Need Advice or Opnion for choose treament of NSLC wth brain mets with egfr neg- - 1257273

Welcome to Grace. I'm very sorry your mother has lung cancer and can imagine how difficult it is to try and understand such a complicated disease in a very short amount of time. I went through it with my husband and found everything I needed on the forums here and also on the rest of the site.

We have an extensive library that will be very helpful to you and of course you may ask questions along the way.

I will post links that can help with the questions so far.

It sounds as if your mother has gotten good standard of care so far. As well, the suggestion for further treatment but there are options that depend on style of care, personal preference, and the individual case. If I understand, the oncologist wants to move forward with what is known as "maintenance treatment" which is moving directly from the first line treatment and continue the pemetrexed (known as pemgem in India) without a break. Another option would be to hold treatment and watch carefully with regular CT scans (6-12 weeks) to monitor the cancer. Taking a break gives your mom a breather from treatment (though treatment won't be as difficult without the platinum chemo drug. Too taking a break means you must be diligent in watching so the disease doesn't progress to the point that she is too disabled to withstand more treatment. Your mom should have a say so in whether she wants a break or if she is too uncomfortable not treating. Here is a post on the subject, http://cancergrace.org/lung/tag/maintenance-chemotherapy/

There haven't been any studies to suggest genfitinib would be a better choice at this point. However it could be held as a next choice when pemgem becomes less effective or difficult to withstand. Tarceva/erlotinib is a drug very similar to Gefitinib in molecular structure. This is the latest info on the subject, http://cancergrace.org/lung/2013/06/12/prose-trial-veristrat/

to be continued

The maintenance link has many posts on maintenance, all good but I really meant to send just the first on the list. It's the most recent and looks at treatment as a long term prospect and using it as little as possible, again it must be watched closely until it's biology is known.

You didn't say but it sounds as if your mother is dx stage IIIB or IV, in which case treatment is for extending life and raising or maintaining quality of life. Unfortunately it's not considered curable. Many people are able to live their lives for several years past diagnosis and more oncologist are looking at nsclc as a disease where that is possible. The focus of this post is 1st line treatment (the treatment your mother had with pem and platinum) but Dr. Weiss goes much further about treatment in general, http://cancergrace.org/lung/2010/04/16/introduction-to-first-line-thera…

I hope this gets you off the a better understanding. Please let us know of other questions you have.

Much luck,
Janine
forum moderator

The fact that a brain metastasis was noted makes it stage IV. In this setting, maintenance therapy is certainly reasonable, a strong consideration, though not necessarily a mandate if patients need a break from treatment.

The many links that Janine provided above discuss a wide range of maintenance therapy options. However, while there are several options, maintenance pemetrexed (Alimta), which I think is the agent you're mentioning (probably a slightly different name in a different country) is far better studied as a maintenance therapy than gefitinib (Iressa), which has never been shown to improve outcomes as a maintenance therapy. I would say that far more experts would favor the IV chemo based approach, specifically with pemetrexed, than gefitinib, since the latter just doesn't have the same level of evidence to support it. I would be also have relatively little enthusiasm for significant value from gefitinib in someone known to not have an EGFR mutation.

Good luck.

-Dr. West