My 75 year old Grandmother diagnosed with Stage 4 NSCLC Wild Type - 1264620

Hi Sakshi,

Welcome to GRACE. I am very sorry to hear of your grandmother's diagnosis, and I hope that treatment can be both effective and tolerable for her. Regarding brittle bones, Dr. West has said:

"While chemotherapy can accelerate osteoporosis, it’s probably more important to focus on controlling the cancer, so we really don’t worry too much about osteoporosis in the overall scenario of metastatic cancer." - http://cancergrace.org/lung/topic/alimta-maintenance-and-l1-compression…

For a patient without an activating EGFR mutation, Gefitinib (Iressa) and Erlotinib (Tarceva) are not usually prescribed as first-line treatment (nor are they FDA-approved her in the U.S. in that setting), since chemotherapy tends to be more effective for such patients. The two drugs are similar; Erlotinib is a newer drug than Gefitinib and is considered to be more effective. In the U.S., Erlotinib is FDA-approved for second-line treatment.

Treatment choices are often determined on a case-by-case basis, so there may be good reasons for her doctor's choice of drug, including the fact that Gefitinb and Erlotinib may be easier for an older patient to tolerate. But if she is otherwise fit and healthy, chemotherapy would often be the preferred choice.

Good luck with her treatment.

JimC
Forum moderator

I agree. While a patient's poor performance status (activity level/energy) is an important factor, and people who are very frail have a real risk of being harmed by chemotherapy, having osteoporosis isn't a reason to exclude chemotherapy if a person is otherwise fit enough to tolerate it. Certainly, her age is still well within a range for which chemotherapy can be beneficial (at least in fit patients in her age range). And with EGFR wild type, there is no evidence that Iressa (gefitinib) will improve survival; there is also no evidence that Tarceva (erlotinib) is a better option in patients who aren't strong enough for chemotherapy.

If the recommendation against chemo was based more on frailty than 'brittle bones", the argument is understandable. If she is truly weak and fragile enough that chemotherapy is more likely to harm than to help her, then an EGFR inhibitor has the benefit of potentially being more tolerable, but it's value is more that it's feasible to try and less that it's of defined benefit. However, "brittle bones" in a fit 75 year-old is not a clear reason to recommend against chemotherapy.

Good luck.

-Dr. West