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Forum Name: Lung Cancer

Question: Question on Treatment Plan


 francesbean - Fri Jan 20, 2006 1:41 pm

Dear doctors,

Foremost, I am grateful to have found this site. I've been scouring the internet for days for some expert's opinion.

Below is my dad's most recent CT Report:
[quote]Comparison made to a previous study dated Sept. 27, 2005 again shows the multiple pulmonary nodules in the right lung base, some of which are about the hemidiaphragm showing mild interval progression in size. The largest measures 2.1 x 2.1 cm, (previously, 1.6 x 2.0). The tiny subcentimeter nodules in the right middle lobe are stable in size and number. The hyperdense / enhancing pleural based nodular density in the right apex is unchanged in size and appearance. A new pleural based pulmonary nodule is now demonstrated in the right apex measuring 1.2 x 1.3 cm.

The lobulated large anterior mediastinal mass with punctate calcifications is slightly bigger in size measuring 6.2 x 4.7 cm. (previously 6.0 x 4.2 cm). The marginal to small-sized lymph nodes in the prevascular space and AP window are unchanged. Small sized lymph nodes in the right hilum are the same. A small subcarinal lymph node is now noted.

Emphysematous changes in both upper lung fields are stationary. The atelectasis in the superior segment of the lower right lobe has slightly progressed.

There is slight progression in the pleural nodularity in the right posteromedial region. No pleural efflusion.

IMPRESSION:
OVERALL FINDINGS ARE INDICATIVE OF MILD DISEASE PROGRESSION COMPARED TO THE PREVIOUS STUDY DATED SEPTEMBER 27, 2005.[/quote]


The onc explains that the progression might be because he has stopped taking Tarceva twice for two weeks each because of infections. The total of 1 month without Tarceva (From Oct. to Present) might have caused the progression.

She recommends Tarceva for another three months. Do you think this a proper prescription? Seeing as his main tumor grew about .2cm to .5cm, and his right nodule grew about .5cm x .1cm, and a new nodule measuring 1.2cm x 1.3 cm popped up.

Would you accept this treatment plan? I am confused. Thanks so much, your opinions are very much valued and I am always grateful.
 Dr. A. De la Guerra - Thu Feb 16, 2006 5:26 pm

User avatar Hi francesbean,

Sorry for not replying earlier. At present, preferred first-line chemotherapy for patients with IIIB NSCLC are platinum-containing combined regimens. Docetaxel (Taxotere) plus Carboplatin have demonstrated to be effective as first-line therapy; as well Taxotere extends survival among patients with disease progression after platinum-based chemotherapy, and is also indicated alone as second-line treatment.

Unfortunately, few treatment options can be offered to patients after failure of first and second-line therapies. In such cases, some patients could benefit from third-line therapy. Erlotinib (Tarceva), a new drug approved for third-line treatment (unless a patient has already been treated with it, since it is also approved as second-line treatment), can prolong survival in patients for whom standard chemotherapy was no longer working.

Another valid option is best supportive care (called palliation). The purpose of supportive care is to identify and resolve problems related to the comfort and support of the patient as they come up so the symptoms can be minimize and the patient can carry on as many of their prior activities as possible. This option is commonly used for patients who would not benefit from, or are not able to tolerate further chemotherapy. It is also an option for patients who choose not to undergo anti-tumor treatment.

About your concerns on whether to accept or not another 3 months on Tarceva, it depends on many aspects. Two of the most important factors needed to decide the right treatment are the stage and the performance status of the patient (general health status). For patients whose cancer has progressed, performance status is a decisive issue to make the best choice. For patients who need help caring for them and are in bed greater than 50% of their waking hours due to ill health, best supportive care is generally recommended rather than chemotherapy or targeted therapy (Tarceva). This is because the worse the performance status, the more likely it is that patients will have significant complications during treatment, and are less likely to gain improved survival.

Because circumstances, aspirations, and life choices are different from one patient to another, the choice to have best supportive care rather than Tarceva is an individual decision that your father should discuss with his love ones and the oncologist. His personal situation is unique and the outcome of his choices may be similar to or very different from what others had experienced. Sorry to say but there is no one right answer applicable to every patient.

Hope you find the information useful.

I wish luck to you and your Dad,

Dr. Alberto de la Guerra.
 francesbean - Thu Mar 02, 2006 2:44 pm

Hi Dr. de la Guerra,

Thanks so much for the valuable and informative response, I greatly appreciate it.

My dad is still taking Tarceva as his second-line after a cocktail of taxotere-carbo has kept the tumors stable. He will again be scanned in April. Please note that while previously on Tarceva for 3 months (on and off) he has had mild progression.

He's pretty much feeling okay, functioning normally but napping a lot. He is less active than before as he has stopped working.

Again, thank you so much.

Regards,
Frances
 Dr. A. De la Guerra - Tue Mar 07, 2006 8:35 pm

User avatar Hi francesbean,

I’m glad to know your dad is feeling all right. About your concerns on mild disease progression, remember that Tarceva prolongs survival and improves quality of life, but unfortunately can not cure cancer. I think Tarceva is a good option, but if both of you have doubts about it, and as long as the disease stays stable or shows only mild progression, and your dad maintains a good general health, he might benefit from newer approaches to lung cancer treatment, within a clinical trial.

I will wait until April for the results.

Good luck,

Dr. Alberto de la Guerra.

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