Hello,
My aunt who is 45 years was diagnosed last summer, in July, with lung Cancer stage 4. Tumor was about 5.5cms and
she had mets to the Adrenal gland, bone ( knee and Sternum).
She had 1 round of traditional chemo, then was put on Tarceva because her biopsy showed that she was EGFR positive.
She had a few rounds a radiotherapy for the knee and as well as for the Chest ( Sternum) but that was later on.
After 2 months of taking Tarceva, Tumor shrunk and was reduced to 2.5cms. Everyone had hope and she herself was convinced that Tarceva was working. The doctor then asked her to come back in 3 months for another scan.
Well, what happened is that Tarceva stopped working right after that last scan. She had a lung pneumopathy, was admitted at the hospital for quite some time. I think that it was Pneumonia but my mom kept insisting on calling it pneumopathy.
It affected both lungs and the lung that has the tumor did not respond well to antibiotics. Why?
When they did the scan to check on the Lung infection, it showed progression, a massive one. It was then 7cms. This was in January 2014.
The worst thing is that while staying at the hospital, she had a 1st nodule growing on her neck.
It is a cutaneous met. The doctor put her on Avastin/carbo, it didn't do her anything. The nodules kept on growing to now reaching a great number.
After 2 rounds of the Avastin/carbo protocol, he decided to swith to Avastin/Alimta.
She's had a 1st round and on Monday she is going to have another one.
What are those Skin nodules? What are they growing so fast? Is there anything that can stop them or is it a very bad prognostic as I read on some articles about it.
I tried finding threads on Inspire about people who might have had the same kind of mets but nothing. Is it very rare or is it that her cancer is really bad and that there is nothing to do?
I sometimes think that maybe the doctor did not give her the right protocol and that is why… but why those skin nodules??
Thank
Reply # - April 13, 2014, 10:38 AM
Reply To: Cutaneous mets: is there any hope?
Unfortunately, lung cancer can always evolve and change behavior significantly, as I describe in this summary presentation:
http://cancergrace.org/cancer-101/2014/03/23/cancer-evolution-adaptatio…
Sometimes that progression is very gradual, but in other cases, it's much more sudden and dramatic. It sounds like hers is in the latter category.
Cutaneous (i.e., skin) metastases are uncommon but certainly seen, and they are generally associated with a more aggressive cancer, but you generally treat them the same way as metastatic cancer to other places. You can always do radiation to a specific area or two that is causing problems, such as pain, but often the progression occurs ratehr quickly in such patients, so you may see new nodules pop up as fast as you treat others.
I strongly doubt that any part of this was caused be the oncologist using the "wrong regimen". I would be surprised if the first chemo was actually just carboplatin and Avastin (bevacizumab) without another drug, most like Taxol (paclitaxel), but regardless, this kind of progression can just happen randomly because the cancer has a tendency to mutate into a more aggressive and resistant variant over time and ongoing treatment, as I note in the link above.
One thing that could potentially be helpful is to biopsy a readily accessible cutaneous metastasis to check if it still looks like non-small cell lung cancer (NSCLC) under the microscope or may have evolved/mutated into small cell lung cancer (SCLC). This can occur in a small minority of EGFR mutated NSCLC tumors, and the pattern of what you'd expect to see is a sudden change to a much more aggressive and widely spreading disease. Finding the growing disease is actually SCLC under the microscope would suggest that a different chemo, such as cisplatin or carboplatin with etoposide, might be the best choice, since that kind of regimen is what we see best results in with SCLC.
Good luck.
-Dr. West
Reply # - April 13, 2014, 11:37 AM
Reply To: Cutaneous mets: is there any hope?
I just want to say hello and welcome to Grace. I'm so sorry to know about your aunt. Please don't hesitate to ask questions as you have them.
Janine