Hi --
After three rounds of chemo for locally advanced EGFR-neg ALK-neg poorly differentiated NSCLC -- the indications are stable disease for my mother-in-law. The evidence for this is unresolved pleural effusion (about 1.5L/3 weeks) and stable CEA. However, right now a trial has opened that might offer a good shot at attacking the disease. Speaking with the doctors in the trial, they suggested that we go for a CT scan and biopsy to see if we qualify.
At this point we have two issues:
1) Is 3 rounds too early to say that chemo hasn't been effective against the tumor? Most people scan at 4 rounds and the trial requires 1st line failure.
2) If we don't get into the trial our oncologist may want to order his own second CT scan. Should we worry about the double-dose?
Our current oncologist has been extremely (frustratingly) indifferent to the idea of our participation in the trial.
Thanks all!
Reply # - October 23, 2013, 09:32 PM
Reply To: Considering early CT Scan after 3 rounds of chemo to
The response to chemo in the first line setting for lung cancer is almost always "front loaded", most impressive after the first 2-3 cycles, then less so with each subsequent scan. For this reason, I'd say that the greatest benefit will have been achieved after the first three cycles. While this doesn't mean that the benefit has been exhausted, you're likely to be approaching a point of diminishing returns if the first few cycles demonstrated nothing better than stable disease. Those with the most significant response are the people who tend to also benefit for longer than the first few cycles.
I would consider the risk conferred by a second scan in the setting of advanced NSCLC to be minimal and irrelevant in this setting of advanced NSCLC.
Good luck.
-Dr. West
Reply # - October 24, 2013, 05:05 PM
Reply To: Considering early CT Scan after 3 rounds of chemo to
As for your second question, doctors will probably use the scan and report from the one done by the trialist.
However repeating scans won't be a problem if needed. There's been a lot written on the subject. Dr. Loiselle a radiation oncologist writes, "Note, in green, that a chest CT is close in magnitude to that which the average person receives in terms of background radiation every year. For patients living at altitude in places like Colorado, their yearly background radiation is even significantly higher." found here in this informative discussion on the subject, http://cancergrace.org/radiation/topic/time-magazine-on-the-radiation-i…
I hope things go well,
Janine