-6 cycles of first line chemotherapy for SCLC.

As for non-standard therapies, these remain really quite unproven, and I'd have to confess that there isn't a lot of enthusiasm about them among most oncologists, since "buzz" has tended to have very little association with real demonstrated benefit in good clinical trials with patients. Thus far, there haven't been any non-standard treatments that have looked especially promising in real studies with SCLC patients, and SCLC has been a difficult area to demonstrate meaningful effects.

Good luck.

-Dr. West

ghuber
Posts: 7

Thanks, Dr. West. It's been a while since I wrote. My dad finished chemo about 3 or so months ago. It was pretty successful -- all tumors besides for the lung went away. About 4 weeks after chemo ended we began to supplement his diet with Green Tea Extract and Curcumin. We've also been thinking of adding Querctin, but have been hesitating because it can alter the metabolism of one of his heart medications. Interestingly he is also on a statin and beta blocker, which I've read in addition to the supplements, may also slow the progression of the cancer.. Whatever the case, these things do seem to be working to slow the cancer's growth and spread -- At his 90 day post-chemo scan, he has no regrowth of any tumors outside his lung and only very, very slight regrowth of the tumor in his lung (<.05cm). He looks and feels quite good, which is a blessing.

His oncologist is now going to give him radiation treatment.(IMRT) as his remaining tumor is a pretty tightly wound mass located on the very bottom of his left lung. We are examining the possibility of using soy isoflavones during the treatment to radiosensitize the cancer cells to the therapy. Have you ever heard of this or the usage of any other radiosensitizers to enhance the efficacy of the treatment? Also, do people generally have a decent response to radiation post chemo? It know it's fairly uncommon to give this treatment for SCLC-EX.

I know there is no way of knowing, but I'm wondering how well you think this might work. It is reasonable to believe there could be an additional 50% shrinkage of the lung tumor? I'd love to aim high and hope it could be eradicated all together with radiation alone, but it seems unlikely. In any case, we'll take whatever we can get! Hopefully, if successful no regrowth or new growth outside the lung will occur anytime soon.

By the way, his oncologist is a great guy. My hat's off to you guys. You have a really tough job.

JimC
Posts: 2753

Hi gman,

Congratulations on your dad's great response to chemo and continued stability. I wouldn't even think of the latest scan result as showing any evidence of even very minimal growth, as .05 cm is well within the variance between the two scans and not at all significant.

As you say, radiation in this setting is not normally pursued. The reason is that even if the lung tumor is eradicated completely, the presence of metastases in the GI tract and pancreas indicate that cancer cells have entered the bloodstream. With extensive SCLC it is likely that those circulating tumor cells will eventually show up as metastases elsewhere in the body. Radiating the lung tumor is not likely to halt that process, so the risks and side effects of IMRT to the lung tumor should be carefully considered.

The idea of radiating a solitary site (in this example, a stage IV metastasis) is thoroughly discussed by Dr. Weiss and Dr. West in the two posts beginning here: http://cancergrace.org/forums/index.php?topic=9855.msg78322#msg78322

JimC
Forum moderator

Dr West
Posts: 4735

Actually, I covered the issue of radiation to residual chest disease for extensive stage SCLC here:

http://cancergrace.org/lung/2008/07/01/rt-for-ed-sclc/

It's not that well studied, but there's evidence that these patients tend to do pretty well: it's just that it may do well not because of the treatment, but because they were unusually good prognosis patients already if the idea of radiation to the chest was being considered.

The idea of isoflavones to radiosensitize doesn't have much evidence to support it and wouldn't be high on my list of interventions to favor.

Good luck.

-Dr. West

ghuber
Posts: 7

Hi All,

Well, my dad got back the results of a CT scan from the last week, about 4.5 months post chemo... Still no signs of the tumors in the intestine or in the pancreas... and no spread...

After 25 sessions of IMRT radiation, the CT showed the remaining lung tumor has decreased in size by about 20% and the CT scan showed that, like the other tumors had, the mass is splitting apart. He is going all the way to 32 sessions, which he expects to finish tomorrow. The oncologist said the tumor will continue to shrink is size for a little while after the radiation is completed. With the extra 7 treatments we're hoping for 25% shrinkage. He's still taking the green tea/curcumin/soy isoflavones. He didn't have any side effects from the radiation other than a bit of coughing.

Is this a good response for RT alone? It's hard to find information to compare his result to since RT is rarely done for SCLC-EX.

JimC
Posts: 2753

Hi gman,

Shrinkage is always good, and in addition it should be emphasized (as your doctor suggested) that not only will the radiation continue to affect the tumor for quite a while but scans during or just following radiation do not always give a clear picture of the full extent of the effect of treatment. As Dr. West has said:

"In truth, there is often no way to really know what's happening if there are still residual findings, which may appear on PET and/or CT after chemo/radiation, except to follow the scans for changes over time. As a very impatient person, I find this less than satsfying, but it's simply the case that unless there aren't any residual abnormalities at all (and call it a "complete response"), you just can't know whether the residual abnormalities in the setting of a partial response (far more common than a complete response) represents post-treatment changes (benign) or residual viable cancer. Following to see whether the scans worsen or improve/remain stable over time is really the main approach we need to fall back on quite often." - http://cancergrace.org/forums/index.php?topic=4164.msg24560#msg24560

Good luck with continued good results from the remaining treatments.

