3rd line failure, 4th line options. ? - 1267715

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billnshirley
3rd line failure, 4th line options. ? - 1267715

NSCLC adenocarcinoma, Wife Shirley

7/12 Lower Left Lobe removed Cancer Free
8/13 Metastic to Midstinum
12/13 Rad/Chemo (Cisplatin, Etopiside) complete, Cancer free, started Avastin and Alimta Maint. (Genetic tests nothing)
3/14 Pet scan: Cancer free, Avastin and Alimta Maint.
6/14 Pet Scan: Metastic to epicardial fat. Avastin and Alimta Maint continued.
8/14 Metastasis; jugulossubclavin, paratracheal region, subarinal region , right infrahilar region, left adrenal gland. Started Taxol, Carboplatin, Avastin. 1st cycle as expected. 2-3 Cycles, fluids, steroids, Zofran, 2 days a week between cycles.
12/14 Stopped treatment for QOL, not tolerating.
12/24/14 – 12/27/14 Hospitalized for Dehydration and Pleureal infection. Given antibiotics. ER X-ray showed tumor still exits in left hemithorax.

I do not even know what to ask. With the Holidays everything seems to be pushed back and on hold and I want a direction and don't know where to start the fight.

JimC
Hello,

Hello,

I'm sorry to hear of these complications. In terms of further treatment, the first concern would be for her doctors to determine if your wife is feeling well enough to tolerate treatment. The second question would be how effective her treatment has been since the scan in August. The ER X-ray would not be a good comparison (they are just not high-resolution enough), and a third line treatment would not usually be expected to eliminate all trace of cancer; it may have shrunk some or all of her tumors, or kept her cancer stable, either of which would be a good result in Stage IV cancer.

If her doctors think further treatment is necessary and that she can tolerate it, the leading options would be the other FDA-approved drugs for second and later line treatment, Tarceva (Erlotinib) and Taxotere (Docetaxel). Tarceva has been shown to provide some limited benefit in this context, even for patients without an EGFR mutation, and Taxotere can be effective even if Taxol has been used. Other drugs which have activity in lung cancer, although not as thoroughly tested in this context, include Navelbine (Vinorelbine) and Gemcitabine (Gemzar). There is also the possibility of a clinical trial with a novel agent.

You will probably want to discuss all of these options with her doctors, perhaps after a new PET or CT scan.

Good luck with her next treatment regimen.

JimC
Forum moderator

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>

billnshirley
Thank you soooo much for the

Thank you soooo much for the quick reply. After 4 weeks since her last treatment, everyone is questioning why she has not at least started to rebound. Sleeping is longer and more frequent, lack of appetite and food intake is dwindling and liquids are a chore. With Holidays among us and her current situation as it is, she did have a CT in the hospital (I cannot get the signed RAD report until tomorrow), and we do have a PET scheduled for 12-31-14. But our ONc appt. is not until 1-13-15. I believe I know what is going on and am prepared. But I cannot wait til 1-13 15 for official report to get the support for Her and I… I will not do the interim ER and such and lose control of this situation. Thank you and all of you so much..

Dr West
It is completely appropriate

It is completely appropriate to seek clarification before 1/13. Those dates are set presuming that there won't be major issues emerging -- if so, it is very appropriate, even expected, to try to re-evaluate the situation ASAP, not in a few weeks.

In terms of options, I agree with the summary of options provided by Jim. The first question is whether she's well enough to consider further anti-cancer treatment and also whether further treatment would have a significant probability of helping her. Tarceva and Taxotere are the leading options that have some established survival benefit, but they don't help everyone. It's appropriate to review the options once she is through these acute issues.

Good luck.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Medical Oncologist
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

billnshirley
Thank you both for clarity in

Thank you both for clarity in your words. It has a real calming affect every time I re read your comments. I cannot express how much your appreciated for you do..

Dr West
I'm glad to hear that. Please

I'm glad to hear that. Please let us know as you learn more.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Medical Oncologist
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

billnshirley
Pet scan done 12/31 brought

Pet scan done 12/31 brought home copy of the test, no official results. Before we reviewed the scan Shirley and I sat down and I had her read your comments. It added calm, clarity, resolve, and removed a lot of emotion that I know would have taken place. I could not have had better documentation to cross this path in our travel.
Reviewing the B/W, 3D rotating view
Gone: 5 tumors, 2 Jugular, 1 epicardial fat, 1 left arm pit, the largest midstinal
Remained from last scan: 3 Midstinal grown slightly larger
Test today, at least 5 new growths: 3 uppers left rib, 1 upper abdomen near spine, 2 pelvis (1 left side, 1 right side).
Reviewing the colored cross sections it is very clear the 2 pelvis growths are in the bone and the others appear to be in the bone.
I have changed her appointment from 1/13 to 1/8 or earlier once they receive the official report. I tend to follow up Monday 1/5 on the report and alert her Drs office when complete. I cannot afford the ball to drop.
I am resting more peacefully this morning and welcome your comments to our update. THANK YOU FROM THE BOTTOM OF MY HEART….. Have a great New Year, ours should be more peaceful

Bill Urban

cards7up
This is just my opinion and I

This is just my opinion and I'm a LC patient not a medical professional. If she's well enough, maybe a new biopsy should be performed to test for mutations. You received good and bad news on the scan, but best to wait and review with the onc. Let us know how she makes out. Take care, Judy

JimC
Hi Bill,

Hi Bill,

As Judy said, interpreting the results of the scan is best left to her doctor. Of course you will want to report all of her symptoms and discuss options for treatment. Depending on the location of larger mediastinal tumors, this may explain her difficulty with liquids and perhaps reduced appetite...it may simply be more difficult for her to swallow, making eating unappealing. You might try a liquid that is a bit thicker than usual, such as a fortified drink like Boost, since that tends to slide down easier and provides at least some nutrition.

JimC
Forum moderator

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>