bowersdomain
![]()
Posts:3
Advise, comments anyone can offer. I am currently stage 3B with Andencarcinoma. I tested EGFR Exon 19 Deletion Non-Small Cell Lung Cancer. Have option of going on Tarceva. My concern is having ulcerative colitis. One of the risk is Gastrointestinal (GI) perforation. Is there anyone else here with this condition and also on Tarceva? Since I am EGFR positive Tarceva is looking the best treatment since I have already done chemotherapy of Cisplatin & Alimta with continued progression. This was prior to genetic testing. So before I knew that I was EGFR positive. I am currently doing radiotheraphy for a total of 6 weeks. I have 3 weeks remaining and need to decide on a treatment soon. Thank everyone.
Forums
Reply # - May 22, 2015, 09:25 AM
Welcome to Grace. I'm sorry
Welcome to Grace. I'm sorry you need to be here but glad you found us. I can't recall nor can I find any info on this. I'll make sure we have a doctor respond. Maybe one of our readers can give you some insight. Readers!
I wonder if starting you at a low dose is an appropriate option. Many people are highly sensitive to tarceva and have extreme side effects. The standard of practice is to start at the recommended dose of 150 mg if the side effects prove too much the dose can be lowered to 75 and as low as 25 mg with good efficacy for some.
I'm sure there are options for you to try without giving up the possibility of an effective treatment. Immunotherapies may also be an option.
Best of luck,
Janine
Reply # - May 22, 2015, 10:05 AM
Janine,
Janine,
Thank you for your response. Having a doctors response would be great. I have not found anyone yet with colitis that is taking Tarceva. I did find one person who developed colitis from taking Tarceva and had eventually had to go down to a very low dosage.
I just want to know if I should start at a lower dosage. What are the risks with this pre-assisting condition? I have been trying to do my research. Any help anyone can offers is appreciated.
Reply # - May 22, 2015, 10:33 AM
Hi bowersdomain, thanks for
Hi bowersdomain, thanks for sharing your question with the GRACE community. Bowel perforation is a known, rare complication of drugs such as Tarceva, and while I have not personally seen this in a patient of mine, published accounts suggest certain conditions can increase this risk, such as using anti-angiogenic agents (like Avastin), using steroids, or having other bowel issues such as prior surgeries.
I am not aware that ulcerative colitis is a known risk factor for bowel perforation, but I think it is safe to assume that it might be. However, you always have to weigh the risks versus the potential benefits, and we know that Tarceva can have very significant benefit in patients with EGFR mutation+ lung cancer, while the risk of bowel perforation is relatively low. This would have to be an individual decision between you and your doctor. Is your UC well controlled or flaring up? If you are having active bloody diarrhea then the risk of worsening that with a drug than can also cause diarrhea might be something to consider.
We also know that it might be safe to start at a lower dose of Tarceva for patients with EGFR mutations, although this is not based on very strong data. I usually start at full dose (150mg) and only reduce the dose if there are problems managing the side effects, but in someone with bad skin issues I have started at a lower dose to reduce the risk of making that worse. These are the kinds of things I mean when I say the decision needs to be individualized. There really isn't a right or wrong answer.
Reply # - May 22, 2015, 12:54 PM
Dr. Parnell,
Dr. Parnell,
First thank you for responding to my question. Have you treated any patients with active Ulcerative Colitis with lung cancer?
I am one of those patient unfortunately that has added risk factors.
I went to have port placement and during procedure had Pneumothorax. Low risk factor of this happening but did. Have extensive neurophy, hearing and cardic problem as a result from Cisplatin. Looked at the statics but have as a result.
I am trying to determine if there is a benefit to start at a lower dosage 100 or 75 mg .Then watch how it effects my colitis. I have been reading what other patients have to say regarding Tarceva and serve diarrhea effects a high level of patients. I have read some patients are on different dosages. Dosages being lower after a serve reaction.
I want to extend my life but have a balance with the quality of it.
If there is a reason to reduce Tarceva for a rash why not for colitis.
Thank you
Reply # - May 22, 2015, 10:12 PM
bowersdomain, I think you've
bowersdomain, I think you've hit the nail on the head and there are pros and cons for just about everything concerning cancer. In his 2nd pp Dr. Pennell said, "I am not aware that ulcerative colitis is a known risk factor for bowel perforation, but I think it is safe to assume that it might be. However, you always have to weigh the risks versus the potential benefits, and we know that Tarceva can have very significant benefit in patients with EGFR mutation+ lung cancer, while the risk of bowel perforation is relatively low. This would have to be an individual decision between you and your doctor."
I am so sorry there is no easy answer, your's is an individual case for which there is no standard of care. In these cases we can only infer. I think this is where cancer care becomes a craft or art form. There isn't just one answer but each an individual scenario treated as its own disease or process. I hope that makes some sense, even if you have to squint a little to make it out. :)