My father is diagnosed with Stage IV Lung cancer/ Adenocarcinoma. We are completing 6 cycles of second line combination therapy which is Avastin (Bevacizumab), Abraxane and Carboplatin. The performance status has been good and my father is having progression free survival. Initial first line therapy of Pemetrex and Carboplatin didn't work favourably for him resulting in fluid accumulation in lung. Given the favourable response of the second line treatment, what should be the best possible option for maintenance cycles. One option is going with Avastin which is expensive, other option suggested is Erlotinib. My father is not found compatible with both EGFR and ALK. Apart from going into maintenance cycle, considering his current good performance status what possible options we should evaluate.
OPTIONS FOR NSCLC MAINTENANCE THERAPY - 1265390
vk123
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Reply # - August 12, 2014, 08:18 AM
Reply To: OPTIONS FOR NSCLC MAINTENANCE THERAPY
I would say that the leading options would be continuing with Abraxane, potentially with continued Avastin, switching to the pill Tarceva (erlotinib), switching to Taxotere (docetaxel), or taking a break from treatment and restarting treatment when there is evidence of clinically significant progression. If Alimta (pemetrexed) didn't lead to good results initially, it's not an attractive option later. There is a study looking at the potential value of continuing maintenance Abraxane, but we don't know how much it helps. We also don't know what Avastin adds to efficacy. It may help modestly, but the cost is certainly considerable.
Both Tarceva and Taxotere can increase time before the cancer progression, with a far more modest effect on survival. In fact, I would say that there's no reason to believe that survival would be improved by giving a treatment as maintenance therapy vs. giving that same treatment once you see evidence of clinically significant progression, which is why a treatment break remains a very reasonable option for patients whose cancer doesn't show signs of being so aggressive that it looks like the disease would likely "take off" without the inhibitory effect of ongoing treatment. We often have hints of the likely pace of the disease from the way it has appeared and behaved in the months preceding this kind of decision.
Good luck.
-Dr. West
Reply # - August 20, 2014, 12:04 AM
Reply To: OPTIONS FOR NSCLC MAINTENANCE THERAPY
Thanks Dr. West. The first time this got diagnosed was without any visible or significant evidence. Assuming the option is between switching to Tarceva pill or a treatment break. Any specific recommendation? What evidence need to be keenly observed during this phase? Assuming there is an evidence of progression 6- 8 weeks down this phase, would continuing with original chemo therapy combination be an option? Any other possible suggestions for improving OS would help...
Reply # - August 20, 2014, 03:57 AM
Reply To: OPTIONS FOR NSCLC MAINTENANCE THERAPY
We can't make a specific recommendation, but if there is evidence of progression that quickly, neither the first nor the second line treatment regimen would represent a very good option, since your father progressed on the first and soon after the second. Going forward, he will receive follow-up scans and examinations by his doctor, and progression will be noted either by results from those scans or by the presence of symptoms such as shortness of breath, pain, coughing, a new pattern of headaches, etc. Although any of these symptoms can be due to causes other than cancer, any new symptoms should be reported to his doctor.
Good luck.
JimC
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