Tarceva and Avastin - 1251341

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alina26
Tarceva and Avastin - 1251341

Hi everyone.

My mom is 52 years old, never smoked. She was diagnosed with NSCLC Stage 4 in February 2011 she had one metastasis tumor in her brain and the main one in her right lung. In February she went under two brain surgery and one month of brain radiation therapy. For the following year she was on 3 courses of Gemzar/Carboplatin, but there was some growth and she got one metastasis in same lung.

Starting in March 2012 she has been on Tarceva 150mg, the tumor hasn't been growing, she has been having some side effects but they come and go. Between then and now she underwent 4 more courses of Carboplatin by itself.
Her recent CT scan showed that she had liquid in her right lung (pleurisy) so the doctor just suck it out with the huge syringe and injected Carboplatin directly in the affected area. The new CT scan shows that the tumor became smaller.

Now the doctor is having her take 2 weeks off from Tarceva because she had skin dryness.

For the next step the doctor wants her to take Tarceva with Avastin. Has somebody had experience with the combination of these two medicine? How did it work? My worry is that I was reading some articles and they were saying that Avastin is really good, until it works, but when it stops working the tumor starts growing faster then before.

Should we go with Avastin? Any other/better alternative?

Please keep in mind that Avastin will cost us $2,500 a month since we have no access to any sort of insurance for my mom.

Thank you.

catdander
Reply To: Tarceva and Avastin

Hi alina26, I very sorry your young mother has lung cancer. It's such a horrible disease for her and her family. You're a good daughter to look for the best for your mom. I'm certain you will find Grace an informative site.

It's good that she has responded well to treatment. I wonder if the pleurisy you speak of was in fact a pleural effusion. That would be an unfortunate complication of lung cancer that's fairly common. I've not heard of a connection between pleurisy and lung cancer. Draining it as you have described is the most common treatment. Though chemo injected directly into the pleural space doesn't sound familiar. But know I'm not a doctor and have gotten my lung cancer education here from being a member on Grace like you.
This is a link to a discussion about pleural effusions. (hopefully your mom is done with them) http://cancergrace.org/lung/2007/03/18/mpe-managment-options/

There are clinical trials that are testing the combination so there is no hard data on whether or not adding avastin is good or not. There are though side effects with avastin that must be taken into consideration.
Other drugs such as alimta are also being used with tarceva.

It sounds like your mom was given more chemo since starting tarceva. Is that true or am I reading it wrong?
Avastin is being tried in trials but not necessarily the first choice in practice. So if your mom wants to add a drug (I'd make sure she's showing signs of acquired resistance first) to tarceva, alimta is being used as well.

A clinical trial may be an option. There are some promising drugs being tested and they are paid for by the researchers.

I will ask a doctor to respond to your questions about progression. But please understand that no one can tell your mom what she should do except her and her doctors.

Janine

catdander
Reply To: Tarceva and Avastin

I was just checking back and realized more now than before that the treatment you describe seems quite different than standard of care. So while you wait for a doctor to comment it will be worth you understanding more about what common treatments look like.

At the end of each discussion or into to video there are additional links.

http://cancergrace.org/lung/2012/12/06/get-the-lead-runner-local-rx-for-...

http://cancergrace.org/lung/2010/09/18/lung-faq-ive-just-been-diagnosed-...

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

Janine

Dr West
Reply To: Tarceva and Avastin

The combination of Avastin (bevacizumab) and Tarceva (erlotinib) has been looked at in several trials and appears perhaps marginally more active than Tarceva alone in some trials, but it really hasn't proven to be significantly superior overall. It is not the standard of care at this time, particularly in patients who have already been on prior therapies, and even if it would arguably be a reasonable thing to do, I think very, very few lung cancer experts would consider it valuable enough to pay for Avastin out of pocket.

The concept that stopping Avastin leads to accelerated progression is a speculative idea, but the evidence does not really support the conclusion that in lung cancer patients do worse in terms of survival after they have been on Avastin. Overall, there are many speculative ideas out there, and a much smaller subset of ideas actually have real evidence to support them. There isn't good evidence that stopping Avastin leads to worse outcomes than if it hadn't been started at all -- certainly not in lung cancer.

Directly injecting chemotherapy into the chest/pleural cavity is certainly an idea that has been tried here and there, but it's also definitely not considered a standard of care or particularly well studied treatment approach for lung cancer.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Medical Oncologist
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

certain spring
Reply To: Tarceva and Avastin

Alina26, may I ask why - given that your mother has been stable on Tarceva - her doctor wants to add another drug? The skin dryness is very common with Tarceva as I'm sure you know. We have a lot of helpful advice on GRACE about how to deal with it. Very best.

flovesee
Reply To: Tarceva and Avastin

Hello, I am so sorry to hear about your mom. I am in a similar situation as I have stage 4 adenocarcinoma (only in my lungs). I just finished 6 cycles of carbo, paclitaxel, and avastin. Since your mom's mets is in her lung, she may be interested to know about Radiofrequency ablation. This is something I am excited about and I am just waiting for my next pet scan to send to Cedars Sinai hospital in LA. You should seriously check this out, it may work for your mom. Take care.

http://www.cedars-sinai.edu/Patients/Programs-and-Services/Imaging-Cente...

Please note, my onc did nothing to let me know if this was even out there, and was not inclined to steer me there even for a consult. She wants to keep me on avastin...forever? To me it is worth everything to find out, even if I have to do it on my own. Maybe I will have to be on avastin, but I will know I turned over every stone to find an answer.

catdander
Reply To: Tarceva and Avastin

flovesee, I hope you will do alright no matter the decisions made. I just wanted to add another couple of perspectives to the discussion. I understand that for those with minimal metastatic disease there is hope, small as it is (I have it for my husband) for long term survival. It also has caused me to cautiously look at possible next steps.

Dr. West and Weiss discuss ablation in the post I've linked to below, Dr. West states their view as,

"Part of our lack of enthusiasm has been that when focal ablative treatment is really indicated, one of the many focal radiation approaches is often available to do the job. In the lung in particular, RFA has been associated with some significant risks of lung collapse, nasty inflammation, and infections, which has also been a factor in why many lung cancer doctors have not favored it over other local therapy strategies."

http://cancergrace.org/lung/topic/radiofrequency-ablation/

Not trying to say it's not appropriate in your case, I have no knowledge of it. Just want everyone to have as much input as possible moving forward.

The very best of luck,
Janine
forum moderator

Dr West
Reply To: Tarceva and Avastin

I would just say that many knowledgeable, thoughtful docs wouldn't refer someone for RFA for a lung cancer because it has no established role right now. It certainly might be a good choice in an individual case, but it isn't part of any standards of care in managing lung cancer, and sometimes we see these services marketed directly to patients in a misleading way that may suggest that this will be helpful in situations in which this is actually very unlikely.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Medical Oncologist
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education