Stage 3b Non small cell , adenocarcinoma- Tumour is unchanged after 3 chemo. - 1291199

vvd7
Posts:6

My mother, she is 68 years old. She had blood through her cough for 3-4 days, so admitted her on Dec 07, 2016.

1. They started treating her based on her symptoms. Chest CT was showing tumors. Whole body PET scan was carried out on Dec 26, 2016. It was showing tumor in left lung.

2. First biopsy was carried on Dec 31, 2016. Where in there was no malignancy detected. So we were relaxed.

3. We had second biopsy on Mar 16, 2017. Wherein she was detected with Well differentiated mucinous adenocarcinoma, lepidic pattern.

4. PET Scan was carried for 2nd time on April 19, 2017 showed stable disease.

4.1 Results are as :- With persistent hypermetabolic consolidation like mass lesion seen involving left upper lobe & lingular segment of lung. Persistent subpleural nodular lesions seen in superior segment of left lower lobe of lung. Few small mediastinal & left supraclavicular nodes seen, persisitent mildly FDG avid hypodense lesion seen in right adrenal gland.

5. Later we had 3 chemotherapies on May 11, Jun 02 & Jun 23 2017. those were involving Inj. PEMETREXATE (PEXOTRA) 650 mg & Carboplatin 400mg.

6. PET scan was carried for 3rd time on Jul 12, 2017. Showed no reduction in tumour sizes.

Report is as :- Sizes are soft tissue lesion in lingula of left lung 99 x 54 x 66 mm

Scattered lung nodules in left lower lobe largest 14 x 13 mm

Precarnial node 12 x 7 mm. Right adrenal gland is bulky.

7. Other medical background is; she is diabetic with fair control over sugar for last 17 + years.

8. After 3rd chemo, no major side effects were noticed. Now days she had problem in breathing sometimes. She felt more fatigue.

Please bear with me if I had made any spelling mistakes in medical words…

Moving forward; looking for valuable guidance…

Thanks,

Forums
Full Archive

Reply # - August 7, 2017, 03:55 AM

vvd7
Posts: 6

She had experienced some infection for same left lung in year 2007. we have biopsy done, but test result was -ve. We didnt followed up on same issue, as there was no symptom, which needed further medical tests to be done. Untill in March 2017, we met with stage 3b, adenocarcinoma.

Reply # - August 7, 2017, 05:30 AM

JimC
Posts: 2753

Hi vvd7,

Welcome to GRACE. I am sorry to hear of your mom's diagnosis. Her type of cancer is often referred to as "mucinous BAC", and there is a great deal of information available on this site if you search for that term. BAC does not tend to spread beyond the lungs; in your mom's case the bulky adrenal gland is suspicious, but that could have a non-cancer cause.

Some instances of BAC can be very slow growing, so much so that treatment need not be started immediately if at all, although the mucinous form of BAC tends to grow faster. In that regard, treatment that produces tumor stability (as in your mom's case) can be a good result. If her symptoms (blood in her cough, etc.) have improved, that is also a good sign of response to chemo.

Follow-up scans will help in assessing the result of treatment and the status of the cancer. If at some point the cancer appears to be growing significantly, there are other options. Although only about 10-20% of patients get a good response to immunotherapy, those who do can respond very well for a long time, so it would certainly be an option, especially since your mom's cancer is EGFR/ALK negative, since a lower percentage of those patients respond well to immunotherapy.

Dr. West has also noted that even patients who are EGFR negative may receive some benefit from Tarceva, so at some point that may be an option.

In addition, this type of lung cancer, though not rare, is not seen by any individual oncologist very often. Dr. West estimated that “most oncologists have treated about 3-5 patients with mucinous BAC in the last couple of decades”, while those “who have more experience with BAC [have seen]10-20 patients with mucinous BAC in the past decade or two.” – http://cancergrace.org/forums/index.php?topic=8756.msg91242#msg91242

With that in mind, your mom might want to seek a second opinion from an oncologist who is more experienced with mucinous BAC.

[continued in the next post]

Reply # - September 11, 2017, 03:49 AM

vvd7
Posts: 6

After 3rd Chemo & PET scan results, it was decided to carry out 4th chemo of same combination. But in last week Dr decided to go ahead with tablet, instead of Chemo.

Her symptoms are continuation of sputum, along with fatigue & uneasiness in breathing ( was seen 3 times in last 5 weeks).
Though her EGFR test was negative, we have started with Tab Erlotinib 150 mg , 1 daily.

Reply # - January 14, 2018, 11:50 PM

vvd7
Posts: 6

Just to update further, one more PETscan was done on Jan 09.

Result in nutshell is disease has progressed. There is increase in uptake of SUV count for main tumour in left lobe of lung, as well as in adrenal gland.

With use of tab Erlotinib, results were not achieved.

Wanted to know about further possibilities of medications...

Thanks,

Reply # - January 15, 2018, 05:19 AM

JimC
Posts: 2753

Hi vvd7,

I'm sorry to hear that your mom didn't get better results from her PET. But before you even consider changing treatments, I think two points should be made.First, a second-line therapy often does not result in tumor shrinkage, but rather a stable tumor, one which has not grown in size. If the SUV increase has not been dramatic and there have been no CT scans done to compare the size of the nodules(s) before and after erlotinib, then the evidence for progression is not that clear.

Also, BAC can be quite slow-growing, so stability can be exactly what you would hope for from treatment (and it may happen without treatment).

Dr. Pinder had this to say about treatment changes based only on a change in SUV:

"I think PET scans are overused in the follow-up of lung cancer. If a patient has disease that is visible on CT scan and can be followed that way, I don't see a reason to order PETs. It just doesn't add value. The other problem I see is making changes based on small increases in SUV on PET. All of the therapies we have in lung cancer have been based on assessing response by CT scan - not PET so we really don't know where PET fits in." - http://cancergrace.org/forums/index.php?topic=10389.0

In another reply in that same thread, Dr. West agrees with that assessment.

JimC
Forum moderator

Reply # - January 15, 2018, 09:59 PM

vvd7
Posts: 6

Thanks for review Jim C.

Yeah we ended up having 4th PET-CT in last 11 months.

Tests were PET-CT, here are few observations from last report of Jan 09-*2018. That gives comparison between SUV uptakes & sizes after chemo-- before / after starting of Erlotinib.

1.For left upper lobe - SUV Max 6.1 - previous SUV 4. Lesion now measures 5.1 x 7.2 x 7.7 CM, with few foci of calcification within.

2. Increase in size , number & FDG activity ( SUM max 2.1) subpleural nodular lessions seen in superior segment of left lower lobe of lung, largest one now is 25 x 19 mm ( earlier it was 14 x 13 mm)

3. few precarnial artopulmonary & left pre-vascular nodes SUV max 2.2 ( earlier 1.4). Largest size 12 x 9 mm

4. Mildly FDG avid , SUV max 2.9 ( earlier 1.9) hypodense lesion seen in right adrenal gland

Conclusion in report::- PET-CT findings progression of disease.
------------------------
Oncologist was mentioning about change in mutation, type of cancer from NSCLC to SCLC.
Does cancer cells properties changes over time?. Is it possible?

earlier EGFR was negative, Is second biopsy recommended to establish EGFR again?

That puts us to new square, where disease appear to be moving from slow growing towards, slightly aggressive path.

Yes, as suggested we are also thinking of starting immunotherapy.

As always thanks for valuable insights...

Previous PostNext Post