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Medical Forum / Diseases and Disorders / Cancer / March 2006Prognosis / Advice please - lung adenocarcinoma with bone mets
Hi, My father has recently been diagnosed with lung adenocarcinoma, with metastatis to his pelvis, spine, shoulder and ribs. He is going to have a couple of RT sessions for his spine to alleviate the pain (which is now his only symptom). He has lost a lot of weight pre-diagnosis, which was not helped by being diagnosed with diabetes a few months ago. Him and Mum saw the oncologist for the first time today. She gave a prognosis of "a few months", and recommended the RT for pain relief. Apparently, they are not going to attempt to treat the lung cancer (possibly a futile thing to try?) - but as Dad is asymptomatic in that respect, that's understandable. As I see it, this would be classified as a Stage IV cancer? He has also been given the option of palliative chemo, with the drugs Carboplatin and Gemcitabine - I do not know the suggested dose or frequency. I am trying to find out more about the likely impact that the chemo would have on his Quality of Life, and prognosis. I would also appreciate any information on what I can expect in the latter stages of the disease - especially pertaining to pain, disability, loss of dignity - as well as the biological underpinnings for this. I realise that statistics can never predict the outcome of an individual, and whilst not medically trained, I am scientifically minded (Chemist by qualification). Any useful links or advice that would help me present my parents with more information upon which to base their decision vis a vis chemo would be particularly appreciated. Thanks, Patrick > Any useful links or advice that would help me present my parents with more > information upon which to base their decision vis a vis chemo would be [quoted text clipped - 3 lines] > > Patrick Sorry to hear about your Dad, Do you live in the US,? I ask since Dana Reeves passed away, all the cable shows have been having lung cancer experts on. My Mom and Father in law died of Lung cancer, my mom died within 6 weeks of diagnosis, my father in law lived 6 months. Have you gone with your parents to the oncologist? From you posting it is clear that treatment is palliative. The goal being would be to keep your father comfortable and functional as long as possible. The American Lung Association has call line http://www.lungusa.org/site/apps/s/link.asp?c=dvLUK9O0E&b=473643 and fAQs http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=35427 Another overview is http://en.wikipedia.org/wiki/Lung_cancer http://www.lungcanceronline.org/ Best of luck and sorry to hear you news. Alex > Sorry to hear about your Dad, Do you live in the US,? I ask since Dana > Reeves passed away, all the cable shows have been having lung cancer [quoted text clipped - 12 lines] > > Best of luck and sorry to hear you news. Alex Alex, Thanks for the speedy response. I live in the UK. I offered to go with my parents to the appointment, but they decided to go by themselves, which I respect - I live about 2 hours drive away, and have 2 kids under two to look after, so that's not a surprising decision. Sorry for your losses. Patrick >> Best of luck and sorry to hear you news. Alex > [quoted text clipped - 10 lines] > > Patrick One thing I remember (which was 1990 and 1993) that once we heard lung cancer, it was overwhelming. There was a short window of opportunity to do something special ( like a trip , family get together or a nice family portrait) which if you don't act upon you can miss. I think you did the right thing not pushing the issue of going to the oncologist which is respectful, but I would advise if there is any unfinished business to do it sooner than later. First your Dad has to be comfortable. Sounds like the UK has good support systems in place encourage your parents to use them, sometimes it is hard to accept help. > One thing I remember (which was 1990 and 1993) that once we heard lung > cancer, it was overwhelming. There was a short window of opportunity to [quoted text clipped - 5 lines] > the UK has good support systems in place encourage your parents to use > them, sometimes it is hard to accept help. We are trying to get as much family time in as we can at the moment, and are hoping to have a joint birthday over Easter (Dad, me and my little son - the three generations of men in the family), so I just hope that he is well enough to enjoy that. Of course, that also gives us a great excuse to get the cameras out without reminding him too often of his prognosis! ;-) Patrick > My father has recently been diagnosed with lung adenocarcinoma, with > metastatis to his pelvis, spine, shoulder and ribs. [quoted text clipped - 3 lines] > information upon which to base their decision vis a vis chemo would be > particularly appreciated. Hello Patrick, Your father's cancer is advanced. There have been some (posters) here with spinal involvement, but we've not heard back from most of them. Here's the combo that was suggested for your father. <http://www.cancerbacup.org.uk/Treatments/Chemotherapy/Combinationregimes/GemCarb oregime>. UK webpage Perhaps the onc (or Steph) would share the most common side effects. It shows the frequency, for