New treatment with Alimta - 1269581

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cubangem
New treatment with Alimta - 1269581

My husband was diagnosed with NSLC Stage IIB back in May, 2014. They tried doing VATS surgery in July but the tumor was too big and inoperable. He has no metastasis and no lymph node involvement anywhere. He was treated with 7 rounds of carbo/taxol chemo very aggressive then had 3 more rounds of chemo (smaller dose) concurrent with 35 radiation treatments. Radiation Onc wanted him to continue the chemo while on radiation but his body was not opt to it (74 years) so we are thankful he was able to complete all the radiation. The doctors at the time thought he was NED. He also developed radiation pneumonitis which they are treating with prednisone.

Subsequent they did a PET SCAN one month later and found it inconclusive so they sent him to a pulmonologist for a bronchoscopy and biopsy to make sure.

Today we got the results and it seems they were not able to get rid of the tumor completely and there are still cancerous cells. (adenocarcinoma). His oncologist wants him now to start chemo treatment with Alimta once every 3 weeks for 6 months or possibly a year to be able to get rid of the whole thing. My question is once you start on Alimta is that for curable purposes is there still chance of complete remission or just maintenance and is his Stage still a IIB?

I wanted to ask on your web site but was not sure how to do it. I hope emailing you is ok.

Thank you,

Martha A Ginory

catdander
Hi Martha,

Hi Martha,

I'm very sorry your husband's cancer has returned. This is the right place to ask.

The role of chemotherapy is to shrink a tumor but it's not been shown to be curable/get rid of all the cancer on its own. The treatment of chemo and radiation or surgery are the proven ways to cure someone of stage IIB nsclc. Unfortunately this doesn't happen near enough.

Remission isn't a term used in nsclc because it's such a rare occurrence. NED (no evidence of disease) is a more common term used when scans no longer detect cancer. Staging doesn't change from what was originally given and if cancer comes back it's referred to as recurrent though and treated like stage IV. Please know that your husband can do very well for years with treatment with breaks. Recurrent and stage IV nsclc is treated to extend longevity and raise quality of life.

A talk with the oncologist to clarify is very appropriate.

Please let us know of questions you have moving forward. We have an excellent library of resources that can be helpful and members who are on the same path.

All best of luck,
Janine

cubangem
Hi Janine,

Hi Janine,

Thank you for your response. Please note that my husband's cancer "did not return" but rather they were not able to completely eradicate with the chemo and radiation. Is it possible that this can now be done with the Alimta. This is what the oncologist told him, of course I understand that when you are dealing with this disease nothing is certain but from what I understand the onc told him that eventually with the Alimta they should get rid of what ever is left. He would be on the new drug for initially 6 months and if need be a whole year. He also said that there was a posibility of another drug but has to study his case more to see if he meets the profile. Again Thank you.
Martha

cubangem
Also his tumor was more like

Also his tumor was more like a spider web rather than a mass so a simple Chest Xray or CT scan would not have caught it any earlier. Is there any difference in the prognosis for those type of tumors.

catdander
The shape shouldn't change

The shape shouldn't change the prognosis. I see what you're saying, sorry for the misunderstanding. What the oncologist maybe thinking is that since radiation works many weeks or even months after the end of treatment he's giving alimta as an adjuvant treatment. Also if the oncologist is indeed looking at it that way the first chemo, before radiation might be looked at as neoadjuvant treatment. Since cancer is such an individual problem and we really are still in just the beginning stages (we hope) of understanding it individual cases are treated individually. Dr. West has just written a post on neoadjuvant care and also references the more traditional adjuvant treatment here, http://cancergrace.org/cancer-101/2015/05/18/neoadjrx/

You may want to have a conversation with his doctor to get a better understanding of his thinking. In any case the treatment seems appropriate. Edit to say, Perhaps start the conversation with something like, "Should we look at this as similar to adjuvant treatment." That way you give the oncologist a hint that you have some understanding of the situation and maybe more willing to discuss more in depth.

Best of luck and hopes,
Janine