Stay on Avistan or not - 1253632

Sun, 02/10/2013 - 19:03

Am currently receiving Carboplatin, Taxol and Avistan (6 rounds) in addition to radiation therapy for nsclc that metastasized from lower left lobe (1b) to hilar lymph node 18 month after initial treatment. They radiated a area the size of a baseball. My doctor initially said that you technically stay on Avistan "forever" I have read articles going both ways (some unsettling). I see many are ned with chemo and radiation and no mention of Avistan forever. If not a maintenance drug does Avistan have a initial purpose for the first 6 treatments? And longer?

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Dr West

There is evidence for Avastin (bevacizumab) to be continued after progression for colorectal cancer, but that's not the general practice in lung cancer. Moreover, there is some risk that Avastin can be associated with complications if given along with radiation for lung cancer, sometimes even if they aren't given at the same time. Avastin has a role for metastatic NSCLC in combination with chemotherapy as first line therapy for 4-6 cycles, then potentially continuing it in the maintenance setting until there is evidence of progression, but there is no evidence that it provides any value in lung cancer after progression, and that isn't the standard approach that is typically pursued for lung cancer.

-Dr. West

koal

What should decide to stay on Avastin (for maintenance) after the first line therapy is completed (there might not be progression)? Would the recurrence at 18 months be any factor?

Dr West

Truthfully, that's just not known. There's no good evidence that the Avastin adds any significant benefit to maintenance therapy.

-Dr. West

koal

Dr. West,
I have been put on Avistan along with Carboplatin and Taxol (2 treatments thus far). But I technically do not have a solid tumor. I did initially and it was Cyberknifed. Now a Hilar lymph node that has lit up has been radiated so technically there is nothing there at this point. Is Avistan warranted with the Carboplatin and Taxol at this point? Thank you.

Dr West

Just like when someone has a lung cancer that spreads to the bone, it's still lung cancer and not bone cancer, someone who has a lung cancer will always be considered as someone with a solid tumor. That's the case whether there's evidence of the cancer visible or not. So you'd still be considered as someone with a solid tumor, even if it's without evidence of disease right now.

It's reasonable to continue on maintenance therapy that may or may not include Avastin when there's no evidence of disease right now. I think the leading experts would really be split on whether it is clearly beneficial to continue on maintenance therapy when there's no evidence of disease, and then they'd be split again on whether to include Avastin or not. I personally don't tend to favor maintenance therapy when there's no evidence of disease visible at the time, and I'd be even less inclined to include Avastin, given that it could be a long time before there's a need for more treatment, whether the person continues on treatment or not. And it may well be that the person can do every bit as well by just resuming treatment again when the cancer becomes visible.

-Dr. West