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hockeyma

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It has been a rough 2 weeks for my husband and his condition has deteriorated somewhat. He is done palliative radiation on Monday and returns to Sunnybrook for appointment with the oncologists to figure if he is well enough for a clinical trial. If he is not well enough he can choose from two other chemo's. Can I get some imput from experience or choice of what has worked for some the best- I have been reading all the profiles but it seems to vary.

-The trial is an IMCLONE trial which randomly assigns a chemo to each client. So he could either get taxotere, alimta, taxotere and erbitux or alimta and erbitux.

- Taxotere alone 1x every three weeks

- Tarceva

If he gets the trial he has to travel to 3 hr round trip 1x / week.

The Gemzar/ carboplatin regimin worked for him initially but then failed in the long run. He only took 4 treatments of the 6. So this is not an option.

Any thoughts? Doctors are now classifying him as very late stage IV and have really dropped all sense of battle.

Heather

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I don't see how you can lose with any of those alone or in combination. You never know what will be the magic bullet and all of those could be successful. Right now I am real partial to Avastin since it is working so well. I hope whatever he does it gives him some shrinkage. Why is it only palliative radiation? Just curious.

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I questioned as to why the radiation was palliative. Initially they said they could do none - so I guess this is better than that. From what I understand it is such a large mass and there is so much cancer in the organs that doing a heavy dose radiation will only be more painful and irritating for him. I queried as to whether by some fate that things improved and could this be done again which they said yes. It is hard to accept the palliative word but at this point by seeing how sick he is - it is probably the best.

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We've only dealt with the Tarceva. Mom had great luck with it for 16 months!

BTW, Mom is just 4 days short of celebrating her 2-year anniversary of dx, and they originally told us they could only do palliative care. You just never know.

Lots of prayers for you for guidance in this situation. Keep us posted!

:) Kelly

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Those are all fine choices, all very appropriate second-line treatments with evidence behind them.

Someone on my website just asked me a similar question of how I'd decide whether to recommend chemo or an EGFR-based targeted therapy like tarceva as a second-line choice. They have pretty similar efficacy results but haven't been compared head to head. If you're interested, you can see my response to the question at the bottom of this page from OncTalk:

http://onctalk.com/2007/01/31/alimta-as ... therapy-2/

In that answer, I didn't really go into why I use smoking status as such an important factor in recommendations for tarceva, but that's on some other points you can find on my website, or I can point you toward them.

I'll add that the imclone trial offers the possibility of doing both at once, although so far there haven't been any great results in lung cancer yet with erbitux (cetuximab). I'm not sure I'd travel three hours each way...

-Dr. West

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Dr West thank you so much for your insight. I read the article and in fact scanned your site on Sunday. My dad started Alimta yesterday as I would think a 3rd line therapy or maybe 4th line? I don't know how lines are counted but anyway, per my profile he has participated now in 3 trials and has had radiation (lung and brain). He is a 3 year survivor to date. Hopefully this will help arrest the cancer for a bit - he needs to be here next year for my son's special day (I know I'm being optomistic but I'm trying and truthfully 3 years ago I didn't think we would even be here).

Paula

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Even within the same stage, there are some patients who show slow progression, and some patients who show fast progression. This reflects the "natural history" of a particular tumor. Some tumors are very agressive and/or unresponsive to treatments, even the "right" treatments. Others are very indolent and/or sensitive to treatments.

The fact that he has done so well for so long actually suggests that he may continue to do well. Obviously, I don't know any of the details, but the fact is that "responders respond", that people who are doing well often continue to do much better than an "average patient" (who I'm still hoping to meet).

-Dr. West

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My husbands cancer progressed very quickly - before diagnosis - they couldn't believe how much he had with such little indication. The fact that his tumour biopsy proved to be neuroendocrine is I am assuming the reasoning for the quick progression. Gemzar and carboplatin did not work as 1st line. For the radiation which was classed as palliative they did his right lung and his chest and mediastinum. There does seem to be symptom relief of the pain in his shoulder as it is reduced. His shortness of breath is improving also and he is on and off the oxygen now. Gerald has however lost quite a bit of weight and muscle. I guess the best chemo will be one that targets the type of tumour???as well as being one that is easiest on his health which he is trying to recover....I have not asked about avastin but I will. I am not sure of the status of it in Canada.

Thanks for your help.

Heather

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