Thanks for your response. To clarify: his treatment was adjunctive. At the time they saw no sign of cancer outside the lung. Now, however, after 4 rounds of chemotherapy the disease seems to have spread during treatment with taxotere and cisplatin: it's now in the liver, bones and adrenal glands. His original tumor was EGFR positive that is why Tarceva came up as a viable second step. The doctors are now hestiant to give it to him, though, because they are not sure if the problems caused by his bone mets could handle treatment by Tarceva. Is Tarceva not recommended for patients with bone mets? From what I'm reading it seems like one of the only things that could help him at this point. What do you think?
Thanks so much for your help.
Hi,
I think you need to clarify the indication for the chemotherapy. If it was given after the surgery - this is usually adjunctive therapy (meaning all evidence of disease has been removed), in order to lower the odds of a recurrence.
When the words first-line and second-line are used- this is usually in the setting of known (and usually measurable) disease. So if the liver lesion represents cancer - we are looking at first-line chemotherapy for advanced/metastatic disease. This means that the chemotherapy that would likely be recommended would be conventional cytotoxic chemotherapy with or without avastin.
Drugs like Tarceva do have known benefit in the 2nd-line setting. Whether it is better than other 2nd line agents is uncertain. There are centers who perform analysis of the tumor tissue for specific mutations that may favor treatment with Tarceva. The problem though, is that the evidence is not robust enough to make a compelling case for such testing. The decision may likely be settled by the side-effect profile of the agents, and prior use of drugs that may have cross-resistance with 2nd line agents.
Thanks very much for your response. I am trying to stay positive that the news we get from the CT scan is not devastating. Just in case it is, can you recommend or let me know what is the recommended next step when the first line of chemotherapy does not work? Is there another drug combination they try? How about the drugs Iressa or Tarceva? Would those be helpful in a case like my fathers?
Thanks again for your help.
Hi,
You are correct that the chemotherapy is designed to control progression and transfer of the disease to other organs. In theory, the chemotherapy can reduce the odds of disease progressing or in your father's case, the odds of the disease coming back. However, it does not afford 100% protection, so your suspicion that it may represent cancer is valid.
Since he was a surgical candidate, he has a good chance of cure. If there was only a single lesion in the liver - then it is less likely to represent cancer. The CT scan would help evaluate the area. Some centers have other scans like PET, which would estimate not just appearance, but metabolic activity as an index of malignancy likelihood.
Stay positive.