Adeno Spread to Brain Only - 1265853

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Adeno Spread to Brain Only - 1265853

Hello Grace - It appears I just lost my first effort at this post, so I apologize if I end up repeating. In any event, thank you so much for hosting the Boston event! My wife (dx 09/2010 at age 46, non-smoker, with adeno, poorly diff, stage IV, with mets to ovary, bone and brain, egfr+, del 19, 1st line Tarceva and still on it) attended, caught up with several of the docs and learned so much! But today I write about her brother, just diagnosed at age 52, non-smoker, with lung cancer, adeno with papillary features, with several small tumors only in his right lung (one at 22mm and several at 19mm or smaller) and one medium size tumor on his brain (which was removed 2/3 weeks ago and it was this tumor that resulted in his ultimate diagnosis. Presently, he is non-symptomatic. He is being treated at a public hospital in Mexico. Our questions:

(1) In an oligometastatic scenario like this, is it reasonable to treat with the intention to cure, or is this a "manage the disease" situation?'

(2) Regarding treatment, while not asking for a recommendation, what would be a reasonable approach to first line treatment? Is this more of a traditional chemo situation or are TKIs reasonable here (if they are able to pursue mutation testing)?

We understand that they do intend to radiate the site of the brain surgery, but as of yet have not heard an overall treatment recommendation. Lastly, my wife will be undergoing genetic testing to determine if there is a family disposition towards LC. Thank you so very much! Dan

Dr West


First, it was very nice to meet your wife at the Boston meeting.

I'm very sorry about your brother-in-law's diagnosis. I'm afraid that with the multiple lung lesions combined with abrain metastasis, this will well within the realm of multifocal and therefore incurable disease.

As far as treatment goes, the standard would be to do testing for EGFR mutation, ALK rearrangement, and in a minimal or never-smoker with an adenocarcinoma, especially at just 52, to test for a ROS1 rearrangement (at least if the more common mutations aren't present). It would be reasonable to do broad genomic testing beyond that, perhaps, but that's not the standard of care. The most important issue is to find out whether there is an actionable mutation for targeted therapy based on the treatments we have available today. If not, chemotherapy would be the appropriate first line therapy.

Good luck.

-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

Thank you, Dr. West, for your

Thank you, Dr. West, for your prompt response. Further, if I understand your assessment re: multi-focal disease, I did not realize that when assessing if a case if oligometastatic disease or not, that one also includes the number of lesions within the then lung as well (not just those lesions outside the lung). Wish it were otherwise, but I understand. Thanks again.

Hi Dan,

Hi Dan,

I just to say I'm sorry to hear of your brother-in-law's diagnosis, and I hope that he does very well with the treatment he chooses.

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>

Thank you very much, Jim, for

Thank you very much, Jim, for your good thoughts and wishes. We appreciate it very much.