Adenocarcinoma. What's next? - 1271134

4 posts / 0 new
Last post
lungpp
Adenocarcinoma. What's next? - 1271134

Hello everyone. I've been reading through all the wonderful information here for a few weeks while my father was being investigated for lung cancer. He's a 65 year old life long non smoker with no other comorbidities. He's in excellent shape. He's had a persistent cough for a few months now and no other symptoms. He was just diagnosed with adenocarcinoma with a mass in the right upper/middle lobe with extension into hilum with mediastinal lymph nodes and left supraclavicular node involvement. MRI of brain showed 4 metastatic nodules ranging from 2.3 to 7mm with no edema and he is asymptomatic. A sclerotic lesion on the sacram also had lit up on the PET scan. I'm hoping he has the EGFR or ALK mutation. We are waiting for results.

I am just wondering what would be the next steps in a situation like this?
Would this be considered olgio metastatic?
If he does have the EGFR mutation, is it better to start Tarceva alone or undergo brain radiation first or do both concomitantly? Do you use EGFR and ALK inhhibitors together if you have both mutations?
Is thoracic radiation a possibility?
This is considered stage IV, but I want the doctors to aim for curative intent or remission - is that a reasonable/ realistic expectation?

We are very shocked at the diagnosis to say the least. This is a nightmare. I appreciate all the information here. I figure at least being empowered with information can only help. All the statistics that I've been reading about so far seem very dismal. :(
Would love any input.

Thank you!

catdander
Hi and welcome to Grace. I'm

Hi and welcome to Grace. I'm sorry your father has been diagnosed with lung cancer. It's difficult to say what the stage and treatment is without knowing whether or not the sacrum and or brain nodules are indeed cancer.

If it's decided there are several mets to the brain or a met in the sacrum he would unfortunately be staged at IV. As you know that means the cancer can't be completely gotten rid of but there is good chance that it can be staved off with treatment and close observation.

If someone is believed to have brain mets they are usually treated first since they can cause sever symptoms. However people who don't have symptoms of brain mets have postponed treating the brain in hopes that they won't grow and cause problems. If no treatment is chosen it's important to keep a close eye out for symptoms and monitor with MRIs. If treatment is decided on WBR can be used if there are more than 4 or so. If only a few brain mets need treatment stereotactic radiation aka cyberknife plus others can be used. FYI, since there is so much variability in treatment (especially stage 3 and 4) doctors and patients often make decisions based on what makes the patient most comfortable.

On oligo metastases Dr. West warned, "...that fits when there is just one area of metastatic spread, or perhaps two. The problem is when local treatments are applied for 3 or 4 or more areas of disease." http://cancergrace.org/lung/2014/02/23/defining-olig/

Let us know when staging is finished. You can get a better understanding of what type of treatment he'll be offered.

Janine

lungpp
Thanks Janine! It is stage 4.

Thanks Janine! It is stage 4.

catdander
I'm sorry about the diagnosis

I'm sorry about the diagnosis. I hope we can bring some peace of mind in knowing he will get treatment that's best for him.

I've commented on tarceva and brain mets prior. First line treatment depends on mutation status. Another mutation to check on is ROS1 it is treated like ALK in 1st line. If your father doesn't have a targeted mutation immunotherapy drug nivolumab/nivo is a newly approved first line treatment. Stereotactic radiation for the brain mets or wbr is in order or a wait and see approach can be taken, this is often a personal choice for a patient whose mets are asymptomatic.

Below is a post from Dr. Weiss about 2nd opinions and doesn't have much to do with not trusting the oncologist one is using but more about having a 2nd head in the game. One of the most important pieces of info in it, I think is if you do see a 2nd opinion see him/her "before" starting any treatment plan. http://cancergrace.org/cancer-101/2011/11/13/an-insider%E2%80%99s-guide-...

and this is another excellent post from Dr. Weiss and a must read when moving into this world. http://cancergrace.org/lung/2010/04/16/introduction-to-first-line-therap...

All best,
Janine