quit alimta as maintenance therapy - 1248742

Hello cabrero, welcome to Grace. I'm sorry that you are going through this. How awful I know it is.

This is a quote from Dr. West about taking a break. He has written essentially the same thing many many times,
"I think it is extremely reasonable for people to take a break from chemo for advanced lung cancer if they’re stable or have shown a very good response and could benefit from a break. And if someone hasn’t progressed on a prior treatment that is feasible to give longitudinally, and if they haven’t experienced prohibitive side effects with that treatment, it’s very reasonable to return to a previously used agent.
By the way, if you just look at many of the discussions here about maintenance therapy, you’ll find that just about all of the experts feel that maintenance therapy is a fair option, but definitely NOT a mandate, for our lung cancer patients. Just about every expert I know feels that breaks from treatment are very appropriate and reasonable for plenty of their patients." http://cancergrace.org/cancer-treatments/topic/moms-continuing-treatmen…

I hope you take the break you need and deserve,
Janine
forum moderator

Let me link you to this thread also, http://cancergrace.org/lung/topic/stage-4-lung-cancer/
Really there are just tons written here about breaks.
The important points seem to be, there are no data to say what to expect, take a break when needed, and keep a close eye (scan) on things and return to treatment when needed.

You may need to log off if you are using explorer browser but this is a list of search returns I came got,
http://cancergrace.org/search-results?q=treatment%20break

As for tarceva after irresa, there is a lot written on it also and many have tried and feel they have gotten benefit. http://cancergrace.org/search-results?q=tarceva%20after%20iressa

Much much luck to you moving forward,
Janine

Hi - just as a fellow patient (in England), and a fellow EGFR person (I refuse to call myself a mutant!), I wanted to volunteer that I did some reading on TKI "switch" therapy, most of which is about trying Tarceva after Iressa. The research is mostly from Asia, where Iressa is the norm, and involves small numbers of patients. It is contradictory and left me unconvinced that switching was a good plan. The only thing I might consider trying (speaking for myself only, and by the way GRACE has a rule that its doctors cannot tell someone who is not their patient what they "should" do, so you might want to rephrase your question), is afatinib, a "next generation" TKI. But even that doesn't seem to have great results so far.
I could not agree more with Janine - Dr West has said about a thousand times that breaks are a good thing if the patient is doing well. I really hope you can have a break and give your body time to recover.
Side-effects can be rough!
best wishes.

Thank you certain spring, I seem to be scattered at the moment. It's early Saturday morning in Alabama.
The word, should, is a gold mind for mal practice online and I really "should" have addressed that upfront.
But we understand what you want we just have to play by the rules.
Thanks for understanding.

I keep accidentally thinking of and nearly typing "Dr. Janine" and "Dr. certain spring" because their recommendations are so thoughtful and reflective of not only what I but many other experts would say here. I don't have anything to add to the question of a break...as both have said, I've written about that everywhere, and it's completely acceptable for a patient who has been doing well.

The question of a switch is certainly debatable. There's some evidence that patients who had a very good response to an EGFR tyrosine kinase inhibitor (TKI) can benefit (usually with prolonged stable disease more than a significant amount of tumor shrinkage) from either switching to a new TKI like Tarceva (erlotinib) or afatinib after Iressa (gefitinib), but patients can also potentially have the same response to restarting the same TKI after being off of it for a while, or have slower progression while staying on it after initial progression than if they were to come off. In summary, nobody really knows the best strategy for patients who have demonstrated progression after a very good initial response to an EGFR TKI, though the greatest benefit of further TKI therapy is in those patients who had the best and longest (>9-12 months) response to an EGFR TKI the first time, and whose progression on their first EGFR TKI was relatively modest and slow.

Good luck.

-Dr. West

Actually your English is so good that I for one didn't notice! Good luck with your decision.

I agree. Your English is far, far better than my French. We don't get too worried about the "should" questions -- just please know not to take it personally when we can't tell someone what they should do, as that crosses into the realm of giving medical advice (which is not appropriate here).

-Dr. West