john

http://www.bloomberg.com/apps/news?pid= ... Vcuy71TmGE

Many cancers are a group called neuroendocrine lung cancers. They are SCLC, Large Cell neuroendocrine carcinoma and carcinoid lung cancers. So SCLC in some cases may actual be diagnosed as LCNEC and vice versa LCNEC is often treated as SCLC so as far as treatment goes it might not make a difference, it is probably more of a research topic at this point since I don't think it is known what the connections are of the different types Just to make things more confusing http://www.cancer.org/docroot/CRI/conte ... mor_56.asp

Generally a SUV of less than 4 is not cancer. There probably are exceptions to the rule but 4 is the cutoff from what I have read. Ask your Dr this and any other questions you have

I believe there are a number of studies out there that suggest that pneumonectomy may lead to better survival than lobectomy for those who have adequate lung function. There was a person on here who had a penumonectomy and became very successful mountain bike racer. There is no information in your profile, so I am guessing it is early stage since surgery would not usually be done for stage IV. Sometimes surgery is done for Stage III and common for stage II or I. http://www.turkishrespiratoryjournal.co ... hp3?id=506

It probably does mean a possible bone metastasis. Ask the doctor. There are drugs like zometa (biophosphonates) that may help some

He was diagnosed with SCLC in June and has not received any treatment? Seems like there should be a full staging and as you said a bone scan. The elevated calcium could mean bone mets Good luck and keep pushing the Drs for answers and treatment

the above shows some evidence that using cetuximab / Tarceva together may work better than one agent alone There are also various pan-EGFR inhibitors like CI-1033 There are basically 4 EGFR receptors. Most drugs only target one, some target more than one. Tarceva only targets one.

I did a search on HKI-272 and progress does not seem too great. http://clinicaltrials.gov/ct2/results?t ... &recr=Open Above is a list of trials in Illinois. Erbitux (Certuximab) targets EGFR like Tarceva, except it works from the outside of the cell while Tarceva works from the inside (from what I remember to have read) I think it might be possible to use Erbitux after Certuximab fails (though no one know for sure of the response since it would be a trial) Some Drs will not try another EGFR inhibitor after one fails

ABT-263 seems to be listed for SCLC Since she was stable on Tarceva/Avastin I wonder if a HKI-272 is a possible option There is a mutation that happens that causes Tarceva to stop working HKI-272 may work when this mutation happens. The mutation is called ERBB2 G776insV_G/C mutation (If she has this then HKI-272) might be an option, or another EGFR inhibitor like Certuximab Since her tumor did not respond to chemo it might be possible that is is a fairly slow/medium growing cancer (which does not respond to chemo as well as faster growing tumors) I am not 100 percent about this (just info that hopefully will be helpful) as you talk to her Drs

You can search clinicaltrials.gov to look for trials http://clinicaltrials.gov/ct2/show/NCT0 ... en&rank=14 The link above is for a sloan trial. It is phase I though. You can also call the cancer centers in NYC or whatever city is the most convenient as a start an inquiry to the clinical trials that are running there.

the hypermetabolic activity could be caused by pneumonitis. Unfortunately, the broncoscopy can also be inconclusive. Has another CT scan and x-ray been done? I would ask the Dr what is the percentage of the broncoscopy being accurate Also endoscopic ultrasound-guided fine needle aspiration is sometimes used (don't know if it is applicable in your mom's case) Maybe a fused PET-CT scan can be done. It is a pet scan and a CT scan done at the same time. This can pin point where the hypermetabolic region is and if it matches what is found on the CT I am not a Dr, best to ask as many questions as possible and it never hurts to get a 2nd opinion

The pin-needles thing is probably Peripheral Neuropathy from the carboplatin. I think the main worry about avastin is bleeding problems

If there are brain mets, then the Drs typically focus on those before doing other treatment Sometimes stereotactic or cyberknife is used on brain mets. These focus more on the mets versus the whole brain. If there are many mets then usually whole brain radiation is done but also with sterotactic There is a drug call Temozolomide (Temodar) that is sometimes used for Brain mets As people said write down any questions you have. Sometimes people will take a tape recorder so they can go over everything later. It is too much information often ot absorb Often patients with brain mets will be given steroids which have sometimes bad side effects (hyperglycemia (47%), peripheral edema (11%), psychiatric disorder (10%), oropharyngeal candidiasis (7%), Cushing's syndrome (4%), muscular weakness (4%), and pulmonary embolism (2%). Good luck John

I believe Tarceva works best for LC with BAC features and pure BAC, but it also works sometimes in other cases (mostly adeno, I think) There is a genetic test that will give a good indication if it will work or not (not sure if this research is still valid) You can go to clinicaltrials.gov and search for clinical trials in your area as a way to start looking for what is available. Unfortunately, unless clinical trials are considered early they may be harder to get into because there are many criteria that have to met. If there was previous treatment it may make one not qualified for a trial

Sometimes broncoscopy's and other tests are inconclusive, so other tests are used, such as a PET or CT with contrast to get a better idea of the percentage a nodule is cancerous. Unfortunately no test is 100%, unless a good sample is taken for a biopsy. I believe that a CT w/ contrast will give the density of the nodule. If the measurement is less than 15 Hounsfield units it is less likely cancerous. This could be wrong so as other people said ask Dr West.