ext. sclc post-chemo maintenance question - 1248996

mayab8
Posts:6

Hello

My father- 72y.o, diagnosed with sclc with mets to liver in June 2012. He developed SIADH- hyponatremia, which is how we found out he had sclc. His left eyelid was very droopy (Horners), and left shoulder pain for at least 4 mths prior to diagnosis.

Prior to this he was in overall very good health, no medical conditions or meds, physically fit etc. He was prescribed 6 cycles of ChT- carboplatin/etoposide, every 3 weeks. Has since had 5 cycles, with 1 more to go.

CT scans performed last week show his main tumor- left apical lung mass, originally 40x60x60mm has shrunk to 2.4x3.4x2.5mm. Also had a13mm lymph node at root of neck on right &12mm small nodes in the AP window- CT says these have reduced, with largest now measuring 4mm in transverse diameter. A 12mm left hilar nodule has resolved. Liver mets: previously had several subtle ill-defined areas of low attentuation in both lobes, largest measuring 20mm; now appear less numerous; still has several low attentuation-ill defined areas in right lobe, but they were hard to see on the scan.

My questions:
1) Could this be a pancoast tumor? Docs mentioned this in an early report, but haven't mentioned it since.
2) Docs have said that after this last (6th) cycle of ChT, they will then monitor him through check ups and a follow up scan in 2-3 months, earlier if any physical symptoms start showing again. I was surprised to hear this. I thought since he was responding to ChT, they would give him a few more cycles to see if it can reduce the tumors even further (my hope was that they disappear altogether).

Is it correct to stop after 6 cycles, or should the onc's give him more cycles?
Thank you so much for any assistance,
Maya

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Reply # - October 13, 2012, 06:59 AM

christineleeds
Posts: 25

Dear Maya
While you are waiting for a doctor to come on I can help on question2.there seems to be a dismissing response with each round of chemo.Philip always got best in first two cycles which were always very good and very little to no response after that.It is very unusual to go beyond 6 as the platinum drugs are very toxic and by then probably doing more harm than good.There is no such thing as maintenance in the context of extensive sclc .The Docs will keep assessing him and will suggest other treatments as and when required or appropriate.If he is symptom free for usually 6 months or more they might be able to repeat the first chemo.
All the best with the next scan
Christine
There is information on these topics if you search sclc on the site info section

Reply # - October 13, 2012, 07:11 AM

catdander
Posts:

Maya, I'm so sorry your father is going through this. It sounds like he is getting the standard of care for ED SCLC. It is normal to give 4 to 6 cycles of cis or carb with etoposide then watch for progression. The maintenance your referring to is given to NSCLC patients but hasn't proven to extend life or improve quality of life for those with small cell.
This is a link to an explanation of standard treatment for sclc. You will need to scroll down to the heading Treatment of Extensive Stage Small Cell Lung Cancer Patients.

As far as the pancoast tumor is concerned. Treatment isn't any different for pancoast tumors if it isn't being treated with curative intent. The exception would be symptom management because it presents with it's own unique problems such as the horner's and the shoulder and arm pain you mentioned; you used the word was so I hope it has resolved. If the chemo hasn't resolved the pain and the eye drooping then that should be examined for further treatment. Below is a quote from Dr. West about horner's.

" The main treatment, as suggested by the very knowledgeable folks above, is effective treatment of the underlying cause. Tarceva may help if it shrinks the cancer enough to relieve pressure from compression of a nerve, most likely near the middle part of the chest on the left. Radiation is also a consideration for readily shrinking the mass where it's causing nerve compression, and steroids might possibly help as well. As catdander indicated, the duration of compression is a factor that tends to be associated with a lower probability of return of function, though I can't really offer any hard statistics. Instead, there's really just a general trend that with nerve compression, the duration of compromise is inversely correlated with the probability of improvement after effective treatment (i.e., tumor shrinkage to decompress the nerve)." from http://cancergrace.org/forums/index.php?topic=7588.0

I hope this helps,
Janine
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Reply # - October 13, 2012, 01:28 PM

Dr West
Posts: 4735

Maya,

I don't know of a formal definition of a pancoast tumor, but it's really considered to be a non-small cell lung cancer. A small cell lung cancer is often so responsive to chemotherapy that we wouldn't be as inclined to initiate radiation therapy to treat it, because it isn't as likely to be needed.

As explained in the link Janine provided above, the clear standard for extensive stage SCLC is to treat for 4-6 cycles and not more. There is no evidence that treating with more than 6 cycles offers any benefit. It is most common after completing 4-6 cycles to follow clinically and by imaging, and "prophylactic cranial irradiation" (PCI) to reduce the risk of brain metastases is also sometimes done in patients who are doing well.

-Dr. West

Reply # - October 14, 2012, 02:35 AM

mayab8
Posts: 6

hello again

What is considered meaningful tumor shrinkage? With my above example for instance ( my dad's ext sclc ct scan results), would the shrinkage be considered meaningful?

thank you again,
Maya

Reply # - October 14, 2012, 07:14 AM

catdander
Posts:

Meaningful tumor shrinkage is a non specific term. It could mean the tx will likely extend life and or add to the quality of life. You wrote the tumor shrank from 6cm to less than half a cm. that is great (another no specific term). Even if you meant to write 6 cm to 3 cm. that is good also.

Reply # - October 14, 2012, 12:16 PM

Dr West
Posts: 4735

It's true that it's not specific, and it's really best for his own doctor(s) to put the results into proper context, though I share Janine's interpretation that the change sounds very favorable.

-Dr. West

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