john
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Posts posted by john
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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
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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
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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.
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It probably does mean a possible bone metastasis. Ask the doctor. There are drugs like zometa (biophosphonates) that may help some
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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
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These two cases illustrate objective clinical responses to gefitinib in patients who failed three or more lines of chemotherapy and two experimental agents, including cetuximab. Although responses to gefinitib after several lines of chemotherapy have been reported,3 the fact that a response was attained after the unsuccessful use of cetuximab is noteworthy, because both drugs block the action of the same receptor. There is some valid concern that patients who fail treatment with an EGFR-blocking MoAb may not respond to a TKI and vice versa. Most clinical trials utilizing MoAbs or TKIs exclude patients previously treated with an agent of the other class. Early evidence suggests, however, that enhanced antitumor activity may be achieved by maximizing ErbB signaling inhibition with the combination of two or more "targeted agents."4,5 Matar et al6 showed that the addition of cetuximab to gefitinib resulted in a synergistic antitumor effect against EGFR-expressing cells both in vitro and in vivo. Furthermore, the combination resulted in a more profound inhibition of the receptor signaling pathways, in a greater decrease in cell proliferation and angiogenesis, and also enhanced apoptosis. Recently, Huang et al7 demonstrated that the combination of cetuximab with either gefitinib or erlotinib resulted in more pronounced growth inhibition than either agent alone especially in head and neck cancer and non–small-cell cancer cell lines. They also demonstrated a greater decrease in the expression of several key regulators involved in the EGFR pathway as well as an increase in apoptotic markers. Furthermore, in cetuximab-resistant cells, treatment with erlotinib or gefitinib alone continued to show growth inhibition.
To the best of our knowledge this is the first report of clinical responses to a TKI after failure of treatment with a MoAb targeting the same receptor. It is still unclear if use of these agents in sequence or combination might benefit patients, but the available preclinical data and these two case reports are provocative, and this strategy certainly warrants further study.
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.
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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
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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
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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.
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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
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The pin-needles thing is probably Peripheral Neuropathy from the carboplatin.
I think the main worry about avastin is bleeding problems
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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
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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
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Joe,
Good luck. I live about 30 minutes north of Bethesda, so if you need anything let me know
Hope the trial works for you
John
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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.
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Doesn't hurt to get a 2nd opinion.
As the Drs said since the SUV is less than 2.5 it might not be cancer or at least is possibly an indolent form of cancer.
I am not a Dr, but I believe chemo works better on fast growing cancers. You might want to ask Dr West about this.
Have you been seeing the same Drs?
Are you sure it was an x-ray. Unless there are serial x-rays or there are computer enhanced x-ray machine, nodules won't usually show below 30mm or so.
Good luck
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I would say it would be odd to receive chemo when there may not be cancer there.
I personally would get a 2nd opinion.
A pet scan or other tests could possibly confirm the cancer
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You might want to ask your Doctors about HKI-272 or other irreversible EGFR inhibitors.
I am not sure how the trials are going for these drugs, but they are supposed to work once a mutation happens and Tarceva stops working
Take care
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http://www.docguide.com/news/content.ns ... 690062EE07
I would investigate and research thyroid treatment. There have been issues with synthroid from what I recall.
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This is something pretty new as far as research and applies to head and neck cancer but
http://archotol.ama-assn.org/cgi/reprin ... 0/1041.pdf
I have seen an research article about hypothyroidism and lung cancer. I will look for it
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Second: What is the significance of differentiation in the pathology of cancer cells. My cancer is moderately differentiated.
differentiated means the cancer cells look like normal cells, so it is the least aggressive type.
undifferentiated means the cells do not look normal at all, so this type is usually aggressive.
Yours is somewhere in between.
Third: Does anyone know if there is anything I can do to raise my blood counts? Diet? Supplements?
EPO was used to boost red blood cells but there is now a concern that it could help the cancer spread.
There is a little evidence (I am not sure how much) that mushrooms may boost white cells and astralagus is another herb. Always tell the Dr what herbs/supplements you are planning to use.
Some Drs are completely against them. Do your research and make sure your source of research is good versus a lot of the junk that is out there.
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That is interesting your Dr is considering RFA.
Do you have lung function problems?
Tarceva is supposed to work well with BAC
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It could be other things besides cancer but no one can really answer here.
A CT scan is not 100% for detecting cancer. I believe the doctor looks at many things in the scan (attenuation, tumor borders, etc). I wouldn't know what is bad vs good. But not every mass is cancer.
If it is a lung cancer it might be a lung metastasis from the sarcoma and not primary lung cancer. If this is the case you might get better information at a sarcoma web site, but of course you are welcome here.
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Hope you are feeling better. It is as Connie said as far as the stage goes.
Unfortunately, your situation is pretty common. During staging using Cat scan, pet scan or medianoscopy (sp?) the doctors look at the various lymph nodes. None of the tests are 100%. Medianoscopy is the most accurate but it is invasive and can not get to reach all the lymph nodes in the chest.
Fairly often nothing is detected in the lymph nodes using the various tests until surgery. So before surgery a person is stage I or II and after surgery is Stage III.
Third hand smoke
in GENERAL
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