JimC
Forum moderator

ghuber
Posts: 7

Jim,

Thanks for your thoughtful response. So I guess an additional question of mine based upon your response -- is there an estimate among oncologists or radiologists as to how long the shrinkage (cell death) will continue upon the completion of the RT? I was thinking it would probably be only a small window of time, like maybe 2 weeks, but some of the posts I've read seem to indicate the length might be significantly longer.

niaqre1
Posts: 15

Hi Gman,

I read about all your story above, I want to know if your dad still doing good?
My husband have the same cancer with your dad which is Extensive small lung cancer.
I want to know more, if you dont mind

Thank you
nia

ghuber
Posts: 7

Hi Nia,

Sadly, my dad passed in October 2013. However, he did not die as a direct result of his lung cancer.

Within a few weeks of finishing the 32 sessions of IRMT, he unexpectedly developed afib, a cardiac condition where the heart flutters instead of pumps.. He had a history of heart palpitations, and as such, had a cardiac defibrillator implanted in his chest. He was shocked 11 times by his device, and his heart was brought back into rhythm. After the episode his cardiologist placed him on a lung toxic drug, amiodarone, to control the afib. During the following three weeks, he developed shortness of breath, tachycardia and ultimately was rushed to the hospital. Diagnostic procedures revealed 'white out' of the lungs, which was initially thought to be radiation pneumonitis, but later after an open lung biopsy, found to be more likely the result of amiodarone, a condition formally referred to as amiodarone pulmonary toxicity. He spent three weeks, mostly sedated, on a vent after which time his developed a very lethal condition called ARDS. Shortly thereafter his lungs failed and he passed.

My dad was brave, and fought until the day he passed. Even though my dad's story did not ultimately end up being a good one, I want to tell you there is absolutely hope! A medical mistake was made in my dad's case -- he should not have been prescribed the amiodarone with his preexisting lung condition, even more so because he just went through radiation therapy of the lungs. Had he not had this wretched drug prescribed to him, he may still be with us. Doctors told my family had this not happened, my dad could have potentially lived an additional 1-2 years given his great results to the cancer treatment.

I hope and wish you luck. I will say a prayer for you and hope for your husband's recovery.

If you have an more questions, let me know. God bless.

Dr West
Posts: 4735

I'm so sorry. Thanks for letting us know and for offering some encouragement despite your father's unfortunate turn of events.

-Dr. West

niaqre1
Posts: 15

hi gmn,

I'm very sorry about your dad. I am sure that your dad was a brave man and a fighter. Same like my husband, he is so brave and a fighter and Still trying to beat this cancer. As you mention above you add supplements for your dad which is green tea extract, curcumin and soy isoflavones?? For curcumin, I bought spring valley whole herb turmeric cucurmin 500 mg. is it the same like you gave your dad? I can't find soy isoflavones. What the name of the brand your dad took?
I want to try the way you did to your dad. If you don't mind...... What are they? How you take it a day? Etc.

So far, what I did for my husband are, eat fish, less meat....meat maybe 2 times a week. And green vegetables. Carrot juice. And for supplement I only give him organic garlic 500 mg, take 2 a day. Which I read that garlic can stop cancer to spread.
I was mention about herb for cancer to my husband oncologist whether it will interfere chemo or not and she said taking herb for cancer there is no research of that but if your body feel good about it, keep taking it. But if not just stop it. So far my husband take garlic.

I am thinking to adding more supplements or change the supplements to the way you use. As your dad was keep up with no sign of spread cancer for 4.5 months.
I really want my husband keep stay around for more longer and longer and longer.

Thank you
Nia

ghuber
Posts: 7

Hi Nia,

My dad was taking Life Extension Super Bio-Curcumin and Green Tea Extract. (He took each once in the morning and once at night if I recall) I was suggest a B95 type of curcumin, because it is far more bioavailable than normal curcumin. The soy isoflavones were meant to improve the efficacy of the IMRT radiation he received. My advise is to be very consistent and make sure your husband takes whatever supplements you decide upon each and every day at the same time. I also want to add we chose not to have him take these supplements while he was going through chemo, although some studies seem to indicate a synergistic effect that improves the efficacy of the treatment. So just to be clear, he only took the supplements after his chemo was done, mainly because he was having a tough time with treatment and we didn't want to risk making it any tougher. The use of the supplements was aimed at delaying the progression of the cancer and it did seem to be working. Perhaps if my dad hadn't so many comorbidities, he'd still be with us.

Good luck and god bless.