My 45 yr old, nonsmoking sister was diagnosed with stage IV neuroendocrine lung cancer. Mets to brain and spine. Hers appears to be very aggressive. She received 4 rounds of avastin, carboplatin and paclitaxil. Developed resistance during 4th cycle. Cancer spread to bones in spine. Now on Tarceva for 3 weeks. Also currently receiving radiation to spine for severe nerve pain and is on morphine. Her lungs are hurting so she thinks the Tarceva might not be working. She has a lot of tumors in her left lung. She wants to give up.
What are some options we might consider at this point to ask her doctor about?
1) Back to some other sort of chemo? I noticed that the chemo she received is not the one they usually do for neuroendocrine? Could cisplatin and episode be an option?
2) If she has a primary resistance to Tarceva is it likely that another EGFR inhibitor is worth trying or applying for compassionate use of one of the 3rd generation TKi's?
She does not appear to qualify for any trials due to pleural effusions, brain and spine mets.
Kaiser will not approve for her to go to Stanford or UCSF for an academic opinion unless we find a clinical trial at one of these locations. So she hasn't been able to see a specialist in either lung cancer or neuroendocrine cancer.
Thanks for any suggestions.