Tue, 09/09/2014 - 12:10
There is evidence that alimta may not be a good choice for neuroendocrine cancers, as Dr. West related here:
"I think you’ve got good reason to question the value of an Alimta (pemetrexed)-based chemo regimen, based on the limited data and association of high TS levels in neuroendocrine lung cancers. It’s definitely a drug I’m disinclined to use for neuroendocrine cancers." - http://cancergrace.org/topic/large-cell-neuroendocrine-cancer-of-lung#p…
In the same thread, Dr. West offered this opinion on the use of carboplatin/etoposide: " I’d say that even if cisplatin isn’t done, carboplatin/etoposide may be very feasible and still beneficial."
Tue, 09/09/2014 - 12:18
The difference might be efficacy or side effects. Neither have been tested side by side to really know. Cisplatin/etoposide is often used for neuroendocrine because it's been shown to have efficacy in that type of lung cancer. Neuroendocrine nsclc is treated more like sclc than squam or adeno nsclc. This link may help understand a bit better about its differences, http://cancergrace.org/lung/2007/03/22/lcnec-tumors/
Tue, 09/09/2014 - 15:02
Thanks for your replies!!! As it turns out, our oncologist consulted with another and next round of treatment may be octreotide injections...husband going for scan this week, then they will decide. Diagnosed in April 2014, received cisplatin/etopisode and then radiation combined with carbotaxol. Follow-up scans showed no further spread/growth and some shrinkage...Thoughts? Thanks!
Tue, 09/09/2014 - 15:12
One consideration would be that if your husband received cisplatin/etoposide beginning around April of this year, it would not be a leading choice for treatment now, since the cancer would have progressed in just a few months. In that situation, a different regimen is usually recommended.
We will hope for good scan results so that no treatment decision will need to be made.
Tue, 09/09/2014 - 20:09
I'd be happy to try to address any specific questions, but there is no treatment here that has a clear role, so it's a matter of judgment. I would consider Alimta (pemetrexed) to be a particularly weak choice for neuroendocrine cancers: the available evidence we have is that it is just not effective for these tumors.
Wed, 09/10/2014 - 05:49
Thank you for your response. My question/interest now is an ocreatide scan and ocreatide injections as treatments for neuroendocrine lung cancer. What is this type of scan designed to show and how effective are the injections? Is immunotherapy pd-1 indicated for neuroendocrine lung cancer? Thank you.
Wed, 09/10/2014 - 07:19
As Dr. Weiss has stated, an octreatide scan is a "scan dedicated to localizing carcinoid but as an important caveat, I've seen NSCLC light up on octreotide scan, so this test is not perfect." - http://cancergrace.org/forums/index.php?topic=5138.msg31502#msg31502
According to the American Cancer Society, "Octreotide is used in cancer treatment to control some symptoms of carcinoid syndrome (such as flushing, wheezing, and diarrhea) and to treat graft-versus-host disease. It is also used to treat diarrhea caused by chemotherapy, radiation, and AIDS." - http://www.cancer.org/treatment/treatmentsandsideeffects/guidetocancerd…
As Dr. West stated previously in one of your threads:
"We haven’t seen enough study of immunotherapy for lung cancer to say reliably which patients respond better or worse. However, it hasn’t really been studied yet in small cell lung cancer, in part because it tends to be a fast-growing cancer, and it can take a long time to see a good response to immunotherapy, even when it works well." - http://cancergrace.org/topic/neuroendocrine-lung-cancer#post-1265208
So the problem would be that with a fast-growing cancer, you might not be willing to wait too long to see whether the treatment is working, potentially wasting time when you could have been trying a different treatment which would provide results more quickly.
Wed, 09/10/2014 - 07:46
Just to corroborate Jim's points, I'd say that we just don't have good evidence on octreotide as a treatment for neuroendocrine lung cancer. It hasn't been studied enough to say much.
And as for immunotherapy, it's being tried for everything under the sun. It is definitely not a miracle treatment for everything under the sun. It does help a minority of patients pretty significantly, but it is too new and hasn't been studied enough to say whether patients with neuroendocrine lung cancer are especially likely or unlikely to benefit from immunotherapy.