Current and Upcoming Treatment Options for Stage 4, EGFR+ - 1274424

Mon, 06/20/2016 - 20:10

Hi, I'm an advocate for my 61 year old mom who has been taking Tarceva since January of this year. I want to do everything I can to make sure we are not overlooking anything that would provide her with the best chances for long PFS.

On Tarveca since 1/12/16 and responding well with primary tumor shrinking from 47 x 26mm in January to 19 x 16mm as of 6/3/16 and stable right hillier node at 17 x 13mm. Her last CT still shows residual nodular pleural carcinomatosis. The treatment has also completely resolved a moderate/large malignant pleural effusion. No other sign of metastasis. She is very sensitive to medication and had severe reactions at 100mg but at 75mg she's doing really well, aside from numbness in various parts of the body that come and go.

With treatments improving at such a rapid pace, would you consider Tarveca to be the best treatment for someone with her profile? Would you consider investigating in combination therapy?

There is a recent study published out of UC Davis that says many have dismissed surgery for advanced stage NSCLC however, there are some that may benefit and should not overlook. My mom is being treated at a major research university hear in Los Angeles but has never been evaluated for surgery due to her MPE. Should all patients seek surgical evaluation despite MPE and/or residual nodular pleural carcinomatosis is seen?



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Hi John,

Welcome to Grace. Thanks for being your mom's advocate in her cancer treatments.

There has been some early discussion about possible surgery in nsclc when the cancer is limited to the primary tumor plus one or 2 stable masses however this is still way too early to know if local therapy (surgery or radiation) would be helpful. Most often this discussion would be had at a time of progression or other need to change treatment.

When treatment is working well to keep cancer stable and minimally toxic it's best to stay on that treatment. There's no need to mess with what's working. Your mom could do well like this for even a few years. Don't fix what's not broken. :)

When the time comes a conversation with her team would be appropriate. At this time the best known practice is to stay put.

All best,


Hi John,

I agree with Janine. Surgery in stage IV lung cancer is usually only considered, not for the primary tumor, but for one or two isolated metastases, in the hope that those locations are the only places to which the cancer has spread. In your mom's situation, surgery to remove the primary would not be likely to be curative, since the existence of the MPE indicates that they are cancer cells in the bloodstream, which can eventually appear as tumors in other parts of the body. Systemic treatment such as Tarceva is what is most likely to keep those circulating cancer cells under control.

I hope Tarceva continues to be effective for your mom for a long time.

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