Stopping Tarceva at NED - 1266871

agpv
Posts:2

I had my first Pet Scan after diagnosis last week. I got my results and I'm in remission, NED, and nothing showed up on Pet/CT. I had radiation treatments, 25 to lung and 20 to T12. I have also taken Tarceva 75 mg since July of 2014.

My oncologist said there is a new journal article that says that Tarceva might do more harm than good once you've reached NED by causing a different type of Cancer to grow. Please give me advice. I want to know the benefits of staying on it versus not being on it or what this new medical article is about. Thank you very much for any input you can give me.

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Reply # - November 1, 2014, 08:44 AM

JimC
Posts: 2753

Hello,

I haven't seen the article you mention, but at least until now it' been an open question whether continuing Tarceva causes resistance to develop faster, and whether it is necessary in order to remain NED. As Dr. West has written about the question of Tarceva causing resistance faster:

We don't know. That's never been tested. It's reasonable to consider using a more intermittent approach to EGFR inhibitor therapy, just when the cancer is progressing and then stopping it when the cancer is well controlled, but we know that some people will experience rapid progression after stopping an EGFR inhibitor, and we just don't know whether an intermittent approach will postpone development of resistance, accelerate it, or have no effect at all. - http://cancergrace.org/forums/index.php?topic=8426.msg63934#msg63934

JimC
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Reply # - November 1, 2014, 08:36 PM

Dr West
Posts: 4735

Congratulations on being NED! I don't know of that article and know of no lung cancer expert who would seriously consider stopping an EGFR inhibitor in this setting. The new result that has changed our view is the oral presentation (not published yet) of the IMPRESS trial, which showed that it's not helpful to continue an oral EGFR inhibitor concurrently with chemotherapy after progression has developed on the EGFR inhibitor previously. However, that's not your situation. Either 99 or 100 out of 100 experts would favor continuing an oral EGFR inhibitor in a patient who is responding well, tolerating it OK, and isn't demonstrating progression on it.

Feel free to ask your oncologist for that details of the journal article in question, because either it's being misinterpreted or it has slipped under the radar of every lung cancer expert attending the lung cancer meeting I've been at over the past several days.

-Dr. West

Reply # - November 23, 2014, 07:04 AM

agpv
Posts: 2

Dr West: what do you think about the above article? I have been taken off Tarceva now for a week yesterday. The oncologist says, it's more detrimental to my health than a help. Personally I feel like I'm in the middle of the ocean and he pulled my life jacket away from me since I'm NED. I'd appreciate your opinion and anyone else who would like to reply. Thank you.

Reply # - November 23, 2014, 08:58 AM

JimC
Posts: 2753

Hi agpv,

The article describes early, laboratory-based research, not human (or even animal) trials. Many conclusions drawn from such studies do not result in changes in clinical practice because actual clinical trials do not support that conclusion. So it seems to me it would be premature to rely on this research in making treatment decisions.

JimC
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Reply # - November 23, 2014, 01:12 PM

Dr West
Posts: 4735

I agree with Jim's perspective here. That conclusion that it's appropriate to now remove Tarceva (erlotinib) in advanced disease based on this work on cell lines is wildly speculative and very well beyond current standards of care. This is a conclusion that would not be made by the vast, vast majority of lung cancer specialists in the world.

-Dr. West

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