Combining Tarceva with another medication - 1261885

Hi katief,

The GRACE faculty have consistently expressed the opinion that increases in SUV, without visible tumor growth or new metastasis, is not sufficient evidence of progression to warrant a change in treatment. For example, Dr. West said previously " I see some oncologists frantically change treatments based on a change in PET SUV from 11 to 12, or an increase in serum CEA from 5 to 6, when the CT shows everything looking stable and a patient is tolerating treatment well. To me, this is like changing from lane to lane in a traffic jam, just moving for the sake of moving, but not getting anywhere any faster." - http://cancergrace.org/forums/index.php?topic=2131.0;wap2

An SUV of 3.2 is still relatively low, so a change in treatment based solely on SUV would probably be premature. Since there is not an infinite number of established agents to treat NSCLC, oncologists prefer to get the maximum benefit possible from each.

If the next scan shows clear evidence of progression, there are several options. One is to add an established chemo agent such as pemetrexed or docetaxel to Tarceva. Another is to discontinue Tarceva and switch to such an established agent. Finally, there are numerous trials of drugs intended to overcome resistance to Tarceva; none of those drugs has been identified as clearly the best.

I'm hoping that you will not even need to consider a treatment change!

JimC
Forum moderator

I don't mean to sound glib or facetious, but your dilemma is a big reason why a leading recommendation as an appropriate management strategy for your cancer is "stop doing PET/CT scans to follow it". You have no meaningful evidence of disease progression, and there isn't any evidence in the world that identifying "pre-progression" with a slight increase in SUV helps anyone -- it just leads to unnecessary anxiety and, very often, bad judgments about stopping or making changes in treatment too early.

This link describes the leading approaches to acquired resistance.

http://cancergrace.org/lung/2012/08/05/acquired-resistance-faq/

Otherwise, novel agents like CO-1686 and AZ-9291 are gaining increasing attention as a potential treatment in this setting of acquired resistance.

Good luck.

-Dr. West

I agree - there is huge variation with PET both between-day and within-day, even in the same patient. A SUV of 4.0 one day may be equivalent to SUV 3.0 the following week, for a huge list of factors relating to the scanner, the technician, the radiotracer, and patient. That is why plain CT scan is preferred for routinely following tumor response to treatment, and treatment decisions should be primarily based on change in size or new lesions.