My husband age 50 was diagnosed in nov 2011 with adenocarcinoma, he has undergone 6 cycles of chemotherapy with Alimta and cisplatin.After 3 cycles a ct scan was taken and there was considerable resolution, therefore 3 more cycles of alimta and cisplatin was undertaken.
Now he is on maintenance with alimta singly every month. His pet scan is due next month.
He is egfr and alk negative. Staging was not done. But doctors said surgery is not an option.His scan report does not show any dimension of tumor. It states that there is interlobular intestitial septal thickening in right lung exhibiting nodularity at places. Major fissure also exhibits occasional nodularity. Peribronchovascular intestinal thickening identified more prominently , centrally in right lung, with nodular densities especially in right lower lobe where a fairly large rather irregular/mildly speculated density is seen in the apical segment. Left lung is aerated and unremarkable.
My husband did have a lot of side effects, however now is through with them and doing well, he has put on weight also. If the pet scan is clear, which i hope fervently, will he still have to undergo maintenance chemotherapy?
Reply # - May 10, 2013, 07:03 PM
Reply To: Is maintenance therapy needed after a good response to
Hi vidhyaranga93,
Your question is a common one. If a patient's follow up scan shows no evidence of disease, the unanswerable question is whether the maintenance chemo is controlling the cancer, or whether the cancer is gone. Some patients prefer to continue treatment, thinking that the current maintenance therapy is the only thing keeping the cancer at bay. But other patients elect to stop treatment and diligently follow up with scans at relatively short intervals, beginning treatment if recurrence appears. The second option has the advantage of a break from treatment side effects. If your husband is free from side effects that certainly is a factor in favor of maintenance.
Regarding maintenance, Dr. West has said:
"Essentially, the goal of maintenance therapy is to address the question “what’s the least treatment required to control the cancer over the longest time?”. That’s going to vary from person to person." - http://cancergrace.org/topic/how-long-can-someone-be-on-maintenance-ali…
And Dr. Weiss has said:
"When approaching the maintenance question, patient values and anxiety are extremely important. In situations where data does not clearly tell me if I should use maintenance or not (for example pem [alimta] after a pem-containing induction regimen) it is THE most important factor. If a patient desperately wants a treatment break, I give it to them. If the patient fears progression and strongly wants to do SOMETHING, then I agree to maintenance." - http://cancergrace.org/lung/2009/12/16/odac-says-no-to-maint-erlotinib/ (this link also includes perspectives by Dr. Pinder and Dr. West).
Hoping for a clear PET scan.
JimC
Forum moderator
Reply # - May 10, 2013, 09:42 PM
Reply To: Is maintenance therapy needed after a good response to
Jim provided a great summary of the issue. It's a judgment call, but I and many other lung cancer experts think it's profoundly reasonable to hold further treatment and monitor patients diligently if they've done very well after first line treatment for advanced NSCLC.
Good luck on the upcoming scans.
-Dr. West