First of all,
A BIG thank you to everyone, all doctors that responded to my earlier posts and all the members that chimed in. Your help means a LOT to me. I was completely shell shocked at the diagnosis, but your responses helped me a lot to wrap my head around it and take it head on.
Dad, living in India, diagnosed with NSCLC in Feb 2014, prognosis 50% chance of survival in a year. Started taxol derivative and carboplatin. 5 rounds without much hassles, but hit a roadblock around 6th round. His platelet count dropped so the oncologist postponed the round. Waited for 2 weeks to get platelets in order, no medications (but Dad ate a lot of Papaya!!) and then did 6th round. Finished about 2 weeks ago.
Dad did his CEA and it was in 80s after 5th round and now 28 after 6th round. I know it is better but not the best. In ideal case, I would like it to be less than 5, if not 2.5.
He is up for a PET scan in 4 days and once the results are in, the next course of treatment will be decided, because CEA level is not a yardstick for metastasis as there could be metastasized cells not secreting CEA.
His KRAS or EGFR status is unknown yet (he was a smoker for last 30 years), and the oncologist is not leaning towards more chemo rounds.
So the questions
- How long does it take for hair to regrow? Of course, it will depend on the course of treatment but Dad is more concerned about it (for whatever reason), but any general idea?
- Should the PET scan show reduction in tumor (a scan after 3rd round showed >50% reduction), with the CEA level of 28, what should be next course of treatment?
- Can you do more rounds of chemo at rather distant intervals? His previous chemo rounds were every 21 days, can you go every 5 weeks or so, for Dad's low platelet count issue?
- Should the Oncologist refuses more chemo, what can be the next course of treatment, maintenance medication or other medications that keep targeting tumor cells?
Thanks a lot in advance.
(Hit the message limit)
Reply # - August 8, 2014, 06:41 PM
Reply To: Dad – NSCLC – 5 months in
deltaforce, so glad your dad has done so well on with 1st line treatment. I've learned if it's important to D it's important and hair is a concern to so many. You're right about growing back depends on if and what treatment is next. D's hair grew back on tarceva and gemzar. It should begin to grow back just after treatment is stopped.
There is maintenance treatment that is given without a treatment break after 1st line or a break can be taken with close surveillance until progression, in that case call 2nd line. Below are links to maintenance and 2nd line treatments. There may be options for a clinical trial as well.
All best,
Janine
http://cancergrace.org/lung/2010/09/24/lung-cancer-faq-im-coming-to-the…
http://cancergrace.org/lung/2010/10/04/lung-cancer-faq-2nd-line-nsclc-o…
edit to add most recent thoughts about post 1st line tx:
https://www.google.com/url?q=http://cancergrace.org/lung/tag/maintenanc… don't miss the links at the bottom
https://www.google.com/url?q=http://cancergrace.org/lung/tag/maintenanc…
Reply # - August 9, 2014, 09:48 AM
Reply To: Dad – NSCLC – 5 months in
Hair usually begins to regrow about a couple of months after completion of chemotherapy that caused the hair loss, sometimes even a little earlier.
I would NOT base treatment decisions on CEA levels in lung cancer. There is no evidence that these should take precedent over imaging results and the clinical situation. No definition of disease progression in lung cancer looks at CEA levels. I think they are as likely to lead to poor decisions as to help improve them.
I would caution that the oncologist "refusing" chemotherapy is really not the right way to think about the situation. An oncologist not favoring more chemotherapy beyond 6 cycles is following the best evidence for how best to help patients, not denying them something beneficial. Of course, there's are complex judgments to make, but an oncologist not favoring more chemotherapy beyond 6 cycles is not punishing his patients.
I would recommend reviewing the FAQ posts and other materials Janine provided links for above. They should clarify that his oncologist is making appropriate recommendations in managing your father's care.
Good luck.
-Dr. West