You are a good friend--can your friend get to MD Anderson in Houston. It is considered the finest cancer institute in the world and has successes that no other institution has.
Thanks for the comments. I'll certainly pass them along.
Hi,
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.