challenging case - 1244128

I agree that his is a challenging case, as it appears that he has demonstrated progression through what are very appropriate therapies. I’m sorry to learn that his treatments up to now haven’t been effective. Alimta (pemetrexed) now seems reasonable, though we would expect it is far more likely to be effective against the non-squamous than the squamous portion of the cancer.

Here is some information on treatment options generally used for patients who have progressed after prior chemo for NSCLC:

http://cancergrace.org/lung/2010/10/04/lung-cancer-faq-2nd-line-nsclc-o…

Good luck.

-Dr. West

Hello sima and welcome to Grace. I'm sorry to hear your dad is so sick and so far away. I know that must be very difficult. I'm not sure how much you understand about lung cancer but I think it will be very helpful for you to do some reading about lung cancer and standard and not so standard treatments. In reality there are very few "standard" cases, all stage IV lung cancers are challenging in their own way.

It sounds like your dad had curative surgery after dx and adjuvant treatment (chemo after surgery). But he progressed in the adrenal gland.

4 to 6 treatments with a platinum drug is considered about all a person can handle safely.

If he didn't respond to tarceva he probably doesn't have an egfr mutation and still may have an ALK or ROS1 rearrangement/mutation for which there is a targeted therapy.

Below are some links that may be a helpful starting point in your search for information.

the first link discusses the use of alimta in adenosquam nsclc.
http://cancergrace.org/forums/index.php?topic=11105.0

http://cancergrace.org/lung/2010/10/04/lung-cancer-faq-2nd-line-nsclc-o…

http://cancergrace.org/lung/2011/02/13/drcamidge-crizotinib-update/

sima, I forgot to mention we are implementing a new forum setup that includes the way in which doctors reply to posts.

Anytime you have you have a question you can't find an answer to through the search please create it in the link below so I can practice getting it to the proper doctor for an answer.
http://cancergrace.org/forum/q-and-a-ask-us/new-questions

Thanks again

sima,

If it is a stage IV adenocarcinoma or adenosquamous lung cancer, can you name any mutation tests (molecular rearrangement) tests that have been done? For example, was it tested for EGFR before trying Tarceva, or was that just a guess that didn't work? If it was not EGFR-driven (if it was EGFR negative or 'wild type'), was it tested for ALK? If also negative for that, was it tested for the not-so-useful KRAS? If negative for that, for ROS1? (A person almost always has only one driving mutation initially, so they might be tested in a sequence like that until the right one is found.)

If I recall correctly, ALK is very rare in squamous and ROS1 hasn't been found in squamous before, but either can occur in adenocarcinoma and theoretically could appear in either of those or adenosquamous. They are rare (4% and 1% chance), but the odds of what's left go up as you rule out more common ones like EGFR and the not-so-useful KRAS. Being a never-smoker also improves the odds (since smoking makes KRAS more likely). ALK- and ROS1- driven cancers can usually (not always) be controlled for a number of months with Xalkori (crizotinib). Xalkori is not available in every country, so it might be useful to know where you and your father each are (which countries). Some countries allow a doctor to prescribe a drug for other uses once it's approved there, although it might be difficult to get insurance to pay for an "off-label" use (at least until it's proven to actually work on the patient). (In the USA this drug is only approved for ALK but the early results from the ROS1 trial here are just as good or better.) Without insurance or assistance from the drug company, Xalkori is crazy-expensive (about $100,000 per year).

Best hopes,

Craig