My dad has been on Tarceva for 14 months. Recently, he started feeling unformatable with his right thigh bone, and feeling is consistent with early bone met pain, and the location is also at the previous known bone met spot. He has been taking regualr shot for bone mets ( the ones that help with bone strength ).
The pain is pretty minimal right now, and we have a CT scan upcoming up within a month. Depends on how the CT look, we might have a few different options.
1. If the right thigh bone is the only spot, based on reading preivous post, it might be best to do radiation to the spot and continue Tarceva. But of all these time he is on tarceva, we have been doing chest CT only to monitor. ( although there were multiple bone mets prior to tarceva ). If his next chest CT looks stable, do we assume the thigh bone is the only spot, since it is the only place symptomatic ? , or do we assume the opposite and do some extensive imaging to found out ?
2. If his chest scan showed progression, we would leaning towards doing biospy and hope to join some trial preferrably CO-1686. In this setting, is there any disadvantage vs advantage of looking into/treating this spot ? or do we actually want to not treat it in case we need to biospy it ? ( not sure if I am making sense here ).
3. In general, since the symptom is light, should we take a wait & watch approach before next scan, or should we go get it checked out and treated as soon as possbile ? I guesst what I am thinking in layman's term is that if there is one place cancer cell is resistant to treatment, wouldn't we want to treat that spot sooner, so minimize the chance of it spreading to other places ?
Thank you for your advices !
Reply # - May 10, 2015, 03:28 PM
Hi dongsheng, I'm sorry you
Hi dongsheng, I'm sorry you're back because your dad is having problems.
I'm adding several links that I think will be helpful. So please let us know what questions you still have and I'll contact a doctor if they're not general type questions. Though since today is Sunday and somewhat of a special occasion day, Mother's Day I'll not ask for comments from any of the doctors. I'll leave you with these links to read that I think will help give info on what's important when going through the decision making process.
If there is progression in more than one or two locations while on tarceva systemic treatment like the CO 1686 trial drug is a good option. Normally focal treatment isn't considered to be helpful in that case unless there are issues of pain and or stability of a weight baring bone. However it's thought that this is the only problem area focal treatment such as radiation can be used and tarceva continued without a change.
http://cancergrace.org/lung/2013/01/23/acquired-resistance-algorithm/
Dr. West stated in his post, "It’s possible to biopsy bone lesions, but they are not preferred for genetic testing because of all of the processing required. Some labs do it, some don’t, and some clinical trials don’t allow tissue samples from bone biopsies. But it is possible to get genetic testing done from biopsies of bone metastases, though not as reliably as biopsies from soft tissues. http://cancergrace.org/topic/is-bone-met-biopsy-possible" http://cancergrace.org/cancer-101/2012/08/03/faq-on-bone-lesions/
I assume the drugs for the bone are these but just in case...http://cancergrace.org/cancer-101/2009/07/10/denosumab-for-sres/
I hope this is helpful. Let us know of any followup questions you have.
Janine
Reply # - May 10, 2015, 05:03 PM
Hi Janine,
Hi Janine,
Thank you so much for taking the time to reply to me on this beautiful Mother's Day. I will check out the links
DONGSHENG
Reply # - June 10, 2015, 11:00 PM
My dad just had the chest CT
My dad just had the chest CT scan last Friday. It looked really good. Overall stable and the tumor even shrink a little bit compared to last scan.
However, his continue to have leg bone discomfort/minor pain at the previous known met site. He then had a CT of the leg and it is mostly likely to be the bone met that caused the pain.
In the scenario where the primary is still responding to tarceva, but a bone met site is progressing ( minor pain ), do we favor treating the bone met site, e.g. radiation ? I have read Dr.Weiss "weeding the garden approach", which makes a lot of sense. I guess my question is more on - for a bone met that is causing minor symptoms , do we favoring weeding the garden now ? or (save radiation) wait later till the symptom is more severe ?
Reply # - June 11, 2015, 07:42 AM
Hi dongsheng,
Hi dongsheng,
As Janine described in her earlier reply, painful bone mets are usually treated with radiation, not only to relieve the pain but when the bone met is in a bone in which a fracture could be debilitating, radiation can help prevent that from happening. So you'd want to do that sooner than later.
As you already know, if there is only one spot that seems to be progressing, treating that spot and continuing the targeted therapy, in this case Tarceva, is often the preferred choice.
JimC
Forum moderator
Reply # - June 14, 2015, 10:45 PM
Thanks for the clarification
Thanks for the clarification Jim ! We'll start radiation tomorrow.
Reply # - June 22, 2015, 10:44 PM
I have an other question, my
I have an other question, my dad also has a met on T1 ( vertebra 1 ? ). This met is asymptomatic. We don't know if this met is progressing or not since we don't have any baseline imaging.
My question is that would we favor radiation to treat it now ? Or wait 6 weeks to do another imaging to compare and found out if it is progressing or not ?
On one hand, this is asymptomatic and maybe kept at bay by tarceva, but on the other hand, I was told this T1 location is not good with potential to cause major complications. so is there any downside to just treat it now ?
Thanks for your helps and advice.
Reply # - June 23, 2015, 07:46 AM
Hi dongsheng,
Hi dongsheng,
If your dad is already getting radiation to other bone mets, there may not be much downside to adding the T1 met to the radiation plan, since he'll be at the radiation center anyway. Probably a good idea to ask the rad onc about possible complications or risks of treating that particular met.
Good luck with radiation.
JimC
Forum moderator