Squamous NSCLC treatment after discontinued chemo - 1265584

Tue, 08/26/2014 - 04:17

Hi Everyone,
I feel lucky to find this forum after weeks of reading WWW pages about NSCLC.
We have got bad news from last PET scan after discontinued chemo.

Here is our short history and questions afterwards . (my English is not perfect, but I’ll try to be as precise as I can in translation of medical data).

Sex: male
Age: 60, previously a heavy smoker

October,13 diagnosis: Squamous Cell Carcinoma
November,13-January 14: chemotherapy Gemzar/Cisplatin 4 round
April,14: left lung pneumonectomy, two lobes left in right
Markers from surgery tissue: RRM1 positive, ERCC-1 negative, EGFR not tested
June,14 chemo carbo/paclitaxel 1 round, not finished
Dad spent 4 days in intensive care unit because of heart failure, vomiting, hiccups. After that pneumonia.
August,14 PET scan results: tumors are growing, no mets in bones and brain
SUV 8.75 1.7*1.1*2.3 cm near right bronchus,
SUV 7.46 2.9cm max near right lung artery stump
SUV 7.12 3.3*1.8*3.5cm near mediastinum
SUV 6.59 3.3*1.8*3.5cm near pleven

Right now: my dad feels relatively good, no pain anywhere, ECOG 2, sometimes oxygen intake.

We do not consider chemo treatment anymore because of high risk.
Radiation oncologist said that radiotherapy may be too risky for his lung also.
So we do not have apparent options to try and this makes us very sad.

Now we consider following treatments:
1. Tarceva
2. Vaxira/Cimavax
3. LDN as “why not” drug

My primary question is about Tarceva or may be other EGFR treatment.
Is it makes any sense to try Tarceva?
Oncologist said that it is unusual to use Tarceva for squamous LC of smokers (doctors suppose that my dad EGFR negative). So Tarceva will never be prescribed on free base in my dad case. But my family has possibility to buy it even for long term treatment.

I appreciate any comment and suggestion about any other possible treatment. May be some one we do not hear about.

Thanks,
Alexander,
Russia

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JimC

Hi Alexander,

Welcome to GRACE. I am sorry to hear of your father's recent scan results, and I hope that another treatment regimen will be effective for him.

Although Tarceva is most effective for patients who have an activating EGFR mutation, and therefore it is the first-line treatment of choice for such patients, it can also provide a more modest benefit to other patients as a second or later line therapy. This includes patients with squamous NSCLC, as described by Dr. West here: http://cancergrace.org/lung/2009/09/25/tarceva-for-squamous-nsclc/

Many doctors do not test squamous patients for EGFR due to the low probability of discovering a mutation, and there is not much reason to do so after first-line therapy, as stated by Dr. West:

"[T]here isn’t a clear incentive to test for EGFR mutation in someone who has already received first line therapy, especially in someone with a very low probability of having an EGFR mutation. The point of doing a test is that the result should lead to a different outcome depending on the outcome of the test. Tarceva (erlotinib) is an appropriate second or third line therapy in a previously treated patient with advanced NSCLC regardless of whether they have an EGFR mutation or not — so in this case, either result leads to Tarceva, at least if you go by the best practices shaped by the evidence. So while it might be nice to know if someone has an EGFR mutation, if they get Tarceva either way, what’s the point of doing a $1500 test?" - http://cancergrace.org/lung/topic/stage-iv-nsclc-squamous-lung-cancer-t…

There is still limited evidence of the efficacy of Cimavax, which was discussed in this thread: http://cancergrace.org/cancer-treatments/topic/climavax-stimuvax-lucani…

Dr. West described his lack of enthusiasm for LDN in this post: http://cancergrace.org/cancer-treatments/2009/04/04/ldn-miracle-or-no/

Good luck with your father's next treatment regimen.

JimC
Forum moderator

Dr West

Jim summarized the key points very well.

I certainly appreciate the idea of LDN as a "why not" drug, but I think that's about the most you can say about it -- years after I wrote that post, there's still no more actual evidence outside of a few zealots talking about how they were told they had 3 months to live and are still alive 2 years later, ascribing it to LDN (which is a very, very weak form of evidence).

I would consider it a far inferior choice to Tarceva (erlotinib), which has a documented survival benefit even in those without an EGFR mutation that is modest but real (averaging 6-8 weeks in those without an EGFR mutation) and reported in several large trials, such as one called BR.21 and another called SATURN. It is unlikely that someone with a squamous NSCLC tumor has an EGFR mutation, but it doesn't matter if you give the Tarceva anyway, whether someone has an EGFR mutation or not.

Cimavax is a hard one to speak to, since there's really been no more evidence presented on it since the post I did years ago. Frankly, that makes me skeptical, especially since no lung cancer specialist outside of Cuba has ever given it a moment of thought in the last 3 years. If it were that impressive, it would have been championed by someone, somewhere. But the short answer is that there's no additional evidence to offer beyond the immature, rather weak evidence in the post Jim cited.

Good luck.

-Dr. West