the combo, but best check with his oncologist, in case it varies. Cancer Backup also has a helpline. I'm sure others here have mentioned that it's been helpful, if that's where your father is. The other option is to put his affairs in order (including arrangements with MacMillan), then getting on with his life, visiting with grandchildren, travelling if he's well enough, finishing off projects, (insert here whatever he loves or wants to do) and seeing the doctor as new things come up. The following are from Steph, seasoned clinical oncologist, trained in UK, which I think, is where you are, (based on your email address), but practising, for many years, in British Columbia, BC. Canada. "For every 100 cancers cured, surgery cures about 50, radiotherapy about 40 and chemotherapy at best 10. There are some relatively rare advanced metastatic cancers which can be cured by chemo - testicular germ cell cancer, - high and medium grade non-Hodgkin's lymphoma, - some childhood cancers, but that's it. Chemotherapy is vastly overblown. It is a valuable adjuvant treatment after surgery for some common cancers, but none of the common epithelial cancers (breast, stomach, colon, rectum, lung, prostate, etc, ) can be cured by chemotherapy. And there is nothing on the horizon to suggest that that is going to change anytime soon" We also have a tool from Steph about treatment decisions (which was archived much earlier) - the link on that post, leads to his original post. (I changed his a bit by adding CEA, so people did not look at it and think it only applied to breast or prostate, because it really applies to any cancer, keeping in mind, of course, the above, about which cancers can be cured with chemotherapy). Steph's "Questions to Ask" http://tinyurl.com/4akk6 I think these are all important tools, for cancer patients, when considering treatments and quality of life issues. And so, I've given you some information about chemotherapy. You, his doctor(s), including his GP and your father have to decide if there are good reasons to take chemotherapy. I'm sorry about your father. Mum died of lung cancer, 7 weeks after entering hospital during which time she was diagnosed (but it wasn't in her spine that I can remember, at this time), so treated with pain meds. There are a number of caring people here (some from UK) who can be here for you right through... J > Hello Patrick, > Your father's cancer is advanced. There have been some (posters) here with [quoted text clipped - 18 lines] > whatever he > loves or wants to do) and seeing the doctor as new things come up. <snip> > There are a number of caring people here (some from UK) who can be here > for you > right through... > J J, Thanks for the reply - the link is just what I was looking for. Thanks also for the advice. Patrick > Hi, > [quoted text clipped - 36 lines] > > Patrick The advice you are getting is good. There is no evidence that chemotherapy has any effect on survival time with stage 4 adenoca of lung. If his only symptoms are pain, the radiotherapy is appropriate. If he otherwise has no specific symptoms, chemo will only make him feel worse, for no benefit. "A few months" is possible, but a few weeks is just as likely > The advice you are getting is good. There is no evidence that chemotherapy > has any effect on survival time with stage 4 adenoca of lung. > If his only symptoms are pain, the radiotherapy is appropriate. If he > otherwise has no specific symptoms, chemo will only make him feel worse, > for no benefit. > "A few months" is possible, but a few weeks is just as likely Steph, It is good to know that the advice he has been given so far is sound. The only question that I have is that in view of the fact that chemo has little or no effect on survival time, and he is currently asymptomatic (with the exception of back pain), why would his oncologist offer chemo as an option? What do you think the putative benefits might be? Or is this just a case of being given all the options, regardless of clinical merit? Thanks again, Patrick >> The advice you are getting is good. There is no evidence that >> chemotherapy has any effect on survival time with stage 4 adenoca of [quoted text clipped - 17 lines] > > Patrick Knee jerk? Wanting to give hope where there is none? Tired of arguing with other families who insist something must be done? Many reasons <snip> >> The only question that I have is that in view of the fact that chemo has >> little or no effect on survival time, and he is currently asymptomatic [quoted text clipped - 12 lines] > > Many reasons Steph, Precisely the thoughts that I was having, so good to have them confirmed and to know that I was not missing some vital bit of information. Even though the information that you have given me in your posts has been hard to read, it has helped me very much. For that I thank you. Patrick Apparently, he has also been offered two pill-based chemo treatments: Gefitinib (Iressa) and Erlotinib (Tarceva). He is seeing the oncologist again in a couple of weeks to let her know whether he wants to try these. Any comments on the effectiveness / side effects of these two drugs? I have already printed off the CancerBacup information on them, but if any of you have any experience of these, I'd appreciate