Advice regarding Tarceva and whether it is time to seek a second - 1293835

Fri, 01/19/2018 - 10:29

My husband has been taking Tarceva for6 months.His latest scan showed Interval increase in size of the lower left lobe mass measuring 4.2 cm x 4.5 cm compared to2.8 cm x 3.5 cm on the prior examination. Interval increase in size of the left hilar mass, and development of new lyric lesion in the T9 vertebral body suggestive of progressive malignancy.
Stable indeterminate 8 mm adrenal nodule.
First, the dr said stay the course until next 3 month scan and radiate the lung and T9. I questioned the radiation oncologist and the nurse navigator about staying on Tarceva. Now oncologist says she will switch medication when radiation is over. Do we need a 2nd opinion?

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Hi cnprek,

I'm sorry to hear your husband's cancer is progressing on tarceva. We can not tell people what they should do.

The growing standard of treatment for TKIs is to change treatment at clear progression. If the cancer appears to be generally stable and just progressing at one or 2 places with no new lesions then radiation can be used to treat the outlying progression. Note that radiation is used if it's believed that the cancer can otherwise be controlled. Another reason to use radiation in advanced nsclc is when there is a threat of blockage to an organ, major bone fracture or spinal compression. Otherwise it's best to not use radiation because of the healthy tissue that is also radiated in the process.
If progression is clear and a change in treatment is needed a test for T790M is done. This is the mutation the causes most egfr mutations to acquire a resistance to tarceva and other first and 2nd gen tkis. Blood test now exists for this mutation and is almost as accurate as a tissue biopsy test.

A conversation with the onc should be had about the decision making process. There could be good reason for his plan. A second opinion is never a bad idea during a transition time such where your husband is right now. However how your husband feels about seeking a 2nd opinion is as important as what someone else wants him to do.

I wish it were easier answer. Keep us posted.
All best,