NSCLC stage 4 with mets to Bone, Liver and Brain - 1257743

I'm sorry to hear that she's progressed through so many lines of therapy. Unfortunately, at this point, the only treatment that has any established role in previously treated patients that she hasn't already received is Taxotere (docetaxel), which is very possibly (if not likely) challenging enough for her to tolerate that it could very easily cause more harm than good. Over time, the cancer becomes increasingly resistant to treatments, while the patient becomes increasingly beaten down by the ongoing therapy. You eventually reach a point where the treatments become just something to do for the sake of continuing to push, but they may well shorten survival and have little to no realistic chance of helping.

I wish we had more good options to offer, aside from perhaps a clinical trial of a novel therapy if you have access to one for which she'd be eligible.

Good luck.
-Dr. West

russellbeh,

[Dr. West posted his reply while I was writing, but here's what I wrote in case it is helpful to you.]

I am sorry to hear of your wife's progression. Unfortunately later lines of treatment tend to be less effective as times goes on, and your wife has had many of the possible standard regimens. The only agent with proven effectiveness in later line therapy which hasn't been used is Taxotere (Docetaxel). Also, have her cancer cells been tested for molecular markers? Most important would be an ALK rearrangement, which would indicate sensitivity to the targeted agent Xalkori. There is also the possibility of a clinical trial of a new, unproven drug.

That being said, usually when there is progression in the brain treating that becomes the treatment priority because growing brain mets can cause so much trouble. Since your wife has already had WBR, usually the only option would be to use targeted radiation to individual lesions if there are only a few. Your doctor can advise you if that is an option. As Dr. West has said:

"Finding disease also outside of the brain doesn't lead most oncologists to recommend against treating the brain metastases. Treating brain lesions is usually the highest priority, since they can lead to both significant neurologic symptoms and limit survival rather quickly. Why? Because there is very limited real estate in the skull, so a growing tumor and surrounding swelling can cause major problems in the brain very quickly." - http://cancergrace.org/forums/index.php?topic=9478.msg75825#msg75825

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Unfortunately, even if the brain mets can be controlled the cancer is progressing in other locations despite a variety of treatments. When we reached that point in my wife's disease, her doctor reminded us that the goal of treatment for Stage IV lung cancer was to prolong life and improve the quality of that life, something he had told us at our first meeting with him. Once the disease reaches a point at which no treatment seems to be slowing the progression, it can become appropriate to shift focus from prolonging life to improving the quality of life through palliative care, which focuses on minimizing symptoms and controlling pain. It may be helpful for you and your wife to have a frank (albeit difficult) discussion with her doctor about the relative value of further treatment.

My thoughts are with you at this difficult time, and my wish is for peace and comfort for both of you.

JimC
Forum moderator

russellbeh,

Rather than a particular therapy, Dr. West was referring to any new drug which might be in the process of testing in a clinical trial near you. To find one, you could ask her oncologist or search clinicaltrials.gov using the search term "lung cancer AND Malaysia"

JimC
Forum moderator

The oncologist you're working with should be able to help you learn more about trial options, which may be offered only at a larger cancer center, perhaps affiliated with a university. Otherwise, the listings on clinicaltrials.gov may include a phone number or e-mail you can contact for further information.

Good luck.

-Dr. West

If those trials came up by using a search phrase which included "Malaysia", there should be a location in Malaysia listed on the page describing the trial. Sometimes it is necessary to click on "Show ## Study Locations" to get the whole list.

JimC
Forum moderator