life after Tarceva as a 4th line - 1262971

Thu, 03/27/2014 - 14:52

husband 66 dx 8/12 squamous cell NSCLC stage 4, mets brain 3 spots cerebellum & rt hip. primary RUL. Brain mets successfully treated with radiation. Carboplatin & taxol x6 brought tumor from 5.7 to 4.1…nothing until 9/13..malignant pleural effusion..alimta was unsuccessful after 3 doses….since Jan 2, 14 on Tarceva 150mgm. Life long non smoker, excellent health, was exposed to agent oragne in NAM, CONTINUES WITH PLEURAL EFFUSIONS…NOW Q 4 WEEKS ….2000 MLS AT A TIME…THAT\'S 6 TAPS since Oct 2013…..recent CAT scan 3/19 showed \"stable\"……he is also negative for any mutations… a tough Mainer & continues to try to chop wood, mow lawns etc……any suggestions? will the Tarceva eventually hit the nodules causing the pleural effusions? How long might that take? This is all taking place in the Rt lung…Lt lung has some mets but not bad….also recent CAT showed RT upper lobe bronchus obstructed. Is he at risk for the hemorrhage….many thanks. JoAnn White

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Hi JoAnn,

Welcome to GRACE, and good news that your husband's cancer has remained stable on Tarceva. Tarceva is a systemic therapy, so it should be able to reach cancer cells throughout the body (although to a lesser extent in the brain). But some patients' pleural effusions persist despite the cancer being under control elsewhere, and doesn't necessarily mean the cancer continues to progress there.

You may want to read these posts by Dr. West on pleural effusions and their management:

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my husband is all tested mutations negative……pleural effusions continue & a pleurex catheter is being considered……..he is on 150 mom Tarceva daily…..what happens to those mutation negative folks? any options? many thanks JoAnn White

Dr West

The majority of people don't have a mutation. Chemotherapy-based treatment is the mainstay of subsequent treatment in that setting, with Taxotere (docetaxel) having evidence to support a survival benefit in previously treated patients.

Good luck.

-Dr. West

Dr West

I would also add that, while not a commercially available, FDA-approved approach, another attractive idea would be an immunotherapy such as nivolumab (an "immune checkpoint inhibitor"/anti-PD1 therapy) or an anti-PDL1 novel agent have demonstrated encouraging results, including in patients with squamous cell NSCLC who may have been previously treated and don't have an activating mutation like EGFR or ALK.

-Dr. West