Alimta vs Alimta and Avastin? - 1258879

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petra
Alimta vs Alimta and Avastin? - 1258879

I was diagnosed with Stage IV Lung Cancer in April 2013, with mets to my L3 spine and a \'hotspot\' on my left Arm. I received radiation to both my lung and my L3 spine along with chemo for 7 weeks. Chemo started out with Carboplatin and Taxol. Unforturnately I did not tolerate the Taxol and they switched me to Taxotere. After that I also received radiation on my lt arm due to increased pain and swelling. Then a Pet Scan was done and my lung tumor shrank by about 50%, but still active, and my L3 did not show any activity anymore. However, the cancer now spread to 2 lymph nodes in my chest and possibly a spot in the colon which will be checked tomorrow and my lt arm was now cancerous too.

My Oncologist now switched me to Alimta only, every 3 weeks hoping to contain or further shrink the cancer. I have been reading that Alimta is a low chemo drug and of course I am now wondering how if the previous chemo let the cancer spread, Alimta should stop it. It does not make any sense to me. I also did some research and found that some patients are receiving Alimta along with Avastin. I am wondering if this would be the way to go? The way I look about it is that the double med chemo didn\'t stop the spreading, how can a single med do it? Am I looking at this wrong? What are your opinions?

catdander
Reply To: Alimta vs Alimta and Avastin?

Hello petra, I'm very sorry you've been diagnosed stage IV nsclc. Treatment options are fairly typical in that they systemic based (they work to kill cancer all over the body) with the use of surgery or radiation focally for situation such as to relieve pain.
First line treatment is usually a doublet, 2 drugs, one containing a platinum such as carboplatin and a second drug that can be a host of options like taxol. Avastin may be added to this but has shown to have only slight benefits along with side effects. If used in first line it is sometimes used in further lines of treatment but not usually added to after first line. A single agent is used in 2nd line treatments or possibly a trial. Any other options are based on genetic testing for EGFR and ALK, both of which have targeted treatments that can be effective.

Below is a couple of links that better describe treatment options. Note the goals of treatment are longevity and quality of life. It's a delicate balance that I hope you will discuss with your doctors and nurses at every change in treatment.

http://cancergrace.org/lung/2010/10/04/lung-cancer-faq-2nd-line-nsclc-op...
http://cancergrace.org/cancer-101/2013/01/27/ramalingam-clin-trials-pt-3/

Please ask followup questions as you have them,
Janine
forum moderator

Dr West
Reply To: Alimta vs Alimta and Avastin?

I'm very sorry to hear of your progression.

I don't have much to add to Janine's thoughtful comments, but just to clarify that the evidence supports either Alimta (pemetrexed) or Tarceva (erlotinib) as the two agents not previously given that have a survival benefit in previously treated patients. Taxotere (docetaxel) is also on that list, except that you've already received it.

Unfortunately, our track record with cancers that have progressed on prior chemo tends to be disappointing, but the evidence is no better for doublets than for the single agent approaches noted above. Avastin (bevacizumab) also has no proven additional benefit in second line treatment when added to chemo and is actually uncommonly given that way -- it's more common to give it as part of a first line combination regimen and then potentially along with Alimta as a "maintenance therapy" strategy in patients who haven't progressed. Moreover, insurers are tending to be more restrictive about how they cover Avastin, given how expensive it is, so they are tending to be disinclined to pay for it outside of the settings in lung cancer in which it has compelling evidence of a benefit and an FDA-approved indication.

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