Adenocarcinoma and use of Tarceva

i'm from Italy and my father (64 years old) has lung cancer (adenocarcinoma) since june 2007 with multiple small cerebral metastasis.

He had a radioterapy cycle (all head irradiation) and 6 chemotherapy cycle (cisplatinum+vinorelbine every 21 days last on january 2008).
In febrary 2008 he had a pulmonary niggle and he was treated with heparin.
At this moment, his cerebral situation is very good (just one small metastasi) and lung situation is stationary. And pulmonary niggle is near to resolve.

Now his doctor has proposed him to take tarceva to inprove and fix the lung situation.

My questions are:
is this a correct valutation or it would be better wait for worsening ??
If there will be a progression in disease, what kind of therapy we can spend again if we uses tarceva now??
Is possible chemioterapy again after tarceva??
Is tarceva dangerous if take in conjunction with heparin?

thanks,
luca

[HeinrikMD]

Hi,
There is no clear answer to your question, only hints.
If we assume that the disease is under control and Tarceva is taken in order to delay the onset of progression, there is solid evidence that this strategy would work. A similar drug to Tarceva called Iressa has been tried in such a setting and the drug did not provide additional benefit. It is also known that Tarceva is more potent than Iressa, and hence a failure of Iressa is not equivalent to failure on Tarceva. The addition of Tarceva after chemotherapy is currently undergoing evaluation. The trials are ongoing, you could investigate if there is a center near you if you are interested. A caveat though, is that aside from Tarceva, another drug called Avastin is included in the protocol. This drug may present some issues with heparin and your father may be disqualified because of this. There is no known problem with Tarceva and heparin.
If you choose to take Tarceva if the disease progresses, then there is a clear role for Tarceva in this setting. This would be a second-line chemotherapy setting. There are other drugs that may be used, Taxotere (Docetaxel) and Alimta (Pemetrexed), but if your father is getting frail – the favored drug would be Tarceva.
There is no known contraindication to doing chemotherapy after taking Tarceva. A problem though is that there is no clear drug to use, so your concerns about what drug to use after it in the 3rd line is indeed valid. As it is, only Tarceva is being recommended for the 3rd line chemotherapy setting.  The best answer perhaps would be the other 2nd line drugs – which would be Taxotere and Alimta. But specific research to answer this question is not really available. There are studies ongoing of taking other drugs similar to Tarceva, which are orally taken, in which the usual side effects are rash and diarrhea. These drugs however are still undergoing investigation.