Stage IV Lung Cancer - 1256421

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suemac
Stage IV Lung Cancer - 1256421

Hello, my brother-in-law was diagnosed last year with stage IV lung cancer with mets to his brain. He underwent chemo and radiation therapy and completed his second round of radiation therapy in March, 2013. He had a PET scan on 5/9 which revealed a mass on his kidney and spots in his brain. He was told he has six months to live. They are considering alternative treatments - do you know of anything? I am afraid they will go to Mexico or something. Thanks.

cards7up
Reply To: Stage IV Lung Cancer

I'm not a doctor or one of the moderators but a LC patient. Do you know what type of LC he has? A PET scan is not used on the brain, it should be an MRI. Has he ever gotten a second opinion? This is the way I would go befoe I'd listen to a prognosis of 6 months. How is he doing overall?
Take care, Judy

catdander
Reply To: Stage IV Lung Cancer

Hi suemac and welcome to Grace. I'm very sorry to know your brother in law is going through this awful situation. Judy is right that the PET scan didn't reveal anything news about the brain; pets measure cellular activity, since the brain and heart are constantly active it would be difficult to impossible to tell what is going on. He probably had an mri or CT scan on his brain.

It sounds like he progressed through first line treatment. It is unlikely that further "typical" chemo would be helpful in someone who did not respond to it the first time around. However there are other options to explore if he is physically able to withstand more treatment. Has he been tested for mutations EGFR, ALK, KRAS, ROS1? There are treatment options for those who have these mutations.
He may be a candidate for a trial for which there are promising options.

Below are a few posts that maybe helpful. I will also contact a doctor for input.

All the best,
Janine

explains several excellent reasons why 2nd opinions maybe a good option including trials, http://cancergrace.org/cancer-101/2011/11/13/an-insider%E2%80%99s-guide-...

http://cancergrace.org/lung/2010/10/10/overview-of-molecular-markers-in-...

http://cancergrace.org/lung/2010/10/04/lung-cancer-faq-2nd-line-nsclc-op...

Dr West
Reply To: Stage IV Lung Cancer

I'm sorry things haven't gone better for him. Unfortunately, some lung cancers progress through first line treatment, and those tend to not respond well to subsequent therapies. As Janine suggested, there are some molecular markers, such as the ones she mentioned, that can be associated with a very good response to "targeted" therapies, like Tarceva (erlotinib) or XALKORI (crizotinib). So if those haven't been tested for, it may be worth checking the biopsy matieral for these mutations.

Other chemo can certainly be tried, but they tend to be less effective than the first line therapy, so we can't be too optimistic about how they'll perform for someone whose cancer has progressed through first line treatment.

As for expected survival, the best we can do is make reasonably intelligent guesses, but we don't really know with any precision.

-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

Dr Sanborn
Reply To: Stage IV Lung Cancer

Hello Suemac--

I am sorry to hear about your brother in law. This story is one that will be difficult to comment on, as many things are not clear here. First of all, as Judy pointed out, the type of lung cancer has significant influence not only on type of treatment options that may be available to consider, but also on prognosis. Small cell lung cancer is very different than adenocarcinoma, or another type of non-small cell lung cancer, for instance.
Another major factor that can influence what types of therapies may or may not be feasible to consider is how healthy and functional a person is overall. If a person is needing to rest more than half of their day, many treatments may become too toxic and not be beneficial to help someone live longer or to feel better.
The timeline and the treatments also factor in. If a person just finished their chemotherapy and the cancer grew straight through it, as Janine mentioned, other chemotherapy drugs are generally not as helpful (although they still can be beneficial, and I have seen patients respond to second-line treatment when they did not respond to first-line treatment). It sounds like treatment started a year ago, which could mean that the cancer progressed either on maintenance treatment or after a break. That is a bit different than disease progressing immediately.
Another issue is where the radiation was given. If there have been two rounds of radiation to the brain (again depending on what type of radiation), and more progression now, then things may be getting difficult from that standpoint.
I think that it will be hard to give much more perspective, when there are many open questions about this situation. Perhaps understanding more of the specifics of the situation will help you, or perhaps these points above may help with your conversations with him. Take care--