Squamous Progression after just 6 weeks? - 1247803

Sat, 09/08/2012 - 06:46

Hello All,

My father recently completed 6 cycles of chemo (gem+carbo) to treat his lung tumours in RLL. He has squamous cell with pleura involvement and chest lymphnode involvement. Throughout chemo, his scans were displaying tumour and lymphnode reduction. From his scan post chemo to his next scan 6 weeks later there was disease progression in lymphnodes, both tumours and now there appears to be a nodule in his left lung. From all I have been reading, squamous is considered a slow growing cancer subset. I know "the rules" don't apply to all individuals, but we were shocked and horrifed at the news to say the least. My question is can the cancer subset change from squamous to adeno for instance? I am just trying to comprehend how treatment seemed to be working and then, in such a short period of time, the cancer progressed. He is having his tumour tissue tested for all known mutations through a clinical trail (IMPACT) since in Canada it is not common practice to do this especially for squamous cell. My understanding is typical second line treatment is taxol+carbo or iressa for his subset, but we may consider other clinical trials as well. Sorry for rambling, any information would be greatly appreciated.

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catdander

Hello son, I'm very sorry your dad is going through this. It really is just so difficult for everyone involved. I hope his pain is being managed until radiation which should help. I hate to say it but yes squamous can move that fast even after responding to treatment. I don't recall that squamous is all that slow growing compared to other lung cancers. But it really doesn't matter when discussing one patient because, as you will find with lung cancer, anything is possible and the stats encompass a huge range of outcomes. Your dad is one person and fortunately and unfortunately anything can, it seems, can happen.

It's really good that he responded well to first line treatment. It's a good indication he will respond to subsequent treatment. A person usually takes up to 6 rounds of a platinum based drug like carboplatin. There are hypersensitivity issues that cause very toxic reactions after that many doses. What is more usual is a single agent. Taxotere is the chemo most studied in line two treatment. Tarceva is also a good 2nd line choice and a nice break from the cancer center since it can be taken at home by mouth. This is also a point at which he and his onc may look at the possibility of a clinical trial.

Below are a couple of links that will give you a good start to understanding better your dad's treatment moving forward.

http://cancergrace.org/lung/2010/10/04/lung-cancer-faq-2nd-line-nsclc-o… (don't miss the links at the end of this blog)
http://cancergrace.org/cancer-101/2011/11/13/an-insider’s-guide-to-the-second-opinion/
http://cancergrace.org/cancer-treatments/2012/07/28/dr-harman-on-cancer… (note there is audio as well as transcript options)

I hope this helps. Please let us know how you dad fairs and if you have remaining questions.
Janine
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lovingson

Thanks Janine for your kind words and insight. I have read some of the the links you posted and I will definitely read the others. Sometimes it just feels as though any remaining hope is lost. We're trying to stay positive and strong. Again, I appreciate your quick response and info. Best Regards.

Dr West

I'm also sorry about his recent progression but think that there's nothing especially surprising about his situation. I'm afraid it sounds to me like your expectations, or at least the range of what you might expect, weren't well-matched to the reality of what we see. Squamous NSCLC isn't particularly renowned for being slow growing -- this isn't to say that it's known for being extremely virulent and aggressive, but there isn't anything unexpected about progression being seen in the first scan after a break following first line chemo. It's exactly what you'd expect to see as often as any other outcome, and as Janine has suggested, it's a result that would lead us to look toward second line therapy.

We tend to see the highest probability of benefit from further therapy in the patients who did well with first line treatment. Good luck.

-Dr. West

certain spring

Just wanted to commiserate - it is a bad feeling, especially when your father did well with his initial chemotherapy. But it does happen, as Janine and Dr West have said. I have a squamous tumour, and when it was on the move it moved pretty fast.
Nonetheless, it's great to hear that your father is getting his tumour profiled. You say it's not common in Canada for squamous - it's not common anywhere for squamous! Most of the work on targetable mutations has been done on adenocarcinomas. The research on squamous is just beginning, and your father is part of it. Hopefully it will help his doctors to choose a treatment or a trial that will help him.
For others who may be interested, I think this is the project (in Toronto) to which lovingson is referring:
http://www.clinicaltrials.gov/ct2/show/NCT01505400
Dr West mentioned a similar project in New York in his top 5 ASCO abstracts, called Sq-Map:
http://cancergrace.org/lung/2012/05/19/my-top-5-notable-asco-2012-abstr…
Best of luck to your father.

lovingson

Thank you Dr. West for your response and well wishes. It is good to hear that he may benefit from second line treatment, if he stays strong enough to endure it. We are just hoping that with mutation testing the Drs may be able to find a more tailored therapy for his disease.

Thank you Ceratin Spring for your response and well wishes as well. I thought mutation testing was common practice for all LC cancer subsets in the US but it's good to hear that it may soon become "automatic" to do so in the near future.

I also wanted to add that this has been a life-saving website. It has provided a wealth of information from great Drs in the field of cancer as well as great input from patients and care givers alike. I would like to thanks all those involved for their time, information and caring thoughts - it has really made a difference for myself and my family.