stash
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Posts:4
Dear Dr. West, regarding stage3b nonsmallcell multinodal lung cancer previously treated with just tarseva
for 1 year, most sites are unchanged however 1 site shows slow growth in periferal lung lobe and 1 site at aortic base shows slightly accelerated growth. Patient is 84 years old and t790m negative.Please comment on most efficatious options; Isolated proton therapy for aortic mass, with tarseva and avastin, carboplatin/alimta with or without avastin, Afatinib/cetuximab, or enter a pembralizumab trial without knowing
PDl-1 receptor status. Thank you sincerely.
Forums
Reply # - May 13, 2015, 08:20 AM
Hi stash,
Hi stash,
Welcome to GRACE. Without having the specific knowledge possessed by your doctors (who have followed the case and have access to all of the medical records including scan results), the first option I would consider would be sticking with Tarceva if the progression is slow, especially if it's being tolerated well. There are a finite number of options, and we like to get as much benefit from each as possible, since the efficacy of any subsequent therapy is unknown until tried.
Radiating one of a number of nodules is not usually recommended unless that site is causing or threatening harm, for instance by pressing on a vital structure such as a major blood vessel. And although there are instances in which the increased accuracy of proton beam radiation is necessary, for most purposes normal stereotactic radiation is perfectly sufficient, and much less expensive.
The other treatment options you mention are reasonable and, with the exception of the trial, have a record of efficacy. When you state that the patient's cancer is T790M negative, is this based on a recent biopsy, or one performed at the time of diagnosis? If the latter, it is of course possible that the T790M mutation has been acquired and that status has changed. If so, a trial targeting that acquired resistance may be another option.
You can find a wealth of information about any of these options in the GRACE archives by using the search function, or feel free to post additional specific questions.
Good luck with the option chosen.
JimC
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