Hello All,
I will try to make it as short and as clear as possible.
My beloved father (65 years old, smoker who quited 4 years ago) was diagnosed with adenoracinoma stage IV (one met to the brain) in June 2015. He had uper left lung lobectomy and the brain met surgicaly removed and then 4 cycles of Vinorelbine and Cisplatine. Tested for EGFR and ALK. Negative for both.
One month after he ended the treatment he had a met in his femur treated with radiation. After other 2 months he had a met in his sacrum treated with radiation.
In april 2016 he had a PET-CT that showed a nodul in his pericardium and it was removed for biopsy (having another toracothomy) and it was only a stitch left there from his lobectomy. But he had to have another major surgery for it. :(
Starting the begining of July his oncologyst put him on Tarceva, saying that this is a second line treatment (I know that it is not very efficient for EGFR negative, but he insisted on it :( ).
Last week my father had a CT scan that showed a micronodule in his interstitium and other two small nodules in his pleura. It also showed a "mixed" lession in his left femur and his sacrum (both areas have been previously radiated).
I don't know what to think... The microndules in the lungs are for sure cancer progression or they can be caused by other things? The lessions that have been iradiated in the bones, can they still show on the CT even if they are treated?
My father will have the appointment with his onc on Thursday. Can he take him off Tarceva that soon? Shouldn't he let him maybe 3 more months just to see if the treatment works?
I am in Canada and my parents in Romania, so they are alone battling this monster. I am trying to help them as much as possible, so your advices would be very much appreciated.
I thank you in advance and please don't hesitate to ask any question you consider necessary.
Take care and be healthy!
Alina
Reply # - July 26, 2016, 08:21 AM
Hi alina,
Hi alina,
Welcome to GRACE. I'm sorry to hear of your father's diagnosis and the apparent progression of his cancer. I understand how difficult it must be for you to try to help from such a distance.
Although the small nodules can be caused by factors other than cancer, in the context of an existing cancer diagnosis they are highly suspicious for cancer, and would usually be presumed so. Previously radiated bone mets can continue to show on a CT, as there tends to be some damage to the bone and scarring left after the radiation. Your father's radiologist and oncologist would be in the best position to judge that, based on the scan images.
If they think the findings in the bone represent residual effects of the radiation, and if the nodules in the lung are very small, then it may be wise to continue Tarceva and rescan in a couple of months (or sooner if symptoms warrant). Dr. West and the GRACE faculty consistently warn against changing treatments in the face of minor progression, since it is preferable to get the maximum benefit from each line of therapy used.
If a change in treatment is deemed necessary, then other standard chemotherapy agents may be used, such as docetaxel (Taxotere), pemetrexed (Alimta), or if available in his location, a clinical trial for an immunotherapy agent.
I hope his appointment goes well.
JimC
Forum moderator
Reply # - July 26, 2016, 08:51 PM
Jim, thank you so much for
Jim, thank you so much for your answer! It helps a lot.
The other big problem is that he has a lot of pain in his back. He feels it as being a muscular pain, but it is so strong that it doesnèt calm with Tramadol (maximum dosage). So it makes me think that maybe the met in the sacrum maybe is not cured yet... I donèt know, but he is crying from too much pain and the doctors didn't seem to find any diagnosis or the right medicine to stop or ameliorate his pain. :(
We put our hopes in the appointment on Thursday, but ... we'll see.
I couldn't find any clinical trial. How could I look for this? Maybe contacting the big pharma companies in Romania?
Thank you one more time!
Alina
Reply # - July 26, 2016, 09:33 PM
Hi Alina,
Hi Alina,
It's certainly possible that the bone metastasis has caused damage to the bone sufficient to cause the pain your father is feeling. If so, the solution may not be more anti-cancer treatment to that bone met, but some manner of orthopedic intervention such as surgery. He may want to ask the oncologist to order an MRI of the painful area, and get a referral to an orthopedist. In addition, the oncologist should be able to prescribe a stronger pain medication.
A good place to find clinical trials is the site clinicaltrials.gov which although it is maintained by the U.S. National Institutes of Health, includes trials throughout the world, you can enter his location in the search criteria.
JimC
Forum moderator