NSCLC - elderly tarceva/side effects/dosing - 1268296

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megannicole
NSCLC - elderly tarceva/side effects/dosing - 1268296

My husband's grandmother, other then mildly elevated cholesterol totally active and healthy at 83, was diagnosed with stage 4 non-small cell in July 2014 she underwent radiation and then started Tarceva. She has struggled with many side effects and a few days ago decided to stop because she could no longer enjoy food, unbearable G.I. side effects and weight loss. There was a push to have her take the 150, she was unable to leave the bathroom, then transition to the 100 and it has continued is it worth it to try the 75? It's a very difficult situation because I work in healthcare and I honor the decision she made, but the family is begging her to continue, her first language is not English and the family withholds the negative news the doctors have. There is an element of denial in regards to the gravity of her situation. While on the tarceva tumor markers have remained low, metastatic sites are questionably shrinking, no new areas, no brain/liver involvement, primary tumor increased by 20% (left apex). How can I help them and her?

JimC
Hi megannicole,

Hi megannicole,

Welcome to GRACE. I'm so sorry to hear that your husband's grandmother has been diagnosed with lung cancer and is having such trouble with her treatments. Some patients, usually those with activating EGFR mutations, are particularly sensitive to the effects of Tarceva, both in terms of its efficacy and its toxicities. In such cases, dose reductions all the way down to 25 mg may be used. For some of these patients, side effects are reduced without a loss of benefit. As Dr. West has said:

"Our general approach is to give people the highest dose (up to the standard dose of Tarceva (erlotinib) of 150 mg daily) that people can tolerate well enough to continue on longitudinally. However, many of the people with an activating EGFR mutation are extremely sensitive to both the beneficial effects and side effects of EGFR inhibitors and need significant dose reductions. Many of my best responders for years have required dose reduction to 100 mg/day or less, and some 50 mg/day or less. I have patients who have done well for a very long time on 25 or 50 mg daily. That said, I don’t presume that’s the optimal dose for everyone with an EGFR mutation and work down from the standard dose, depending on tolerability." - http://cancergrace.org/topic/25mg-tarceva-enough-better#post-1262355

On the other hand, if the primary tumor truly has increased by 20%, not only does it seem much less likely that she has an activating EGFR mutation, but it calls into question whether she should continue Tarceva, especially in light of the difficulty she is having with it. Was her tumor tested for an EGFR mutation? Were other lung cancer treatments discussed and rejected? If she does not have an EGFR mutation, normally standard chemo would be the first treatment of choice.

[continued]

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>

JimC
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With an older patient, however, a determination may have been made that she is not fit enough to undergo a standard first-line chemo combination of a platinum agent and another drug. But it's also possible to use a single agent in order to make the chemo easier to tolerate. Alimta (pemetrexed), for example, tends to be one of the least toxic chemo drugs for many patients.

Dr. Rogerio Lilenbaum has provided an informative presentation on treating elderly patients which you may find helpful http://cancergrace.org/lung/2011/10/03/lilenbaum-on-lc-in-elderly/

And Dr. West has written a post on the use of Tarceva by elderly patients: http://cancergrace.org/lung/2008/06/21/tarceva-in-elderly/

I hope this helps. Please let us know if you have any further questions.

JimC
Forum moderator

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>