Hi everyone, nice to meet you all.
DH was diagnosed almost 3 years ago with Stage 4 NSCLC Adenocarcinoma. His initial symptoms were due to a rib met causing bone breakage and blood clots in the legs. He's never smoked.
Because of the location of the primary, and the amount of necrotic tissue, it was hard to get a good sized biopsy sample, so no mutation testing was done. He was started on Cisplatin and Alimta, switched to Carboplatin and Alimta due to side effects. He has transitioned to Alimta alone after a good 1st line response, and has recently transitioned to Tarceva as a 3rd line treatment. His CEA has always been a good indicator of his disease progression/activity. CEAs have always been a good indicator of his disease activity.
Subsequent biopsies have yielded enough tissue for some limited mutation testing.
He is doing fine on Tarceva (1 month) except for expected side effects which were Tarceva rash (treated successfully with doxycycline) and peeling skin on hands. Hands seem to be responding to Vitamin E oil.
He also reported some skin break out on legs and was prescribed a steroid cream yesterday.
So we are almost 3 years into this journey, which is great by a lot of standards. I am just curious what kind of time frame is normal for being on Tarceva. How long will the onc let him be on the drug? Is there a time limit? If there is, then what would a 4th line treatment likely be?
Lisa
Reply # - January 29, 2016, 11:18 AM
Hi Lisa,
Hi Lisa,
Welcome to GRACE. I'm pleased to hear that your husband is doing well with Tarceva and I hope that he responds well and for a long time, with continued manageable side effects.
Normally a targeted therapy such as Tarceva is continued indefinitely, until either progression or unacceptable toxicity. In large part, that's because (1) many patients are able to tolerate such drugs pretty well over extended periods, and (2) some patients achieve a long-lasting response. I certainly hope that your husband is one of those patients. That's much more likely if he has an activating EGFR mutation, but since that isn't necessarily known, his doctor will likely want to stick with it until there's a reason to change.
If progression does occur, there are other conventional chemotherapy agents which could be used, with docetaxel (Taxotere) being the best-tested as a second-line (follow-up) therapy. If there is a confirmed EGFR mutation and a later biopsy reveals a T790M resistance mutation, there are a number of targeted therapies which could be used. There is also the possibility of turning to one of the new immunotherapies, which are very successful for some patients.
Hopefully, that will not become an issue for quite a while, at which time there may be new options - the pace of development of treatments for lung cancer has increased the past few years, so there are more choices than ever before.
JimC
Forum moderator
Reply # - January 29, 2016, 02:58 PM
CEA might help monitor but
CEA might help monitor but only a CT scan can show progress or progression. No change of treatment should be made without a scan.
Take care, Judy
Reply # - January 30, 2016, 07:23 AM
Hi Lisa,
Hi Lisa,
Judy is absolutely correct...you wouldn't want to make any treatment decisions based solely on CEA. The two best ways to judge whether there is progression are scans and the clinical appearance of the patient. If the patient is feeling good, with no increase in cancer-related symptoms, and current scans don't show growth, the best choice is usually to continue the current treatment regimen.
If CEA has correlated with progression in the past, elevated levels may be a reason to get a scan sooner than previously planned, thus acting as a sort of "early warning" system.
JimC
Forum moderator