Stopping Tarceva Before and After Cyber Knife? - 1267152

Hello Faith, I'm very sorry you're experiencing this setback. I hope it's just a bump in the road and you're back on track and in the classroom in no time.

Dr. West describes a study where wbr was given concurrently with tarceva without detrimental effects, "This question of the safety of giving Tarceva (erlotinib) along with brain radiation comes up in our clinics. In general, cancer docs tend to be conservative about giving anti-cancer therapies concurrent with brain radiation unless we have a good sense of its safety. This video talks about the question and the findings from a series of 40 patients from MD Anderson who provide an answer that can help guide us in the future."
http://cancergrace.org/radiation/2013/02/07/is-it-safe-to-give-tarceva-…
One point about the info in the video might be the difference between wbr and cyber knife since ck is given in more potent doses.

Too, we have a member, Sherry who has just been dx with a recurrent brain met and will have cyber knife. She too is on tarceva. However she's going to stay on tarceva as part of a trial to test what happens when one stays on tarceva during radiation treatment. But off trial the safest thing to do is still to take a break. Sherry wrote, "I have also joined a phase II clinical trial at Hillman. It is a study of people who have progressed on erlotinib and who will have cyber/gamma knife treatment while remaining on Tarceva. I am a perfect candidate because I have one met. They said I am their only patient who has the met in the brain, so I think they are interested to see what will happen."
http://cancergrace.org/topic/brain-mets-treatment

I hope this is helpful,
Janine

It hasn't been looked at, and there's no formal recommendation to be had. Because the dose of radiation is so high and it's just a single treatment, I see this as a situation in which the risk of some combined toxicity exceeds the benefit, which is essentially no anticipated benefit. Moreover, holding Tarceva for 1-3 days is really not remotely likely to lead to any serious adverse effects (it's held for a few days all the time in people with significant side effects, a very routine situation), so I see no reason to accept ANY unknown risk of having these treatments overlap if the risk of holding treatment for a few days is as close to zero as we could imagine. I favor having my patients hold it for a day before and day of the procedure. No science, no consensus, and I suspect we're never going to have an evidence-based answer to the question.

Good luck.

-Dr. West

Hi Faith, while Janine quoted me correctly, I think I may have written in a way that is misleading. I have a solitary brain met that will be treated with one treatment of cyberknife on Friday. I was told to stop taking Tarceva for 3 days before and will remain off of it for 3 days after. I am only on 25 mg.

The study I am on will have me continue on Tarceva instead of stopping it now that I have progression while on it. I just won't be taking it for a few days.

Best of luck!

Sherry

The timing of restarting it is just a preference, not a clear best way to proceed. I wouldn't expect any crisis from being off for two weeks, especially if you know to look out for any symptoms of progression, which could lead you to potential resume treatment earlier.

-Dr. West

Faith, I was just looking for an update from you. Have you had your treatment? I trust all is well.

Hi Faith, I wanted to let you know that Sherry has been on hospice care for a month or so and we haven't heard from her in that time. I do know she is still at home with her family and send comforting hopes her way daily.
Janine