Hello,
My mum has NSCLC, diagnosed last June, following 5 years of chronic lung infections.
She has left lung, adenocarcinoma, stage 4.
Lymph node involvement, and a ground glass nodules in right lung.
She had attempted surgery to remove the tumour, but this was abandoned due to the location of the tumour and the lymph node involvement.
She completed 5 out of 6 rounds of Taxol / Carboplatin every 3 weeks, which would take 6 hours.
The day of round 4 Chemo, a CT scan showed that her tumours had shrunk slightly & stabilised
Her last treatment was delayed due to peripheral neuropathy.
She received a CT scan last week, this showed the tumour was still stable with no change, However, there is a new spot on the left lung that need to be Biopsied next week.
Her doctor spoke about using Avastin as she did not qualify for Tarceva.
If her new spot tests positive, will she receive a new Chemotherapy?
Will this delay the possibility of her taking Avastin for the existing tumour?
Or can a new Chemotherapy be combined with Avastin?
If you can suggest anything else we should ask, please can you let me know.
Thank you!
Reply # - January 22, 2013, 06:22 AM
Reply To: Stage IV NSCLC, 5 rounds of Chemo for Tumour, new Spot
I'm sorry to hear about the new nodule. In the event of progression, there are a few treatments that have an established benefit in previously treated patients with advanced NSCLC. These include Taxotere (docetaxel), Tarceva (erlotinib), and Alimta (pemetrexed), the last being only for patients with non-squamous NSCLC. Here's a link with some further discussion:
http://cancergrace.org/lung/2010/10/04/lung-cancer-faq-2nd-line-nsclc-o…
You'll note that Tarceva is on that list. It's incorrect that a person doesn't qualify for it. Even if she doesn't have an EGFR mutation, which is probably what her oncologist is referring to, the evidence overall indicates that there is a benefit with it that is comparable to that seen with chemotherapy.
http://cancergrace.org/lung/2010/09/21/benefit-from-egfr-tki-if-egfr-wt/
There isn't a clear role for Avastin (bevacizumab). It's reasonable to add, and it's almost always given concurrent with chemotherapy in lung cancer. However, we don't have any data to say whether adding Avastin to a regimen on which someone is progressing would be better than switching to a different regimen. I think most experts would only favor this if there was just very limited progression, though it sounds like that's the case here.
Good luck.
-Dr. West