Thoughts On These New Findings Re Treatment Of Leptomeningeal Metastasis? - 1249579

laya d.
Posts:714

Hi Docs:

Having read time and time again over the past few years that "pulsed" Tarceva may be the only real shot a patient may have to prolong survival and quality of life if their cancer has spread to the cerebral fluid, I was wondering your thoughts on these recent findings - - particularly with regard to treating patients with Intrathecal Chemotherapy (which, from what I understood, was previously thought to be not too terribly effective for lung cancer patients dealing with lepto):

http://www.ncbi.nlm.nih.gov/pubmed/22186628

http://www.ncbi.nlm.nih.gov/pubmed/22089116

Thanks,
Laya

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Reply # - October 27, 2012, 02:21 AM

certain spring
Posts: 762

I am not quite clear how they can isolate the effects of the chemo from the effects of having the EGFR mutation?
There is a good discussion of pulsed Tarceva vs intrathecal chemo in the comments following Dr Weiss's post about his patient "DC" (who I hope is still with us): see the exchange between him and Jazz at 12.45pm on November 18 2011:
http://cancergrace.org/lung/2011/11/03/pulsed-tarceva-for-lmc/
I did some reading at the time and found this interesting (for patients with the EGFR mutation):
http://www.ncbi.nlm.nih.gov/pubmed/19059670
I also thought this more recent abstract - co-authored by GRACE's very own Dr Wakelee - might be useful:
http://www.ncbi.nlm.nih.gov/pubmed/22836285.
Perhaps Dr Wakelee might be invited to comment on your question, when time allows?

Reply # - October 27, 2012, 11:58 AM

laya d.
Posts: 714

Thanks Ladies. . .I had read Dr. Weiss' post, but somehow had missed the comments between Dr. Weiss and Jazz re intrathecal chemo. Very interesting indeed. . .

I'm wondering what the docs think about intrathecal chemo v. 1500 mg pulsed weekly Tarceva for an EGFR activating mutation patient who has progressed in the lepto while on Tarceva - - particularly given the more recent findings. . .

Laya

Reply # - October 27, 2012, 09:14 PM

Dr West
Posts: 4735

I think there's just so little information that it's not possible to say anything meaningful; I have never given Tarceva (erlotinib) at 1500 mg weekly and know no oncologist who has given it outside of a clinical trial.

Overall, I don't think it's that helpful to compare people who respond to people who don't respond -- we know that people who respond do better, in every disease and after pretty much every intervention.

Is it possible that intrathecal chemotherapy improves survival? I suppose, but it's a very significant amount for a patient to go through for something that is rarely very impressively effective. Many of the people who do it are those who have an unusually good performance status and minimal disease elsewhere, so it's really not valid to compare their outcomes to the people who don't do intrathecal chemo because they are sicker.

-Dr. West

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