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I am ALK+ from Canberra Australia and I've been on Alimta and Avastin on a 3 week schedule approaching 4 years and NED for more than 2 years.
We've read about the ECOG 1505 results. However, having been diagnosed as stage 4, and not having had resection, I don't correspond directly to the patients in the trial.
I'm wondering if you could comment on the implications for my treatment. Does this suggest it's not worth me continuing on Avastin?
My results have surprised my oncologists who have described my results on chemo, without having any targeted therapies, as unusually good. It is difficult to know how much, if anything, Avastin has contributed to my results.
Dave
Forums
Reply # - November 16, 2015, 08:03 AM
Hi Dave,
Hi Dave,
Welcome to GRACE, and congratulations on your terrific results! You've asked (and pretty much answered) a question that others have had the good fortune to face. There's really no way to know whether Avastin, or at this point even Alimta, is contributing to your current NED status. As Dr. West has said with regard to Avastin as single-agent maintenance therapy:
"We really don’t know how much Avastin (bevacizumab) as a single agent adds…and many specialists think it’s relatively little. But there are no trials done that directly answer that question.
I think that Janine’s point about a treatment break is a fair one, as I think the most relevant question is whether your cancer would demonstrate the same pattern of very slight progression over a very long time if you’re on Avastin, chemotherapy, some other targeted therapy, or no treatment at all. These treatments have very real cumulative side effects, so it is very appropriate to at least question how much they’re really needed and not reflexively treating without end, just for the sake of doing more and more treatment." - http://cancergrace.org/topic/avastin-maintenance-when-to-stop#post-1263…
There is the very real possibility that you may be cured, and that no further treatment is necessary. The only way to find out is to cease therapy, in your case most likely by stopping Avastin first, and getting close follow-up. That can be a worrisome course of action, but since your cancer has responded so well to date, there's no reason to think it wouldn't respond again.
JimC
Forum moderator
Reply # - November 16, 2015, 04:20 PM
Jim, thank you for your reply
Jim, thank you for your reply. Thank you also for the link to the other thread. I have got into a pattern of taking a break once each half year. I would skip one cycle, giving me roughly 5 good weeks instead of 2. The past 18 months I have had 3 double breaks, giving me 8 good weeks each time. Further, there have been many treatment cycles over the previous couple of years when I have had no avastin, either due to high blood pressure or due to the need for dental treatment, as I have had 5 root canal therapies, I suspect as a result of dry mouth side effects.
I have been NED since May 31 2013. During this time my scans have usually been 3 monthly. Given the number of times that I have had to break from the avastin, I feel fairly comfortable with stopping the Avastin when I need to, however my oncologist has not wanted me to stop alimta. He keeps saying that this type of cancer doesn't get completely destroyed by chemo, so I therefore have active cancer cells, therefore I need to stay on treatment ad infinitum. I no longer have to pay for either drug so this has helpfully removed any financial bias.
I keep thinking, what if he is wrong and I don't have active cancer cells and am therefore simply building up unnecessary toxicity and damaging otherwise healthy organs?! But no one can say for sure.
Can I ask what you would consider close follow up, if I was to stop chemo altogether?
Reply # - November 17, 2015, 03:04 PM
Hi Dave,
Hi Dave,
A CT every 6 weeks is considered close follow up to start and can be moved further apart. There's no set rules for this.
What if you are cured or can achieve stability with much less treatment?
Best of luck,
Janine