Stage? Will Tarceva really help?

My 77 year old dad was taken to hospital with chest and rib pain. He had lost 12 kilos in two months. There were no symptoms like coughing. A CT scan revealed a 86 x 75 x 72 mm tumor. The report said: "It extends from the level of superior border of aortic arch upto the aortic valve inferiorly and abuts the aortic arch, main pulmonary trunk, left pulmonary artery. No calcific or necrotic areas are seen within". A followup needle biopsy. Part of the biopsy report read "FNAC smears from lung mass showing features of a poorly differentiated carcinoma (non small cell).". The oncologist said my Dad has advanced stage lung cancer and is not a candidate for chemo, surgery or radiation. They put him on Tarceva and morphine sulphate 10 mgs/4 hours. Tarceva had such serious side effects (bad mouth sores) that it affected his food intake. He is able to take only liquids anyway.
His pain is so intense that the current dosage of morphine gives limited relief. He cannot walk without support and we are looking at palliative care in Bangalore. My question is "Will Tarceva help him?".
Thanks.
Geetha

[Kamal S Saini, MD, MRCP (UK), DM]

Hi Geetha,
Modern oncology has much to offer your father, who has locally advanced non small cell lung cancer. At the very least, he should get effective pain relief. Also, we can evaluate him for additional therapy. Radiation, if technically feasible in his case, may provide good palliation and pain relief. Has a PET CT been done? Has the disease spread beyond the lungs?
Tarceva has modest efficacy in lung cancer, especially among western populations where most studies were conducted. It is somewhat more active in Asians, women, never-smokers, and in certain histological subtypes.
Bangalore has many world class oncology centers, and you may consult any of them for good care.
All the best, and God Bless!