Status decline since starting Tarceva - 1250830

I'm sorry to hear of his recent symptomatic decline. I suppose it's always possible that Tarceva (erlotinib) could be the culprit, but the symptoms you're describing would be extremely uncommon from Tarceva. Because hypercalcemia can be associated with advanced NSCLC (particularly squamous) and hypercalcemia can cause most or all of these symptoms, I suspect that it's the underlying disease that is more likely to be the leading culprit here.

Good luck.

-Dr. West

Hi Angela, I'm so sorry your husband is not improving. However you suggested he is having a better day today and that could be the beginning of a positive trend. Hopefully it is, fingers crossed.

Hopefully another Grace doctor will answer a weekend call to comment on your question...so we'll have more minds in the conversation.

Until then I have personal experience dealing with D's appetite issues. He has been very lucky in that megace has always helped when he can't otherwise eat. I understand that isn't true for many who have tried it. For more info on appetite issues Dr. West has that covered too as well as several other faculty in the comment section. http://cancergrace.org/cancer-treatments/2009/02/16/acs-mgmt/

While looking for side effects from megace I came across this gem of info from Dr. Harman. From a piece on fatigue she writes, "Other medications that have been used for CRF include megace (megestrol acetate) and corticosteroids like decadron or prednisone with the goal of both improving fatigue and appetite." The blog is very informative and can be found here. http://cancergrace.org/cancer-treatments/2009/05/01/cancer-related-fati…

For the sake of easily accessing background on your husband so the doctors to have context for which to discuss possibilities would you copy the background info in your first post of this thread and paste it into your "signature". It will then appear at the bottom of your posts. It's easy!
Click on your avatar (your pic to the left of your posts). this will take you to your "user profile"
Click on "edit you signature"
Paste in the info.

I hope he experiences continued improvement on tarceva if not there are several options; good ones since he responded well to his first chemo tx (responders respond)

All the best,
Janine

Dear Angela,

I'm so sorry to hear about all your husband's symptoms (fatigue, no appetite, rash and confusion) over the last few days and weeks. Sometimes it really is hard to tease apart what patient symptoms are cancer-related and what are treatment-related when so many things happen at once... however I DO agree with Dr. West that Tarceva would be an unlikely cause of the hypercalcemia/confusion, and if his calcium levels are finally down now, I'd favor keeping it going for the time being. I also agree with Dr. Harman's comments summarized by Janine above-I often prescribe corticosteroids like dexamethasome to stimulate energy and appetite and this may be helpful for your husband if your oncologist also agrees...also, is the rash bothersome? Topical steroid creams and even oral antibiotics can help bring the Tarceva-rash under control....

The holiday season can be such a happy, hectic and/or stressful time for patients and their families battling cancer diagnoses. Does your daughter know he is having more symptoms of his cancer than when she was last home? Sometimes a little advanced warning and adjusting expectations can be helpful for loved ones who aren't living every minute with your husband the way you are...Also, if I might suggest one last thing, try to focus on (and celebrate) the small successes of each day of recovery from his hospitalization right now ...rather than looking too far in the future because it may lead to feeling overwhelmed or added stress.

Best wishes for these next few weeks
Sincerely
Dr Johnson

Angela, There's just no way to get around the effects that lung cancer has on everyone. My dad too died of cancer 43 years ago March 24. I doubt there are many ways to smooth the edges of watching your daddy decline and die. However I understand the palliative care teams are the people to lean on for that type of help. I think it's quite wise of your husband's onc to have you and your husband utilize the palliative doc for help they should get to know your family well and will be able to help without much prompting when your husband moves off anti cancer tx. I wish we all had that type of support. It's ok if you don't say but I wonder where your husband is being cared for.

As for the forum signature, well. At this point all I know to say is, have you looked real good :roll: I know, I'm sorry, I'm sure you have. Mine is right at the top of the page, no big fanfare just over my profile pic, it says, Profile: catdander forum moderator (Edit Forum Signature). Too I understand that the sig gets erased when changes are made on your profile so having it on your bio is a good insurance plan against losing it. Take one more look then let me know and I'll contact Mark.

I'm glad your family will be together soon. It must be so difficult for your daughter to be away at college during this time. Again please take advantage of your palliative care peeps. Are there nurses you've made contact with? I'm really very interested in how they've made themselves available to you. But very understanding if you'd rather keep things to yourself.

Janine