NSCLC w/mets including Adrenal Gland - 1266316

Sat, 10/04/2014 - 09:10

NSCLC adenocarcinoma Wife
July 2012 Lower Left Lobe removed Cancer Free
August 2013 Metastic to Midstinum
December 2013 Rad/Chemo (Cisplatin, Etopiside) complete, Cancer free Started Avastin and Alimta Maint.
March 2014 Pet cancer free, radiation fibrosis, Avastin and Alimta Maint
June 2014 Pet Scan: Development of a metabolically active prominent lymph node within the epicardial fat. This is compatible with metastic lymphnode. Avastin and Alimta Maint continued
September 2014 Pet
1. Development of hypermetabolic lymph nodes in the jugulosubclavian angles
of the lower neck, development of hypermetabolic lymph nodes in the right
paratracheal region, prevascular space, development of a hypermetabolic
lymph node in the subcarinal region and in the right infrahilar region.
Mild increase in size and apparent mild increase in activity of the
previously present lymph node in the epicardial fat. Development of
subcentimeter mildly metabolically active nodule in the left axilla.
2. Development of a small hypermetabolic nodule in the left adrenal gland,
compatible with adrenal metastatic lesion.
3. Development of more numerous and more sizable hypermetabolic lymph nodes
and the left adrenal hypermetabolic focus is compatible with progression of
the disease.
4. Post-treatment site in the paramediastinal aspect of the left upper lung
zone shows evidence of post-radiation pneumonitis.
5. Development of hypometabolic modest pleural effusion on the left.

Just received Shirley's latest Pet report. Alimta and Avastin does not appear to have worked. Radiation and new chemo? New chemo? Surgery to remove glands? Is this now considered stage IV? Clinical trials? We meet with her Onc 10/7/14, trying to get my hands around this to ask educated questions. As always I sincerely thank you all for being here and your help to all of us. Bill Urban

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Dr West
Posts: 4733

When disease is multifocal and spread outside of the chest, it got there by spreading through the bloodstream. meaning that it's metastatic spread and not curable. There would be no benefit from doing surgery, but she would be subjected to all of the risks and potential harmful effects.

Further chemotherapy would be the main recommendation outside of a trial, with Taxotere (docetaxel) being the chemotherapy that has the survival benefit and is a standard of care for previously treated non-small cell lung cancer. That's presuming she doesn't have an EGFR mutation -- if she had an EGFR mutation, Tarceva (erlotinib) would be the leading consideration, but otherwise Tarceva is still an option but one that is more often relegated to 3rd or 4th line treatment.

Those options are all outside of a trial, which is definitely an option to consider if there is one available for which she would be eligible.

Good luck.

-Dr. West

Posts: 12

Thank you Dr. West. She had the genetic testing done and nothing came back from the test. I would have to assume this would have shown any mutations or other key information. Thank you all and god bless. Bill Urban