BAC & Chemo - 1267437

In his post, Treating Bronchioloalveolar Carcinoma by Not Over-Treating It: What the Experts Really Do (and Don’t Do) Dr. West states,
"People with a very slow growth rate are likely to do very, very well no matter what treatments they get, as much despite as because of those treatments. In many cases, interventions are pursued on patients who are destined to do very well, and then when their short term survival is good, the people who did that intervention write a paper saying how their approach is feasible and attractive because the patients did well — not recognizing, or at least glossing over the idea, that they were going to do very well anyway.

"I would say that in no other area of lung cancer care is it more important to distinguish between what can be done and what should be done. And the real experts know when to not intervene." http://cancergrace.org/lung/2013/01/20/mf-bac-algorithm/

I'd be curious to know why the specialist at MDA suggests aggressive treatment in light of the seemingly slow growing BAC. Was there an explanation?

Janine

Janine, I referred her here to Dr. West. My question would be since this is a recurrence, does that change how you'd treat it? The nodules are in both lungs (5mm largest), isn't that considered multifocal and would that also possibly change treatment options? Or would you still consider this indolent?
Take care, Judy

No, it doesn't change the situation whether this is a recurrence or an initial presentation with multifocal disease. The past history of surgery and then new nodules appearing years later shows this is following a very indolent pace. I wouldn't consider there to be a real value to doing local therapy except that it enables everyone to pretend they've treated the cancer effectively until more nodules appear in a few years.

Janine provided key quotes and a link to my detailed discussion, which really supports your mindset. Even at illustrious centers, I fear too many oncologists fall prey to the temptation because of a compulsion to "don't just stand there -- DO SOMETHING", no matter how unlikely it is to be helpful, or at least not likely to be helpful to do now vs. later.

Is it possible that your cancer will mutate and completely change its behavior and become more aggressive, and you might miss an opportunity? Yes, it's a very small possibility (I'd estimate 1%/yr - but that's just a best judgment, which is really all there is to go on). You need to weigh that against the risk of significant complications from treatment, which may be at least as high. I also see no value in exhausting the potentially valuable treatment options to treat very small, stable, asymptomatic lesions now, then have the cancer develop resistance to the treatment years before it's actually needed. More likely, if the cancer doesn't progress, it leads to a temptation to continue treatment that may be doing no good at all -- you'd be quite likely to see complete stability for months or longer on no therapy as well -- but then patients are prone to potentially being on chemo for months or years, with very real risk of organ damage and diminished quality of life that this entails.

Overall, I use the yardstick of whether lesions are growing visibly (not just 1 mm that you can't see) over a 4-6 mo interval to define "clinically significant progression".

Good luck.
-Dr. West

Thanks for answering my questions Dr. West. I did read the article previously and this is why I told her to come here. I will tell her to come back and read your response. Take care, Judy

no, that's totally fine. It's a fair question to ask.