How Long can someone be on maintenance Alimta? - 1247650

cancersucks
Posts:4

My mother began her chemo regimen of Carbo/Alimta in September 2011 and has been on Alimta Maintenance since January 2012 - so far no new mets and no progression of disease. She receives her infusions every 21 days - Is it possible to be on Alimta indefinitely so long as it continues to keep the cancer at bay? or would an oncologist attempt to discontinue after a certain period of time? I would imagine being saturated with so much chemo would create high levels of toxicity and eventually the body would no longer be able to tolerate it?

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Reply # - September 4, 2012, 03:03 AM

certain spring
Posts: 762

Hi there - just while you are waiting, there was a good thread about this recently, in which several people report long-term use of Alimta (as in a year or more), and Drs West and Pennell give their comments. It's definitely worth a look (including the second page where there is a discussion about longer-term side effects):
http://cancergrace.org/lung/topic/is-anyone-tracking-long-term-alimtaav…
Glad your mother is doing so well.

Reply # - September 4, 2012, 10:52 AM

catdander
Posts:

Thanks Certain Spring. I think that answer the question really well.

Cancersucks, I'm glad your mom is doing so well on alimta. I hope it lasts a long time.
If you need more clarification let us know.

Janine
forum moderator

Reply # - September 4, 2012, 12:24 PM

cancersucks
Posts: 4

Thank you for the Link - was very helpful. Keeping my fingers crossed that her body will tolerate the Alimta for years to come and that is remains as effective. Thanks Again.

**Stage IV Adenocarcinoma NSCLC (right lung) w/ 3 brain mets dx. 8/2011 at age 65 - EFGR/ALK negative - PleurX catheter placed 9/3/12 achieved pleurodesis 6 weeks later -Gamma Knife for 3 brain mets on 11/2011. Completed Carbo/Alimta - 6th cycle 1/9/12 now on Maintenance Alimta. Developed edema of treated brain lesions in March 2012 - treated w/ High dose Dexamethsasone - developed right optic nerve swelling June 2012 - treated again w/ high dose Dexamethasone - consequently developed "Moon Face" w/ subsequent fractures to her L1 due and left intercostal rib due to osteoporosis due to chemo/dexa effect. PET scan 7/18/12 shows stable disease w/ less FDG intensity than in Jan. 2012 PET. Taking Low Dose Naltrexone and TumorX in addition to Sodium Bicarbonate as complimentary treatment.**

Reply # - September 4, 2012, 05:02 PM

Dr West
Posts: 4735

I don't have much to add. The drugs we use for maintenance are generally only feasible to serve in that capacity if they are both effective and don't have bad cumulative side effects. Alimta (pemetrexed) is one that tends to be very well tolerated, even as months turn into a year or more. Sometimes we might consider switching to an every four week schedule or taking breaks for a few weeks or months at a time, then jumping back in with treatment. Essentially, the goal of maintenance therapy is to address the question "what's the least treatment required to control the cancer over the longest time?". That's going to vary from person to person.

-Dr. West

Reply # - September 5, 2012, 07:19 AM

bh
Posts: 66

Have not read the other thread so sorry if this is redundant. Mom had 7 rounds of Alimta and the doc asked us if we wanted to keep going or take a break. It was decided to give a break in April as mom developed diabetes due to the steroids she was on. The steroids have since been discontinued. She is monitored every other month and so far it has been good. The onc said she wants mom to be able to handle the Alimta better if and when she requires it again and hence the break. Her other consideration was mom's kidneys, as they have been compromised due to years of high BP so the doc felt taking a break as long as possible would help.

I am not sure how to add the blurb about the diagnosis as a post script, had it on the old forum but not sure how to resurrect it.

Reply # - September 5, 2012, 07:41 AM

catdander
Posts:

I'm going to steal this thread for a moment to help bh add the blurb back. bh, click your user name "bh" on the left of your post (below the big brown, green, orange G).
Now in your "forum profile" edit your "signature" and click submit.
Hope that works. :)

Reply # - September 6, 2012, 06:19 AM

cancersucks
Posts: 4

Thank you all - right now the big issue is addressing her back pain- which is impacting her quality of life - she is becoming less and less able to ambulate for extended periods of time. Don't know if it is related to her L1-L2 fracture - or muscle spasms or pinched nerves in her lumbar area or a combination of it all. She tried a little piece of a hash brownie last night and it at least relieved some of her anxiety and depression for the time being - but not so much her back pain. She has not started taking any narcotics yet as she is on the Low Dose Naltrexone and my understanding is that it would contraindicate being an opiate antagonist. We have given her Toradol injections and used a TENS unit on her lower lumbar area and purchased a lift chair and a temper-pedic adjustable bed for her to be more comfortable. She seems to do well with some Aleve however because she is also on coumadin for DVT prophalaxysis - she has to be somewhat careful. It also appears that every Alimta infusion is becoming more and more difficult for her body to tolerate - her side effects(nausea and fatigue) are lasting up to 10-14 days whereas before they would dissipate after 1 week. Thanks for reading and any and all suggestions are greatly appreciated.

Reply # - September 6, 2012, 08:48 AM

Dr West
Posts: 4735

I don't have much to add. Indeed, naltrexone is meant to not be given with opioid narcotics, or vice versa, since naltrexone blocks opiate receptors. Dr. Harman covers some alternatives in her summary discussions here:

http://cancergrace.org/cancer-treatments/2012/07/28/dr-harman-on-cancer…

http://cancergrace.org/cancer-treatments/2009/07/19/cancer-related-neur…

Good luck.

-Dr. West

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