Dear Dr. West & team,
My mom (aged 74) was diagnosed with Stage 4, Adeno 19 months ago. The tumors were localized on the left lung along with malignant pleural effusion. She went through VATS & Pleurodesis. She was EGFR & ALK negative. She received 6 rounds of chemo (Carbo & Alimta), followed by Alimta maintenance for around 11 months now. Her performance status is excellent.
Her CT scans have indicated stable, localized disease though there are 1 or 2 lymph nodes that seem to be important to watch, including an enlarged mediastinal lymph node. Today her 3 month CT scan shows she remains stable and the main lymph node appears to be stable with a minor / non-significant reduction in size. What are some options she should consider? Is Tarceva an option that makes sense?
Thank you very much for your help.
Semone
Reply # - September 23, 2015, 06:31 AM
Hi Semone,
Hi Semone,
Congratulations to your mom on her good response to treatment! Stable stage IV disease for 19 months is a good result, and it's great that she's feeling well also.
From what you've written it doesn't appear that there is any evidence of progression, so if she's tolerating Alimta well I don't see much reason to change therapy at this time. As Dr. West pointed out in one of your previous threads, Taxotere (Docetaxel) or Tarceva would be good options if progression is noted, but normally you want to get as much benefit from each agent as possible. Right now she's doing well on Alimta, and I think most oncologists would continue it until her symptoms and/or scans suggest a change is necessary.
JimC
Forum moderator
Reply # - September 23, 2015, 10:22 PM
Jim,
Jim,
Thank you so very much, as always, for your detailed response. It is indeed a huge blessing that she is stable.
I am curious as to whether the following statement on her CT scan represents progression, "Nodular thickening of left oblique fissure is noted. Bilateral apical pleural thickening is seen."
Regards,
Semone
Reply # - September 24, 2015, 07:19 AM
Hi Semone,
Hi Semone,
Such thickening is not very strong evidence of progression, as it can also be caused by inflammation or infection, and it's possible that it simply wasn't noted on prior reports. As Dr. West has said:
"[N]ot being noted isn't the same as not being present. ... this is common enough that it may not be mentioned by every radiologist, so it wouldn't be correct to presume that it is a new finding because it failed to be mentioned in a prior report. It would need to be specifically mentioned in the report that this thickening is new and was not seen in the prior CT, and even then, recurrent lung cancer wouldn't leap to the top of my list." - http://cancergrace.org/forums/index.php?topic=6602.msg46410#msg46410
You'd probably have to see better evidence of progression before you would consider a change of treatment.
JimC
Forum moderator
Reply # - September 24, 2015, 08:13 AM
Got it. Thank you for
Got it. Thank you for providing clarity an support in such a prompt and compassionate way. I'm deeply grateful.