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This is my first post on Grace. My sister has NSLC stage IV metastatic to brain. EGFR mutation positive. She finished 4 rounds of chemo 4 weeks ago. Started Tarceva maintenance 7 days ago. CAT one week ago showed chemo had shrunk lung tumors (15 in left lung) slightly but still metabolic activity. After 1 week on Tarceva, pain in left side of back is increasing rapidly to the point of needing morphine again like before the chemo. How long does it take for Tarceva to start working usually? By day 7-8? Or can this drug take longer to take effect? Or does it vary a lot from person to person? We were expecting rash but not such a drastic worsening of her pain. Thanks.
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Reply # - March 5, 2015, 04:44 PM
Among patients with an EGFR
Among patients with an EGFR mutation (who tend to be very sensitive to EGFR inhibitors and often have an excellent response), some people feel better within days, some take weeks to months, but you shouldn't feel much worse on treatment. That's a red flag that something's amiss. It may or may not be disease progression vs. some other process, perhaps something like a collapsed vertebra (which may or may not be related to cancer), but it's always worth keeping in good contact with her doctor if symptoms are getting worse fast. Her oncologist can help triage and determine what follow-up and/or further workup is appropriate.
Good luck.
-Dr. West
Reply # - March 5, 2015, 07:32 PM
Thank you Dr. West for your
Thank you Dr. West for your helpful response. It makes sense that she shouldn't feel much worse on treatment. She ended up needing to go to the ER and had a thoracentisis of 2 liters. We don't know how long the fluid was building up after her last chemo 4 weeks ago and whether it was already building before the Tarceva. She only seems to get uncomfortable after 1.5 liters when she had this issue prior to chemo. It looks like we will have to wait and see what happens and stay in touch with her doctor over the next week. We really hope that there is still a chance Tarceva will work.