Dear Dr. West,
My mother was an 85 yo Asian, non-smoker, who had NSCLC and was positive for EGFR and c-met mutations. She did well on Tarceva for 2 years then showed progression. In waiting for a clinical trial to begin, she did 6 cycles of Alimta then 2 or 3 cycles of Sutent. When she had her MRI as part of the screening process for clinical trial, she showed too numerous to count brain metastases. She was asymptomatic. We were told that WBR was her only choice and that it would extend her life. We did what was recommended and at her next scan, the brain metastases was gone but she was shown to have leptomeningeal involvement. That's when I found your discussion and the article about pulsitile dosing of Tarceva on this site and her oncologist agreed to try it for the leptomeningeal disease. Her next two MRI's were negative. The leptomeningeal disease was gone! The whole family feels that the WBR was the worse choice that we could have made for Mom. We know that Tarceva is a small molecule, TKI and that it can pass through the blood-brain barrier. My question is; For people who are EGFR positive, would rechallenging with Tarceva (with or without pulsitile dosing) have worked just as effectively on brain metastases as WBR? Are there any articles you could refer to? Thank you. This answer may help someone else.