3.2 x 1.7 mass found - 1261184

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3.2 x 1.7 mass found - 1261184

Dear Dr. West,

My dad was diagnosed with Stage 4 Lung Cancer Adeno in Feb 2013. He had small plerual effusion, which led to the diagnosis. The CT scan showed lower lobe of left lung collapsed , but couldn't see any tumor. The diagnosis was done based on the fluid drained, he is EGFR positive. He completed 4 rounds of Alimta and Cisplatin and went on 2 Alimta maintanence. That was in June 2013.

Then we decided to take a wait and watch approach. His next scan was in late September 2013, and the result was good. The fluid was completely gone, and they did not find anything on the CT scan.

Now he just had another CT scan today, and they found a 3.2 x 1.7 mass on the lower lobe of left lung and small plerual effusion there too. other part of the lung is normal.

my questions are
1. would the mass grow this fast ? from no seen on CT to 3.2 cm in 3 months ?
2. what would be the next steps ? is it necessary to get a biospy to confirm ?
3. since he was tested EGFR positive, would target therapy be a better option this time than chemo ? is another mutation test required, given this is the first time we've seen this mass ?

Thanks for your advices.

Reply To: 3.2 x 1.7 mass found

I'm sorry your dad is going through this as well as you and the rest of your family.
Cancer can grow that fast. Since there are no other masses his onc may want to make sure it's cancer by doing a biopsy. Since your dad is EGFR positive a first gen targeted therapy (gefitinib/iressa or erlotinib/tarceva) is the choice most oncologists would use.
I'll ask a doctor to comment on your questions.

I hope for the best,

Reply To: 3.2 x 1.7 mass found

Thanks Janine,

Also to add the CT result from Sept 2013 -
lower lobe of left lung saw patchy ground glass opacity, in which bronchial can be seen. And there are high density funicular shadow surrunding it, and does not form soft tissue density mass.
No narrowing of bronchus are seen. no enlarged lymph node are seen in both lungs and mediastinum area. no fluid presents.

so I am wondering if this new 3.2cm mass was totally new that wasn't there 3 months ago, which sounds like a very fast growth, or is it turned solid from the ground glass opacity...

dr. weiss
Reply To: 3.2 x 1.7 mass found

1. This speed of growth is certainly reasonable and possible with this type of cancer.
2. The need for biopsy depends on how convinced the doctor is that the new area visible is the old cancer growing again. As I'm sure that you can appreciate, it's impossible to definitively address in this context. I will, however, comment that in the average case, such biopsy is not necessary.
3. For patients with EGFR-mutated NSCLC, the most effective treatment is an EGFR tyrosine kinase inhibitor. In the US, there are two of these that are FDA approved--erlotinib (tarceva) and afatinib (tomtovok). Elsewhere in the world, gefitnib (iressa) is also available. Standard of care therapy is to either give one of these medicines, or a trial that contains one of these medicines (as an example, we have a trial of erlotinib + bevacizumab at my institution). As a theme, this treatment lasts longer and has less side effects for the average patient with EGFR mutation than chemo. Further, it is more convenient as it is pills instead of IV infusions.

Reply To: 3.2 x 1.7 mass found

Thanks Dr.Weiss,

I am just very concerned about the fact it grew from not visible on CT to 3.2 cm in 3 months.. I probably read too much online about the VDT, which be like doubling volume every 15 days.

Considering how fast it grew, would chemo be a better options ( I was thinking this based on my understanding that chemo kills fast growing cells ).. My dad did have good response when he was administered Alimta +Cisplatin before.

Dr West
Reply To: 3.2 x 1.7 mass found

Reiterating what Dr. Weiss said, it is possible that this is cancer, but if there is significant doubt about it, a biopsy would be very reasonable.

If the cancer has an EGFR mutation (which may not be the same thing as being reported as "EGFR positive", which may refer to immunohistochemistry and not a gene mutation), then the response rate is much higher with an EGFR inhibitor than with chemo and would be the clear recommendation of just about every lung cancer specialist on the planet, particularly after chemotherapy has already been administered.

-Dr. West

Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education