What are my options? - 1262012

Wed, 02/05/2014 - 09:16

Hi, my name is Rizalito was dx of stage 4 nsclc adenocarcinoma in sept 2013.
Multiple pulmonary nodules with in left lung, largest is in medial left lower lobe 2.5cmx2.0cm, enlarged left hilar lymph node 1.1cmx1.7cm, multiple mediastinal lymph node, representative lymph node is the subcarinal lymph node 1.5cmx3.2cm, pre vascular lymph node1.5mmx2.7mm
Never smoke, athlete..
Told not a surgery candidate. Started chemo oct 2013, carbo/alimta. Second and third treatment delayed a week each due to low WBC. Onco start giving me neulasta shot for third to fifth.
Had a bone scan,MRI.ct scan in dec cause of some pain and new sob. MRI clear, bone scan clear, ct scan stable with very slight reduction.
November result positive for alk. Onco suggested to keep doing chemo keep xalcori as back up.
Scheduled for scan again on the 12th of this month.
Dr. plan
If stable, maintenance with alimta only or xalcori, with progression switch to xalcori.

My question is,
would you recommend going with alimta for maintenance or xalcori? Why?
Was I really not a good candidate for surgery?
Thank you very much for taking your time to read and hopefully answer my question...
Take care and god bless,

Revision log message
Created by FeedsNodeProcessor


Hi Rizalito,

Congratulations on your good response to treatment. There is evidence that ALK positive patients do particularly well on Alimta, although it's unclear whether that is because of the mutation or their non-smoking status: http://cancergrace.org/lung/2011/02/26/alimta-for-alk-rearrangment/

Regarding the question of whether to stick with a conventional maintenance treatment or switch to a targeted therapy such as Xalkori, Dr. West has said:

"the general approach has been to ride the wave of whatever treatment is both effective and well tolerated, with the extra bonus that the commercial availability of XALKORI (crizotinib) provides one more extremely promising option." - http://cancergrace.org/topic/continued-response-to-alimtaavastin-mainte…

And Dr. Weiss agreed, saying:

"My general treatment philosophy is the same as Dr. West’s. I define, “working” as both cancer controlled, and not too much side effects. As long as both conditions are met, I typically “ride the wave” when something is working."

Good luck with whichever treatment you choose.

Forum moderator

Dr West

I hate to discard a well tolerated treatment on which a patient is responding or at least demonstrating stable disease. The goal is really to get the opportunity to be treated with as many potentially beneficial treatments as possible while a person is doing well enough to tolerate these treatments well. Beyond that, there's really no evidence that there's a significant difference based on the order in which the treatments are given.

Also, for stage IV disease, as is indicated by the multiple lung nodules, surgery is not an appropriate treatment and would be extraordinarily unlikely to help at all and would most likely only be associated with the risks of surgery but no benefit.

Good luck.

-Dr. West


Hi all. Got my results from ct scan, everything is the same except for the main tumor. It went from 2.3cm to 1.7cm

My appointment with my onco will be tomorrow to discuss my next treatment plan.



Thanks for sharing the good results! Some tumor shrinkage and otherwise stable is great! As long as you're tolerating your treatment pretty well, it meets both criteria described by Dr. West and Dr. Weiss for continuing a line of therapy - effective and well-tolerated.

Wishing you continued good luck.

Forum moderator


My Dr. decided to keep me on alimta only and scan again after two months. I had my pet scan in September and bone and MRI in December. How often should I need to be doing those scans???
Thanks for the response.
Take care and god bless..


Hi Rizalito, Welcome to Grace and a Big Congratulations on the good scan.

From our FAQ section, "For most cancers, there is visible evidence of a cancer on scans such as CT scans that are done periodically during the course of a patient’s treatment." http://cancergrace.org/cancer-101/2010/09/16/cancer-101-faq-assessment-…

CT is the standard scan used to follow a person after diagnostic scans of the type you mentioned earlier. The timing depends on the biology of an individual's cancer. After a few scans you and your onc will get a feel for how often you'll need scans usually every 2 to 3 months.

This may be of interest, http://cancergrace.org/cancer-101/2012/08/29/treat-the-patient-not-the-…

I look forward to good news,

Dr West

Yes, the most recommended approach is follow up CT imaging every 2-3 cycles, usually about every 6-9 weeks, and then sometimes less frequently after that, to assess areas of visible disease over the course of treatment. There is no standard recommendation for repeat PET, bone scan, or MRI imaging.

-Dr. West