it. Patrick (away from home, hence the different email address) http://oncolink.org/treatment/article.cfm?c=2&s=10&id=280 http://oncolink.org/treatment/article.cfm?c=2&s=10&id=280 http://www.lungcanceronline.org/ Here are some more links. The bottom line is that without treatment the long term outlook is bad. Chemo may buy some time. Are the side effects from the chemo equal to the side effects of the chemo? That is a question only your father can answer. Since it is oral, and doesn't require an infusion it sounds like a reasonable plan but I wouldn't have high expectations. > http://oncolink.org/treatment/article.cfm?c=2&s=10&id=280 > http://oncolink.org/treatment/article.cfm?c=2&s=10&id=280 [quoted text clipped - 7 lines] > infusion it sounds like a reasonable plan but I wouldn't have high > expectations. Alex, Thanks for the links. It seems that Dad is considering Tarceva as an option, as the side effects seem to be a lot milder then standard chemo, so it is worth trying to see whether it helps - although none of us are really very optimistic. Patrick > Apparently, he has also been offered two pill-based chemo treatments: > Gefitinib (Iressa) and Erlotinib (Tarceva). He is seeing the oncologist [quoted text clipped - 6 lines] > > Patrick (away from home, hence the different email address) Hello Patrick, I don't recall anyone here having both of those. Or are you referring to a choice of one or the other? Could you ask at www.acor.org http://www.acor.org/mailing.html?l=l Clinck on NSCLC to "join". Select "digest" mode for receiving so you don't get overwhelmed with individual responses. I'm also posting some links. I got bogged down in gene mutations and shrinkage of tumors. I'd like to post them before I lose them so I can pick up where I left off and in case any of them answer questions for you. http://www.mskcc.org/mskcc/html/55336.cfm Why Some Lung Cancers Stop Responding to Tarceva and Iressa http://www.fda.gov/cder/drug/advisory/iressa.htm For gefitinib the surrogate end-point was tumor response rate. The response rate in patients taking the drug was approximately 10%. The approved indication was for the treatment of patients who were refractory to established cancer treatments (both a platinum drug and docetaxel). However, since the initial approval of Iressa, Tarceva (erlotinib) has been approved for treatment of this same group. Tarceva was approved based on improved overall survival. In the second trial in patients with stage III NSCLC, after completion of induction and consolidation chemotherapy and radiation therapy, patients were given either gefitinib or placebo maintenance therapy. No gefitinib survival benefit could be demonstrated. The Food and Drug Administration is not considering market withdrawal of gefitinib at this time. New clinical trials are being developed, other ongoing trials are being completed, and there will be further analysis of the completed trials described above. http://www.cancer.gov/clinicaltrials/results/erlotinib-TRIBUTE0805 Erlotinib (Tarceva®) Plus Chemotherapy Fails to Improve Overall Survival in Non-Small Cell Lung Cancer http://theoncologist.alphamedpress.org/cgi/content/full/10/7/467 I don't know what to copy and paste here, there's so much to read and digest.... The Current Situation: Erlotinib (Tarceva®) and Gefitinib (Iressa®) in Non-Small Cell Lung Cancer Erlotinib is being evaluated in combination with bevacizumab [22] for the treatment of NSCLC. Now that we have two new agents, erlotinib and bevacizumab, that have proven survival benefits in various stages of NSCLC, it is important to explore how both agents can be combined to further improve treatment outcome in the early stages of the disease. DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST Dr. Comis has served as a consultant for OSI Pharmaceuticals; Genentech, Inc.; and Bristol-Myers Squibb. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=545207 KRAS Mutations and Primary Resistance of Lung Adenocarcinomas to Gefitinib or Erlotinib Sorry, my brain's tired after trying to figure those all out. I hope you'll read them carefully or sort the wheat from the chaff, then maybe ask at the ACOR list as well. Later, (and I'll try to have a reread and take notes and try to sort it my brain as well :) J > Hello Patrick, > I don't recall anyone here having both of those. [quoted text clipped - 8 lines] > I'd like to post them before I lose them so I can pick up where I left off > and in case any of them answer questions for you. <snip many useful links> > Sorry, my brain's tired after trying to figure those all out. I hope > you'll [quoted text clipped - 4 lines] > brain as well :) > J J No, the options was one or the other. Having read some moe about the drugs, it seems pointless to consider Iressa, but Tarceva might have a slight chance of prolonging things a bit. The side effects don't look too bad, compared to more standard chemo regimes. At the end of the day, it is obviously Dad's choice, but the information in the links which you kindly dug out for me will help him in coming to a decision before his next oncologist's appointment. I'll let you all know what he decides to do, but in the meantime, thanks again for all the help and support offered. Patrick >> Hello Patrick, >> I don't