Pulsed Tarceva - 1246851

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sleepless in jersey
Pulsed Tarceva - 1246851

The patients who have been on the pulsed Tarceva were all EGRF pos.. I didn't see any that were neg. has there been any recent updates that you have tried or anybody else that you have heard?
What kind of reactions/symptoms have they incurred from 150mg to 600mg?
Now if someone was to start the pulse and was on 100mg and script written for 150mg and not to start the 150mg until 8/30. Would you start the 150mg for a week or 2 than go to pulsed to make sure OK first?

Thanks for all your help Lord knows I need it.

Dr West
Reply To: Pulsed Tarceva

You're right that the favorable results we have sometimes seen with pulsed Tarceva have been in patients with an EGFR mutation. I haven't seen any especially encouraging results with pulsed Tarceva for patients who don't have an EGFR mutation.

In general, the side effect profile with the 600 mg every 4 days schedule has been within the range of what I'd often see in patients on the 150 mg daily dose: primarily skin-related side effects and a tendency toward loose stools.

In terms of dosing, I can't provide personal guidance for an individual situation like you're asking about.

-Dr. West

Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

Reply To: Pulsed Tarceva

Hi Sleeplees, I hope you won't mind me changing the title of you thread. We can't assume Dr. West will be available for comment on demand.
I think you will find most of what Dr. West has to say about your mom's situation and pulsed tarceva in your longer thread. Please don't take this as a scolding or anything other than trying to help. We all know how difficult it is to understand any of this on a good day. So I'm asking you to reread that info because I have a hunch you will gain a better understanding by reading it over. It's like a friend of mine, a gifted artist; she'll leave a painting for a while then return to find she sees it differently after the break.

Here too is a quote from Dr. Weiss on the subject,
"There is some evidence that tarceva gets into the brain, regardless of dose. The pulsed regimen has gained greater attention based on data showing that at these higher doses, it can penetrate the CSF. CSF or cerebrospinal fluid is the fluid that bathes the brain and involvement of it is even worse than regular brain mets. When CSF has cancer in it, this is called leptomeningeal disease. Pulsed tarceva seems to help with leptomeningeal disease in patients with EGFR mutation.

Pulsed-dose tarceva is also being tried, with less data thus far, for other conditions. It's being tried for regular brain mets and for patients with prior responsiveness to tarceva who are now resistant. These avenues of investigation are worthwhile, but pulsed-dose tarceva has not been proven for either of these situations." from http://cancergrace.org/forums/index.php?topic=11055.0

As far as moving right into the larger dose without a gradual stepping up. There aren't answers. And since she is already taking tarceva it's kind of a moot point.