options for our next step - 1244052

this quote from Dr. Pennell speaks mostly to squamous cell but also includes any wild type nsclc (nsclc without the egfr muation) including your husband. Dr. Pennell wrote, "Hi Marian, good question. Tarceva has been shown to be effective in squamous cell carcinoma, although not usually to the extent that one sees with an EGFR mutation. Patients with mostly EGFR wild-type (normal) NSCLC were included in a large randomized trial called BR21 that showed, on average, longer survival in second line with Tarceva compared to a placebo. This same benefit was also seen in the squamous cell patients. I don’t think that the smoking status would be likely to affect this much one way or the other." in this thread: http://cancergrace.org/lung/topic/effectiveness-of-tarceva-on-nsclc-squ… There are also links to blog posts written by our doctors in the thread above.

Good luck to you and your husband and continue with other questions when they arise.
Janine

P.S. When starting a thread please click the bar at the top of the page the reads "ASK A QUESTION ABOUT _________" and choose lung cancer. It will take you to the appropriate forum. This is a site management forum.

I actually don't see where you've said that he has a squamous NSCLC tumor, but that's relevant: one of the potentially helpful chemo agents for people with a non-squamous NSCLC tumor is Alimta (pemetrexed), but this agent isn't effective for patients with a squamous NSCLC tumor. Otherwise, Tarceva (erlotinib) can still be at least modestly effective in patients who don't have an EGFR mutation, as described more here:

http://cancergrace.org/lung/2010/09/21/benefit-from-egfr-tki-if-egfr-wt/

Otherwise, here is a link that describes the general ways in which we approach patients with previously treated advanced NSCLC:

http://cancergrace.org/lung/2010/10/04/lung-cancer-faq-2nd-line-nsclc-o…

Beyond that, it gets into the range of individualized medical advice for someone who isn't our patient, so we can't legal do that.

Good luck.

-Dr. West

Hi naevesherri,

I'm sorry to hear about the latest scan results, although it will be important to speak to your husband's oncologist about just how much growth there is. At times if the progression is slow enough, it makes sense to continue a well-tolerated treatment, especially if several options have already been used. Dr. West has described this as "slow brakes as opposed to no brakes".

As discussed in previous posts, Tarceva is an FDA-approved treatment for previously-treated patients. In addition, there are other drugs which have not been thoroughly tested in clinical trials as second-line treatments (so they are not FDA-approved), as well as clinical trials of new drugs. Each of these options should be discussed when your doctor returns.

In the setting of metastatic lung cancer, radiation is used to palliate symptoms or relieve pressure on a critical body structure. Radiating a tumor when it is known that there are cancer cells in the bloodstream is not usually advisable, since the cancer simply reappears in another location, after the patient has suffered through a treatment which cannot be expected to eliminate the cancer completely or control it throughout the body.

JimC
Forum moderator

Just wanted to say I am sorry to hear about your husband. It sounds as if you are both going through a tough time.

I'm sorry about his recent progression. Again, the options are really what is covered in the link above about options in previously treated patients, as well as the one specifically about Tarceva in pateints who don't have an EGFR mutation. Radiation usually isn't a leading option for people with metastatic disease, unless only one are is growing or causing a specific problem. Because progression of metastatic disease is usually in several areas and not limited to just what can be seen, chemo and targeted therapies ("systemic treatments") are usually the leading strategy for patients with metastatic lung cancer.

-Dr. Ws