Alimta Failed, What Now? - 1254712

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Alimta Failed, What Now? - 1254712

Dear all,

my mom had her post-Alimta therapy CT-scan yesterday. Well, the news are not good - Alimta seems to have failed in all aspects.

There is a slight increase in the rest tumor in the lung (from 2.5cm to 2.8cm), but the liver mets are the real problem. Initially (i.e. before the Alimta therapy), there were two of them each measuring approx. 1.8cm. Now one of them has doubled in size to 3.5cm and the second one nearly trippled to 5cm. Plus, there is a third new "suspect" lesion measuring 0.8cm.

We are devastated. The doctor thinks my mom has an aggressive form of cancer (at least the mets seem to be aggressively growing), but I am still in a shock. Nothing makes sense to me. The initial lung biopsy said proliferation rate was 25-35%, as the doctor explained me that was a "normal" LC behaviour. Ok, but now we have the super-progressive liver lesions, although my mom's liver values are still all within the norm.

The next step that he suggests (before giving all up) is trying out Tarceva 150mg. But she has been tested negative for EGFR.

I don't really know what to ask here, I am simply shocked and devastated.

My mom wants to rest a bit from the chemo. Is it risky if she tries Tarceva in e.g. one month?

I don't know what to do anymore, the odds that Tarceva could work for her are very low according to what I have read. And to put her through so many side effects, and again have zero results - I do not want her to suffer.

What shall we do? (I know you don't like these questions, but they are human.) Would you give it a try if it was your mother or would you say - have and keep the good life quality you have now for as long as possible?

Thank you so much in advance!

Reply To: Alimta Failed, What Now?

Hi meli, I'm so sorry your mom is progressing and needs to move off her current treatment. Taceva for people without the EGFR is a very good option in 2nd line treatment. I'm sure your mom is ready to give chemo a break. Since tarceva is a pill she won't need to visit the cancer center as often and taking a pill is much preferred over IV infusions. Below is a blog post by Dr. West describing options for 2nd line treatment; included are alimta for non squamous, for both squamous and non squamous is taxotere and tarceva. There are other options as well but these are the 3 that have to most data behind them.

My husband did well on tarceva for 10 months he has a squamous cell nsclc and not EGFR+.

I hope this helps,
forum moderator

Dr West
Reply To: Alimta Failed, What Now?

The summary in the link provided by Janine really speaks to your exact question. I can't answer what I would do if she were a member of my family, but the side effects of Tarceva (erlotinib) are quite variable and different from standard chemotherapy.

I would also add that if the cancer has progressed rather readily through first line chemotherapy, it's likely to progress at least as quickly, and potentially faster, off of any treatment. Because of that, there is a chance that this will be the best or only window to consider further therapy without her getting too sick from the cancer progressing to pursue further treatment options.

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

Reply To: Alimta Failed, What Now?

Thank you both for your feedback and infos.

Dr. West, this was my mother's 2nd line therapy. I guess that isn't any better. This is so horrible, I cannot understand how the lung tumor can remain more or less stable now for more then 8 months and these liver mets just grow like crazy!?!

Would Avastin be an option for her?

Can Tarceva stop liver mets' growth too?

She is so scared.

dr. weiss
Reply To: Alimta Failed, What Now?

Avastin is typically used only for the first treatment.

The response rate of erlotinib in patients without EGFR mutation is close to 0. However, "response" is defined as at least 30% shrinkage of cancer. Some patients without EGFR mutation will have smaller degrees of shrinkage or stable disease. Even stable disease is a victory--to cause suffering or take a patient's life, cancer needs to grow; as long is it is not growing, it cannot do these things. The rate of disease control with erlotinib in non mutants is real. Yes, if it did work, it could work in the liver too.