Tarceva for asymptomatic brain metastasis? - 1271144

The general thought is if treatment hasn't begun, if one is egfr positive, has asymptomatic brain mets and is willing then beginning with tarceva is an appropriate treatment decision. Dr. West as well as many other nsclc specialists have used this plan with patients though it's not been tested in clinical trials (and probably never will) it does make sense to give tarceva a chance to have some efficacy in the brain if time is on your side. The information you gave in your other thread does seem to fit that criteria. The most important issue is to keep a close eye out for symptoms and maintain a short follow up brain mri schedule; so to begin wbr if needed.

It would be wonderful if this is the case and works for you father. Best of luck to him and you.

Janine

Hello,
I was diagnosed with at least 9 brain mets right at the beginning and started Tarceva treatment shortly after.
My brain mets responded within one month with significant shrinkage and went down from 9 to 3.
After 6 months on Tarceva , two of the remaining three brain mets started to grow again by a few mm each month and will now be treated with stereotactic radiation surgery.
I had been told at the beginning, that I will need WBRT at some point and the folks at Dana Farber in Boston said that that is what they would have started me with, before putting me on Tarceva.
Now in hindsight I'm so happy that that was not necessary, even though they where very worried at the time that the 9 brain mets would get out of hand.
But I would definitely not have such a good quality of life right now If I had started with WBRT right away.
I have very few side effects from Tarceva, the rest of the body is still under control and I can lead an almost normal life right now. Lets hope it will continue for a while longer.
Thanks,
Kempten

Hi Kempten,

Congratulations on such a good response to Tarceva, and especially its efficacy with respect to your brain mets. I hope that SRS to the growing mets helps you, and obviates the need for WBR for a long time.

Of course, it would be much easier to make these decisions if we knew in advance whether a patient would respond well to their EGFR TKI (in the brain as well as the rest of the body), or how quickly their brain mets will grow, but at the time of diagnosis and initial treatment planning we just don't have that information. Even having an activating EGFR mutation is not a guarantee of good response.

I'm glad that you and your doctors made the right choice for your circumstances.

JimC
Forum moderator

Hello Jim,

Thank you for your response.
You are right, we never know beforehand and there are no guaranties, unfortunately.
I'm thankful for each day I can get up and breathe and live with little to no pain.
I'm worried of course , and know that this can change at any time.
I know we are all in the same boat.
Prayers and healing vibes to all
Kempten

HI kempten,

Congrats on living life with so few problems! I know how much feeling well can help you forget about your worries a bit. And thanks for sharing, it's so helpful for others to hear.

Janine