effectiveness of avastin/alimta in 80yr old - 1248593

doyle
Posts:3

My mother is 80 yrs old and weighs 98 lbs. She has stage IV non-small cell lung cancer (both lungs, nodes of the lung and bones). She has been advised to consider a combination of AVASTIN and ALIMTA. Research I have done indicates that this is not an effective therapy for a person of her age and general condition. However IF it would extend her life AND/OR give her a better quality of life then she would consider it. Can anyone please give me some feedback/input on this situation? Also are there any statistics regarding life expectancy with and without treatment? Thanks.

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Reply # - October 3, 2012, 06:39 AM

catdander
Posts:

Hello Doyle,
Welcome to Grace. I'm very sorry your mom is going through this awful situation.
When studying lung cancer treatment for stage IV the outcomes looked for are extending life and or quality of life.

This is my non professional answer and should be taken as such. There seems to be a lot of back and forth about avastin in treatment non squamous nsclc. It is approved though for first line treatment that usually includes platinum based drug. But if you mom is having other health issues it isn't unusual to leave off the platinum (carboplatin or cisplatin) and just use the others. In your mom's case alimta and avastin.

I have asked a doctor to comment on your thread and you should hear back within a day.

I hope for the best for you and your mom,
Janine
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Reply # - October 3, 2012, 09:20 AM

bh
Posts: 66

Dear Doyle, my mom is 78 and was diagnosed last year, as Janine says, the docs skipped the platinum based drugs and she has been only on Alimta. She has been on a treatment break since April. Alimta in her case was given once in 3 weeks for about 15 to 20 mins. She did get tired the second and third day after chemo but the tiredness tapered off by the end of the week. Hope this helps.

Reply # - October 3, 2012, 10:58 AM

doyle
Posts: 3

Thanks for the feedback and input. Janine, thanks for passing it along to MD. Will check for reply. Also of note, my mother is in basic good health except high blood pressure. Is there a protocal for taking either the Avastin OR Alimta with better outcomes?

Reply # - October 3, 2012, 11:43 AM

carrigallen
Posts: 194

Hi Doyle,
I'm sorry about this news, I can imagine how disruptive this diagnosis has been for your family.
I would agree with doing the Alimta chemotherapy, because this agent in particular tends to be fairly tolerable even in persons older than 75. The goal of treatment is purely to improve life span and improve symptoms. Alimta (+/- avastin) by itself is not considered 'aggressive' or 'harsh' , and it is not unusual at all to use it in patients 75 - 85.

Everyone reacts differently, but the common side effects of Alimta are fatigue for the 2-5 days after treatment, modest nausea, and low white blood counts. I have had patients who were on death's door with pain and cancer-fatigue who experienced remarkable symptoms improvement with combination of alimta with carboplatin.

Avastin is an IV drug that has modest benefits in many different solid tumors. It is an antibody, not technically chemotherapy. The up-side is that it has relatively few common side effects. An optimist would say it is a generally well-tolerated drug that might only help. A pessismist would say it is an expensive drug that has trivial benefit, if at all. The benefit of adding avastin to alimta is unclear, but it seems reasonable in this situation. One thing is for sure: in lung cancer, using avastin alone (by itself) is not supported by evidence, and is unlikely to help in this situation.

If she is otherwise healthy, then I think it may even be reasonable to consider adding carboplatin to the alimta. This would be more likely to cause sustained control of tumor growth and improvement in symptoms. Side effects of carboplatin are mainly low blood counts and fatigue, but in generaly it is quite tolerable. If this drug were added, I would also add a shot called 'neulasta' to reduce the risk of infections related to low blood counts since both chemotherapies together will depress the white count.

Bottom line: I think it's worthwhile to go ahead.

Reply # - October 3, 2012, 11:58 AM

carrigallen
Posts: 194

Independent of the chemo issue:

1. Has her cancer tumor tissue been tested for EGFR mutation? It is reasonable to check this regardless of smoking history. If it is positive, then an oral pill called Tarceva could be an option. This pill usually works better than chemo for people, if they have the tumor mutation. Fyi this is a mutation in the tumor, not in the person (it is not inheritable). Something to ask about at the next visit.

2. If she is actually having significant pain at a site of cancer in the bones, many would consider adding a short (3 - 5 days), focused, course of radiation - purely to reduce the pain there. Something to ask about at the next visit, if applicable.

Reply # - October 3, 2012, 08:01 PM

Dr West
Posts: 4735

Work on inherited EGFR mutations is just beginning, and I think the most I'd say is that we're trying to learn more. There aren't many people in your situation, so at this point I don't think there's enough known. In the vast majority of people with an EGFR mutation, it's a random finding that isn't inherited.

-Dr. West

Reply # - October 4, 2012, 12:05 PM

doyle
Posts: 3

We met with her oncologist today and they are doing the EGFR study. He has revised protocol to CARBOPLATIN and PACLITAXEL which from what I can see are harsh with lots of side affects. She is experiencing extreme nausea and is having trouble eating. Fortunately she is NOT have much pain. Weakness, fatique and nausea are it, but it could be from the surgery for the thoracoscopy and the pleurodesis which was done last Friday. We are just trying to decide how to proceed and if there is a chance of improving and/or extending her life with the use of chemo or whether she should just enjoy the time she has left and seek pallative support. Thanks for all your responses.

Reply # - October 4, 2012, 01:58 PM

catdander
Posts:

Doyle, Thanks for the update. I hate she is experiencing these side effects. Nausea can and should be aggresively managed. There are several options but each has its place and timing when it should be given.
Please read the link below and give her as much support in the management as possible.
I know I sound pushy. But nausea suks and there are good remedies.
You're a good son,
Janine

This is a list of posts (you may need to log off for this one)
http://cancergrace.org/cancer-treatments/tag/nausea/

this is the first one on the list above and the last written. You have options of listening to the podcast or reading the transcript.
http://cancergrace.org/cancer-treatments/2012/08/03/dr-stephanie-harman…

Reply # - October 5, 2012, 01:02 PM

carrigallen
Posts: 194

Re: Family EGFR mutation. That's really interesting, Sherry. Your question stimulated me to look this up. Clearly I was wrong - there are actually rare cases of familial (germline) EGFR mutations.

I am posting a link from a paper by a lung cancer researcher named Dr Oxnard on this subject. His email is goxnard@partners.org. I think his group could be interested in learning more about your family.

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