Relapse after 36 rounds of Pemetrexed, sound familiar? - 1264498

7 posts / 0 new
Last post
afellner
Relapse after 36 rounds of Pemetrexed, sound familiar? - 1264498

Looking for someone who has had a similar treatment regiment to share their story. I was diagnosed June 2011 at 32, as a never smoker with NSCLC, Adenocarcinoma, ALK+. After 6 rounds of Cisplatin/ Pemetrexed, I cleared my Pet scan and continued on 900 mg Pemetrexed as maintenance until now (June 2014). Six months ago my PET showed an area of uptake that was further identified on MRI as a "fatty liver." The past month started having a cough and some tightness in the chest and my PET last week revealed new uptake in abdominal lymph nodes and one in the neck. No mention of anything seen in the lung. I have received my report but have not been in for my appointment yet. I wanted to try to familiarize myself with some possible treatment options for the next step. I'm concerned that being on the Pemetrexed for so long (36 cycles) may hinder my chances of a targeted therapy having success. Just want some insight so I can go in confident and educated, rather than scared and confused. Thanks

JimC
Reply To: Relapse after 36 rounds of Pemetrexed, sound familiar?

Hi afellner,

If you are ALK+ then Xalkori (Crizotinib) would be a good option for you. As Dr. West has said: "[T]his marker may also be correlated with responsiveness to Alimta (pemetrexed), providing a readily available treatment option before or after these patients start crizotinib." - http://cancergrace.org/lung/2011/09/07/alimta-for-alk-pos-nsclc-lee-jto/ He states that the trial results he describes in that post "lead me to favor treatment with Alimta in ALK-positive patients, before or after crizotinib."

JimC
Forum moderator

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>

Dr West
Reply To: Relapse after 36 rounds of Pemetrexed, sound familiar?

I would say that the overwhelming leading choice among experts would be XALKORI once there's evidence of progression in an ALK-positive patient who hasn't been in an ALK inhibitor previously. To my knowledge, there is no evidence that crizotinib or another ALK inhibitor would be any less effective after a long duration of benefit on prior chemotherapy. Many of the early patients who first tried XALKORI had been on many prior therapies for a long time but still had great success with XALKORI once they had access to it.

Good luck.

-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

afellner
Reply To: Relapse after 36 rounds of Pemetrexed, sound familiar?

Thank you so much for your quick responses. I'm waiting to see if my doc will call me this week or wait until my scheduled appointment next Tuesday to give me the news. Already starting to feel some changes. Fingers crossed:)

afellner
Follow up to my previous post

Follow up to my previous post---After completing two rounds of Cisplatin/Pemetrexed the tumors began to shrink so we continued with the treatment. Now after two more rounds the pet scan showed worsening with increased size and hyper metabolic activity in mesenteric lymph nodes in the abdomen/pelvic region. There is no evidence of recurrence in thorax or organ involvement. So my questions at this point are should I be rebiopsied and will Crizotinib be effective against these lymph nodes or should I look at adding another agent such as Avastin? Is radiation to lymph nodes in certain areas ever an option?

JimC
Hi afellner,

Hi afellner,

The first question would be whether the progression is significant enough at this point to warrant a change of treatment. Of course only your own oncologist would be able to help you make that determination.

If you need to change treatment, then as discussed above XALKORI would be the leading choice. Since you haven't been treated with it previously, there's not much reason to expect that it will not be effective or that you will have developed acquired resistance to it. With that in mind, a biopsy might not be necessary.

Radiation or other local therapy is not usually appropriate in Stage IV lung cancer, since the cancer has already spread into the bloodstream and is likely to appear elsewhere. You can read about this principle in this GRACE FAQ: http://cancergrace.org/cancer-101/2011/01/01/cancer-101-faq-i-have-metas...

JimC
Forum moderator

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>

Dr West
As Jim reminds us, it's

As Jim reminds us, it's important to first ask if this is clinically significant progression or just measurable progression that is closer to stable disease.

I don't see a clear value to doing a biopsy now if a prior biopsy already documented ALK-positive disease and you haven't been started on crizotinib yet.

There is no evidence that adding Avastin or some other drug would be helpful in the setting of progression now.

Radiation would really not be a favored approach, when there is a readily identifiable treatment option with a very high probability of success still to be tried.

Good luck.

-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