bone metastasis response to systemic treatment - 1269965

apatient
Posts:8

Just got the first restaging first scan (brain/spine MRI + Chest CT) following starting tarceva about 4 weeks ago. Overall, my scans show a great systemic response, with the primary lung tumor reducing in size and developing cavitation, and the nodules throughout both lungs also decreasing in number and size.

However, in the bone metastasis the imaging shows an increase in size in the lesion at T5, as well as new lesions in other vertebra. The activity in T5 corresponds to increasing pain I've been experiencing in the area of my back starting prior to the scan. My doctors have assured me that, given the good systemic response, the progression in the imaging is actually the bone remodeling in response to the cancer treatment. But the pain I'm experiencing at the T5 area is causing me to worry.

The pain at the T5 area started immediately after a zoledronic acid infusion 3 weeks prior to the scan and has been intermittent since, worsening recently.

In general, what is expected in the response of bone metastasis in the context of a good systemic response? Could the zoledronic acid be causing the pain?

Thanks

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Reply # - May 26, 2015, 08:34 PM

catdander
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Hi, Congratulations on the good results! Zometa can cause bone pain though normally transient. Also it's very true that trying to follow bone mets is very difficult and not normally a priority. Remodeling of the bone looks a lot like a growing met. If the vertebral met causes continued or worsening pain it may be decided that the met is growing and radiation maybe an option for managing the pain. Too if tarceva is effective systemically with one or two exceptions then focal treatment is an option while continuing tarceva as shown in the algorithm here, http://cancergrace.org/lung/2013/01/23/acquired-resistance-algorithm/

I don't know if this will help but here is a link to a blog post on the subject of bone mets. http://cancergrace.org/cancer-101/2009/04/14/rs-bone-met-mgmt-bisphos/

I can only imagine the worry however often it takes time to see what's causing problems. It sounds like you're responding well to tarceva and your oncologist is watching closely. Don't hesitate to let the onc team know of new or worsening pain or other symptoms.

Best of luck,
Janine

Reply # - May 27, 2015, 07:37 AM

apatient
Posts: 8

Thanks catdander. I did some more research and this is a known phenomenon.

http://www.ncbi.nlm.nih.gov/pubmed/20357621

The osteoblastic bone flare or response is the paradoxical phenomenon of increase in the quantity and/or density of bone lesions in the presence of well-documented disease response to treatment in other tumor sites. It results from the rapid repair and increased osteoblastic activity in bone metastases responding to therapy and therefore represents treatment efficacy.

Reply # - May 27, 2015, 09:13 AM

catdander
Posts:

That's right, a response to treatment in bone mets can actually look like progression. Most oncologists find it best to not judge treatment efficacy by how a bone met looks.

I can see how this may cause pain. An orthopedic physician/surgeon working with your oncologist maybe best qualified to handle those pain issues.

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