A good friend was diagnosed with adenocarcinoma of the right lung at the end of Dec 2007. An mri this week shows 7 tumors in the brain. She has not started any chemo/radiation yet. She is 52 and in good health. I lost a brother to a brain tumor so understand the severity of the mets. I'm doing research as quickly as I can to help she and her husband make an informed decision about what to do...if anything. The local drs are recommending 4 weeks of full brain radiation followed by tarceva. Prior to the finding the mets, they were planning 6 weeks of radiation to the right lung in combination with etoposide and cisplatin.
I'd appreciate any feedback. My thanks in advance to all responses....sue
Try to find out what areas of the brain are affected and what kind of functional loss would be expected.
Metastasis to the brain is indeed particularly problematic as they are associated with poor survival. dealing with the brain with local therapy (radiation) is indeed the first step.
If the patient improves with the radiation, or maintains adequate strength or performance status(sufficient strength is usually defined as able to remain up and about at least half of the waking hours), you may wish to discuss other options aside from tarceva - such as the original plan of cisplatin and etoposide. This is because there is a known benefit for these drugs in terms of survival when used as first option among good performance status patients.
There is evidence to suggest that women with minimum (less than a hundred cigarettes total lifetime smoked) to nil smoking history and with adenocarcinoma variety seem to respond pretty well to tarceva. This evidence however is still waiting validation. Some centers perform genetic testing to check for mutations that seem to predict response with this medication. Tarceva has a different side-effect profile than conventional chemotherapy - generally milder/less life threatening complications and seems to work well in poor performance status patients.
In general though, plans change depending on how well the cancer responds and the patient tolerates treatment. Keep an open mind and know your options.
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