Continuing Tarceva after starting Alimta - 1256858

Hi mkdr,

Your question is one that continues to be debated. Some experts favor continuation of an EGFR TKI such as Tarceva, adding another agent (often Alimta) upon progression, while others choose to discontinue the TKI and switch to either standard chemotherapy or a trial of a new targeted therapy which seeks to overcome the resistance which has developed.

You can watch a podcast on the subject here: http://cancergrace.org/lung/2013/05/20/bonomi-manage-acquired-resistanc… On that page, under "Related posts" you will find other experts' opinions on the same question, and you can see how even the top names in the field do not agree.

For what it's worth, when my wife's cancer first started to progress, she added alimta (which had worked well in her first-line treatment) and achieved stability for a while.

JimC
Forum moderator

I'm speaking on this topic on Saturday at ASCO, but there's no resolution on this topic. There hasn't yet been a study to clarify whether targeted therapies should be continued beyond progression and whether concurrent therapy should be preferred over possibly switching to chemo and then possibly going back to the targeted therapy later.

-Dr. West

I am at cycle 11 of Alimta, along with 100 mg of Tarceva. Outside of an initial spike in my ALS and ALT s' I am at a stable state.I have taken Tarceva for almost 3 1/2 years and had slight progression 1 year ago. After upping my Tarceva doasage to 150 mgs there was still some mild progression therefore the addition of Alimta, 1004 mg. every three weeks. My oncologist from Winston Salem is pleased with the response.

Stefano, NSCLC contained mets to lungs, 3 1/2 years after DX.

That's fantastic, Stefano.

Certain Spring, are you considering a change in treatment?

Stefano

Yes - changing or stopping. I am not sure Alimta would be useful for me as I have a squamous tumour. And, sadly, the progression is far from mild. But it is nice to hear of other people doing well! All best.

Certain spring - Like everyone else, I've been so sorry to read your recent news. We each have such different issues and react to things so differently that what works for one person doesn't for another, but I wanted to mention taxotere. I see that you turned it down before. I'm laying in a bed now waiting for my 6th (total of twelve overall) taxotere infusion. I do really quite well through 4 treatments but seem to get fatigued and sprout red watery eyes as I hit 5/6. Again I know that I don't have the struggles you are having but when I heard from a LC specialist that they are finding EGFR mutants tend to do well on taxotere, I'm more motivated to keep returning for more. I scan near the end of June and am planning on a break, probably eventually trying Tarceva again but I'll also be willing to return to taxotere if it continues to keep me relatively stable. Just a thought to maybe run by your drs.
Wishing you the best.

Thanks very much Judy. I'm busy trying to clear my prejudices off the deck! It is great that the taxotere is working for you.

Apologies for hijacking the thread, but I just wanted to comment to certain spring. Beyond anti-PD1 immunotherapy that has worked so well for quite a few people with squamous NSCLC, perhaps there might be a value in Abraxane (nab-paclitaxel), which has some (modest) evidence of particular efficacy in squamous NSCLC. I've also been impressed with how it has worked in several of my patients, particularly those with squamous NSCLC -- albeit still a small number of patients overall.

-Dr. West