After 6 rounds of Carbo/Alimta, my mom's adenocarcinoma (KRAS) remained stabile -- showed slight shrinkage and decreased FDG uptake numbers, EXCEPT that a new small metastases in her right upper Iliac hip bone. Not clear whether this in her hip was from lung cancer or her primary breast cancer. The breast cancer lumps shrank considerably on anastrazole.
She then went on Alimta maintenance for 4 rounds (with Zomeda added for 2 of them) 11/5 PET/CT scan showed mild increase in FDG uptake #'s (6.9 from 6.6, 9.3 from 8.2, 7.0 from 5.4) and slight increase in tumor in Iliac bone. Dr. says the Alimta is not working so stop it. Since it seems like such a slight increase in the FDG uptake #'s in a 3 1/2 months, do you concur that Alimta is definitely not working ?
The Alimta rounds were done @ 3 weeks, 3 weeks, 3.5 weeks, 5 weeks -- could this timing have effected the efficacy of the Alimta ? Since it seems like such a slight increase in the FDG uptake #'s in a 3 1/2 months, do you concur that Alimta is definitely not working ?
My Mother – dx @ 76 yrs old:
7/11 – dx NSCLC (adenocarc,, KRAS, suspected multifocal + slow-growing), 2 cm LL, few suspicious nodules RL, lymph nodes clear
10/11 — LL ling. resection, watch RL
10/12 — PET/CT – slight progression into LL Pleura
1/13, 4/13, 7/13 – CT’s — very slight progression if any in pleura, considered stable
1/14 — PET/CT – progress. in LL pleura, RL nod. from 1.4 – 1.9 cm, new dx tumor (left rib @incision + primary breast cancer
2/19 — 1st Chemo — CARBOPLATIN ONLY
3/12 - 6/12 -- 5-6 rounds
6/25 - PET/CT showed slight shrinkage, decreased FDG uptake all around, BUT small metastises to right upper iliac bone
7/9 - 9/30 -- (4) rounds maintenance on Alimta with Zomeda added 2 of the times
11/5 -- PET/CT showed somewhat increased numbers in FDG Uptake -- slight increase in size in Iliac bone
Reply # - November 16, 2014, 09:34 AM
PET scan findings alone are
PET scan findings alone are quite weak evidence for progression, but we generally favor making a change in therapy if new lesions appear or existing ones are growing. Where to draw the line between pretty much stable and progressing enough to favor a change in treatment. That's a matter of judgment, so I'm afraid we can't make that interpretation. I would say that when there are viable alternatives that are associated with an anticipated survival benefit, it makes sense to not delay too long to change treatments. We have to expect that treatments will only become less effective over time.
-Dr. West
Reply # - November 16, 2014, 09:39 AM
Another question I have is:
Another question I have is:
even though the recent PET/CT scan doesn't show that the cancer has increased in size, in the last 3 -4 weeks my mom's breathing seems much worse. She walks even 10 ft. and is very out of breath. If she bends over strainght in front, she is completely breathless and says it's very scary cause she feels she can;t breath at all.
ANY IDEAS ON WHY THIS IS SUDDENLY WORSE, IF TESTING DOESN'T SHOW ANY MAJOR WORSENING OF HER CANCER ?
Could it be the pleura has gotten more rigiht and is more restricting the lung from moving ? Her primary cancer is of the pleura and scans shows extensive pleural thickening. Her O2 level mesaure by figner monitor is always at least 92, ususally 94 or 95.
She is also VERY tired. sleeps 11 hours every night, gets up, Sits at kitchen table for 3 - 4 hours, then to recliner to rest or nap. NO engergy at all to do even the littlest tasks. would this be due to Alimta only or from the cancer itself ?
Reply # - November 16, 2014, 09:51 AM
healmymom,
healmymom,
When scans show significant progression, it's easy to attribute new or worsening symptoms to the cancer. But when scans don't clearly show progression while symptoms change, it can be a more complicated question. Pleural involvement can certainly cause shortness of breath and in turn that can result in increased fatigue. But as you mention, chemotherapy causes fatigue as well.
The best person to be able to try to sort this out would be your mom's oncologist, who will have an opportunity to examine her and view her scans and who has access to all of her other medical records. Worsening symptoms should always be discussed promptly with your medical team.
I hope that you can get to the bottom of these problems and get symptom relief for your mom.
JimC
Forum moderator
Reply # - November 16, 2014, 09:53 AM
I can't explain why she's
I can't explain why she's more breathless, as there are literally dozens of potential contributing factors. Sometimes as chemotherapy continues, patients become more anemic, which can contribute to shortness of breath.
Increasing fatigue may be from chemotherapy or progressing cancer, or some combination. Probably the best way to clarify the situation is to take a break from chemo for a bit. If the fatigue improves, you can surmise that the fatigue was primarily a side effect of treatment. If it worsens or doesn't improve with time off of treatment, then it's likely to be primarily be due to the underlying cancer.
Good luck.
-Dr. West
Reply # - November 16, 2014, 12:43 PM
THANK YOU FOR SUCH QUICK
THANK YOU FOR SUCH QUICK RESPONSES -- all of you on this site are remarkable - I can't tell you how much respect I have for your and your help.
The current dr. /facility says there are no other options to try for the lung cancer after being on Alimta alone has showed slight increased FDG uptake, and possibly slight increased pleural thickening.
From all the reading I've done on this website, I am thinking this might not be true, so we are going for a 2nd opinion tomorrow.
I read here that the more effective the 1st line therapy was, the more likely the 2nd line therapy would work. Since my mom showed stability but only a little shrinkage with Carbo/Alimta, would you still think it's worth it to try TARCEVA ?
What about PD-1L, which I know is in clinical trials -- but perhaps via compassion use?
or my last idea which I read about on this website is MEK inhibitors (Selumetinib)?
would you think any of these would be possible things to try?
Reply # - November 16, 2014, 01:31 PM
These are all reasonable
These are all reasonable options to consider, and a lung cancer specialist offering a second opinion may have additional options to consider.
Tarceva can certainly have some activity in EGFR wild type (no mutation) advanced NSCLC, but the benefit tends to be on the modest side (arguably minimal). See this link:
http://cancergrace.org/lung/2010/09/21/benefit-from-egfr-tki-if-egfr-wt/
Having a KRAS mutation is associated with a very low response rate (often 0% in trials), but there still may be a modest survival benefit of 1-2 months, primarily from extending the duration of stable disease/prolonging time until progression.
It may be very hard to get an immune checkpoint inhibitor (PD-1 or PD-L1) as a compassionate use protocol, but there may be regular clinical trials with one that might be a more readily available option.
Good luck.
-Dr. West
Reply # - November 16, 2014, 01:31 PM
These are all reasonable
These are all reasonable options to consider, and a lung cancer specialist offering a second opinion may have additional options to consider.
Tarceva can certainly have some activity in EGFR wild type (no mutation) advanced NSCLC, but the benefit tends to be on the modest side (arguably minimal). See this link:
http://cancergrace.org/lung/2010/09/21/benefit-from-egfr-tki-if-egfr-wt/
Having a KRAS mutation is associated with a very low response rate (often 0% in trials), but there still may be a modest survival benefit of 1-2 months, primarily from extending the duration of stable disease/prolonging time until progression.
It may be very hard to get an immune checkpoint inhibitor (PD-1 or PD-L1) as a compassionate use protocol, but there may be regular clinical trials with one that might be a more readily available option.
Good luck.
-Dr. West