recall anyone here having both of those. [quoted text clipped - 29 lines] > slight chance of prolonging things a bit. The side effects don't look too > bad, compared to more standard chemo regimes. There isn't any evidence at all that tarceva or anything else will prolong survival. It has about a 30% response rate, but a response is meaningless unless it leads to something useful, like improved survival or quality of life, and it often doesn't. It's always easier to do something rather than nothing, but soemtimes nothing is best. > "Patrick Mullin" <News@AuroraDigitalis.com> wrote in message > > Having read some moe about the [quoted text clipped - 8 lines] > It's always easier to do something rather than nothing, but soemtimes > nothing is best. Hi Steph, It says here http://www.cancer.gov/clinicaltrials/results/lung-and-erlotinib0604 The median survival among patients who took erlotinib was 6.7 months compared to 4.7 months for those on placebo. At one year, 31 percent of the patients taking erlotinib were still alive compared to 22 percent of those taking the placebo." So am I I'm getting this right, if his father was a responder, he'd likely have rash and diarrhea (most common side effects, I think) but could possibly survive (median) 2 months more (meaning 50% live more than 2 months more and 50% live less than 2 months more)? Or does that only apply to those who were going to live longer anyway? Or only applies to those who were in clinical trials because of the selection criteria? And is the rash something similar to Erbitux? (which seems to be more of an acne type mess)? I don't want to talk someone into potentially being miserable, but if the side effects are tolerable his father might appreciate an extra month or so. There's a clinical trial in UK called Topical http://www.cancerhelp.org.uk/help/default.asp?page=10302 The aim of the Topical trial will be to compare erlotinib to a dummy tablet (placebo) for patients with advanced non-small cell lung cancer (NSCLC). The doctors want to find out * How well erlotinib works for non-small cell lung cancer * What effect it has on patients' quality of life * More about the side effects J <snip> > There's a clinical trial in UK called Topical > http://www.cancerhelp.org.uk/help/default.asp?page=10302 [quoted text clipped - 8 lines] > * More about the side effects > J I believe that this might have been the trial that my Dad was affered a place on. However, he has decided that if he is going to try chemo, then he would want to know that the drugs were the 'real deal', and not placebos - even though it may well turn out to be the fact that the drugs (for him) are no more effacious than placebos. Patrick >> "Patrick Mullin" <News@AuroraDigitalis.com> wrote in message >> > Having read some moe about the [quoted text clipped - 52 lines] > * More about the side effects > J That study had several flaws of a technical nature. There are several other studies which show no benefit. One swallow does not a summer make............ > There isn't any evidence at all that tarceva or anything else will prolong > survival. It has about a 30% response rate, but a response is meaningless > unless it leads to something useful, like improved survival or quality of > life, and it often doesn't. > It's always easier to do something rather than nothing, but soemtimes > nothing is best. Steph, Thanks for your insight. I think that as long as the side-effects are minor (which seems potentially to be the case with this drug), then the placebo effect in itself may be worthwhile. It may not prolong life, but as long as it does not reduce the quality of life, it may allevaite some of the 'helplessness' associated with the diagnosis. Then again, if the side effects are less benign, then Dad'll stop taking it. Patrick >> There isn't any evidence at all that tarceva or anything else will >> prolong survival. It has about a 30% response rate, but a response is [quoted text clipped - 15 lines] > > Patrick I think that attitude is an entirely sensible one Hi patrink: Sorry to here about your father cancer. I work in Beaumont Cancer institute in Texas. I am an herbalist/Acupuncturist. I work for an oncologist and a metabolic doctor MDs. I suggest you find a metablic doctor to prescribe Vitamin C injection , and maybe also laetrile injection which is illegal is US. They are effective in treating cancer -75% success according to the doctor. If you choose Chemo /Radiation you have to have herbs to get rid of the side effects. Without the herb the chance of suscess if slim, because Chemo will damage the heart, and many cancer patient died of heart damage, and not from the cancer. Use co-enzyme Q10 to protect the heart during chemo. As for Radiation, you need the herb to hydrate the body, water would not help. The herb can also treat the diabetes at the same time and maybe the pain. Even though it might be stage IV you can still enhance his quality of life by providing energy and reduce pain. Mike Nguyen L.Ac lifespanrx@yahoo.com >Hi, > [quoted text clipped - 35 lines] > >Patrick > Hi patrink: > [quoted text clipped - 24 lines] > > Mike Nguyen L.Ac lifespanrx@yahoo.com I'm sure you are well-meaning, but that is an entire crock |
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