Hello,
I'm a first-time poster but long-time lurker here - love and strength to everyone fighting their battles.
I'm writing this for my mother-in-law, who has Stage IV NSCLC Adenocarcinoma with multiple mets in both lungs but no progression outside of the lungs. She has been responding well to Alimta maintenance therapy, currently showing stable for 9 cycles. She is a 56-year old never smoker, in general health other than the cancer.
She was diagnosed in September 2014, and first-line treatment with Carboplatin-Gemzar significantly shrunk the main tumour by over 50%. After adverse toxicity, she was moved onto Carboplatin-Alimta for 3 cycles, which again showed a small reduction in tumour size (though not in nodules). Since then, she has been on Alimta maintenance, and each CT scan has shown little change, indicating stability. (There has been some fluctuation in lymph node sizes, probably due to infection/reaction to drugs, but that also seems to have improved in the most recent scan).
The Alimta side effects, especially the fatigue and body/bone pain, have recently become very difficult to bear for her, however. She has had a significant reduction in general mobility, and doesn't get out of the house very much. She is also suffering from a lack of motivation, probably depression, and has become less inclined to follow her doctor's advice (regarding certain medical supplements, physiotherapy sessions, and so on).
Her doctor advises her to continue on Alimta, but leaves the choice of taking a 2-month break up to her, but doesn't give any other advice. We would like to know if there are any studies/statistics about stable cancer states recurring after such a break. Is this decision reasonable? Currently, given the choice, she would prefer a break, but this could be due to her lack of motivation. If pressed/encouraged, she may be able to continue.
Thanks very much, and hope to hear from you soon!
Stuart
Reply # - January 25, 2016, 09:06 AM
Hi studenison,
Hi studenison,
Although you've been here before, welcome to GRACE. I'm sorry that the side effects of treatment have become so difficult for your mother-in-law. Treatment breaks due to toxicity are not at all uncommon, especially during maintenance therapy. There's really no way to know how much of an effect maintenance treatment is having, other than seeing what happens if it is discontinued. Most patients do quite well despite a few weeks off therapy.
JimC
Forum moderator
Reply # - January 25, 2016, 09:31 AM
Was she diagnosed with adeno
Was she diagnosed with adeno in situ? What was the size of the large tumor? AIS normally does not spread outside the lungs and Dr. West here would tell you that many live for years without even having any treatment. If that's the case and she has AIS formally known as BAC, then a chemo break shouldn't hurt.
Take care, Judy
Reply # - January 25, 2016, 07:01 PM
I would agree with respecting
I would agree with respecting her wishes and trying a few months off treatment. The dose of the Alimta can also be reduced, or it can be given every 4 weeks instead of every 3 weeks. Hope this helps.
Reply # - January 26, 2016, 02:38 AM
Thanks for the responses. We
Thanks for the responses. We have been discussing the options with her, and today made a decision to take the break for about 2 months to let her body heal and recover.
The effect was really positive - knowing she won't have to have any more chemo for a while has already lifted her spirits significantly, and she has been up and about cleaning the house. Thinking about further treatment had obviously been quite a burden for her.
Hopefully we can use this time to refresh body and mind, and prepare for possible further chemo over the spring and summer. I just wish there was more research about maintenance therapy and recurrence/progression rates to help with making these decisions. It feels rather like guesswork otherwise.
With regard to a dose reduction or increased cycle duration, her oncologist refuses to go down that course for now, saying that it would reduce the efficiency of the Alimta, which has been working well so far. Hopefully it may be an option in future.
Best wishes to you all, and thanks for the comments
Reply # - January 26, 2016, 02:40 AM
And her cancer is not AIS,
And her cancer is not AIS, unfortunately, but thanks for the suggestion @cards7up
Reply # - January 28, 2016, 07:16 AM
Hi Stuart, at the risk of
Hi Stuart, at the risk of stating the obvious, has she been tested for the typical mutations (EGFR etc)? There are alternate treatments which may be less taxing with potentially very good results.
Reply # - January 28, 2016, 09:31 AM
Hi Luke,
Hi Luke,
I should have mentioned this in the original post - tests were negative for EGFR and ALK mutations. Thanks though
Reply # - January 28, 2016, 09:10 PM
Hi Luke, thanks for the
Hi Luke, thanks for the update. It can't be understated, taking a break from chemo provides so much relief for someone.
The trend toward taking a break instead of maintenance seems to have evolved along with having an option to take maintenance. The benefits from a break are already seen with your mother in law and hopefully will continue. Many specialist believe if you keep a close watch (call the onc if new or worsening symptoms appear and following a scan schedule a break) a break can be as good. I hope the family can back her in her decision, whatever it is it's the right one for her. Frankly after seeing my husband endure what he has I'd easily call for a break if given the chance.
I hope she feels good for a long time.
Janine