momloveselvis
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My mom got her new CT report today and it says lung tumor "grew significantly" as well as the met to adrenal gland. She has been on alimta maintenance. She has nsclc adenocarcinoma with no mutations. She is supposed to have her next alimta treatment next Wed. one day before she sees her Dr.
In general, would it be likely for her to be advised no more chemo, or are there other things they still try even with no mutations? She still feels good, except for quite fatigued. This is the first bad news since first starting treatment in April with carbo/alimta for lung, lymph, and adrenal and WBR for brain mets. She's had a great 7 months, seems we're making a turn :(
Thanks,
Tonya
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Reply # - November 20, 2014, 09:02 PM
HI Tonya, Welcome to Grace.
HI Tonya, Welcome to Grace. I'm very sorry your mom has progressed on maintenance therapy.
Usually when progression is found while on chemo treatment it is stopped. Though there are choices that may be of benefit such as tarceva (even if she has no mutation) and taxotere have shown efficacy in people in 2nd line treatment. Gemzar and navelbine are also fairly commonly used. More on the subject can be found here, http://cancergrace.org/lung/2010/10/04/lung-cancer-faq-2nd-line-nsclc-o…
Immunotherapies have shown promise in clinical trials but are still under investigation. Depending on where your mom is she may be a candidate for a clinical trial. Following is a link to the first of 4 podcasts on the subject of clinical trials, http://cancergrace.org/cancer-101/2013/01/06/clin-trials-ramalingam-pt-…
We have a large collection of blog posts and videos. Our search engine is the best way to find more info and don't hesitate to ask when you have questions for which you can't find answers.
I hope this is helpful and the best to your mom,
Janine
Reply # - November 20, 2014, 09:55 PM
Tonya,
Tonya,
I'm sorry to hear of her progression.
Usually we like to review the results of recent CT scans before pursuing the next cycle of chemo, primarily for situations such as this, where there is progression. As Janine noted and is detailed in the first link, there are some subsequent treatment options, and usually one of these options or perhaps a promising clinical trial approach would be favored over treating with one more cycle that could only be expected to be associated with further progression and side effects from treatment. Accordingly, it would be very appropriate to ask her oncologist about the value of changing the plan rather than proceeding with more of the same chemo, now that you have evidence it isn't working as effectively as you'd hope.
Good luck.
-Dr. West
Reply # - November 26, 2014, 08:52 PM
Dr. West,
Dr. West,
I just finished reading many of your articles related to 2nd line treatment, and choosing Tarceva vs. Taxotere. My mom's oncologist cancelled her alimta infusion today as her tumors have all grown. He has ordered the Veristrat test. He told her that her best options are either Tarceva or Taxotere. He said that even though she does not have the mutation he would recommend Tarceva over the Taxotere, if the test shows that it may help. For your info, she was a heavy smoker for 40-50 years, and although cut down and quit in the last few years, may or may not be still sneaking one here and there. She had some shrinkage and or stable with her 4 cycles of carbo/alimta. She had alimta every 3 weeks and completed 4 before now finding progression.
If I read correctly, with her smoking history and the fact that she responded fairly well to her 1st line treatment, you would most likely advise trying Taxotere over the Tarceva? I wonder what her Dr. is thinking in feeling the opposite. I will make sure he is aware of her true smoking history.
My mom is also weighing the option of doing nothing and living out her days. I do see her point, as if she got much more fatigued or weak I think she would become bedridden. She is scared of the side effects of both these drugs.
Tonya
Reply # - November 26, 2014, 09:28 PM
Hi Tonya,
Hi Tonya,
Both those drugs are FDA approved for second line treatment of NSCLC, regardless of smoking history or EGFR mutation status. Since either is a good choice, it seems reasonable for your oncologist to prefer Tarceva if the Veristrat test indicates it may help, as it provides a rationale for choosing one over the other. It wouldn't hurt to ask if that's the only reason he would choose Tarceva; perhaps he feels that Taxotere would be particularly difficult for your mom, based on his knowledge of her overall health.
JimC
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