Does this mean we should move on from Tarceva? - 1274098

Holly,

Just want to share an experience when my wife started Tarceva. She enrolled in a clinical study that combined Tarceva with another study drug in a double blind study. The study was stopped. It ended up she had the placebo as the study drug so the side effects she experienced were likely due to Tarceva. Below is the experience:

During the first three weeks of taking Tarceva, she complained, numerous times, about the feeling that her heart is beating really fast as though the heart wants to jump out of her throat. In one instance, we ended up taking her to the emergency room. All of the emergency room tests revealed nothing unusual except that she was really dehydrated. They infused her with two IV bags. The next day, we visited our oncologist at SCCA and the decision was to stop tarceva for a week to see if same symptom appear. The symptom stopped and we learned the importance of hydration when taking Tarceva for my wife. A week later we restarted Tarceva and she drank lots of liquid. The whole experience was really intimidating! To ensure lots of liquid consumption, we bought bottle water and numbered the bottles. That symptom never returned and she was on Tarceva for 4.5 years before switching to Tagrisso. Even today, I make sure she drinks lots of liquid.

I don't know if your mom has EGFR del 19 type of mutation which my wife has. I read somewhere that Tarceva tends to have longer effectiveness duration for such type.

Hi Holly,

Each patient responds differently, even to a targeted treatment.such as Tarceva. Some patients have quick, dramatic shrinkage, while others have less impressive shrinkage or stability. Some in the first group, despite the rapid shrinkage, don't have a long-lasting response, while a number of the latter group have a response that lasts much longer. And there is a small percentage who, despite an activating EGFR mutation, don't respond at all.

The small difference in the tumor size from one scan to the next is probably not significant, especially considering the use of two different CT machines. The images, even from the same machine, will "cut" a bit differently since the angle is not precisely the same, and since primary tumors don't tend to be spherical, radiologists may use different point at which to measure the longest dimension of the tumor.

Taking all of that into account, I think it's too soon to presume that Tarceva has not been effective, and helpful to remember that stability is a good response to stage IV lung cancer treatment.

JimC
Forum moderator

Another piece of data that might be useful to you Holly.

I learned the usefulness of doing CT scans over time is to compare the scans for growth or stop of growth. There is definitely small discrepancies in the comparison depending on how each CT reader measured a none even view. The reader usually provides a two dimensions read and our oncologist was not concerned with millimeter read differences such as 1.2 cm vs. 1.4 cm and would be concerned with 1cm vs. 2 cm. When discrepancies between each reading are in mm, one needs future readings and comparisons to jump to conclusion that the treatment is not working. When my wife had what appeared to be spot progression in mm, our oncologist and us decided to keep eyes on it for 3 additional CT scans and 4 months before concluding spot progression. Each successive reading measurement differs in mm.

Hi Holly,

I think that's an important point that wadvocator makes. We like to think of cancer treatment as a marathon, rather than a sprint, and trying to stamp out any small sign of progression doesn't help to achieve that. As Dr. West has said:

"It’s not rare to have a situation in which our interval scans show a relatively minor change that you need to squint to see, but it may well lead us to overreact and make a change, because we’re predisposed to action, even when it’s just like changing lanes in a traffic jam and doesn’t get you anywhere any faster." - http://cancergrace.org/cancer-101/2012/08/29/treat-the-patient-not-the-…

We like to get the maximum benefit from each line of therapy, so it's preferable to avoid making changes in treatment until progression is significant and the change is necessary.

JimC
Forum moderator

Based on the description above, it seems prudent to try the Tarceva for a while longer. It is ok to reduce the dose of the Tarceva if side effects occur. Often older patients require dose reductions of Tarceva. The afib could be a side effect of the Tarceva. It may not necessarily be related to the lymph node.