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Chemo is over! / Early Stage Tarceva Trial from OncTalk


pewjumper

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:D:D:D:D:D:D:D:D <-- This is me today.

Mom just finished her last chemo and is in great spirits. The doctor told her that she should live life without worrying now. She has to make an appointment for a chest x ray and then in six months, she will have scans again. Does this sound right? I was thinking she'd be back in three months for scans.

Second, has anyone here read about/studied/participated in the clinical trial for Tarceva for early stage resectable NSCLC? There's an article on Dr. West's website about it.

http://clinicaltrials.gov/show/NCT00373425

http://onctalk.com/2006/11/12/clinical- ... ant-nsclc/

What do you all think? On the one hand, I want ALL the protection she can get from recurrence, yet at the same time, would this be detrimental if she ended up having a recurrence down the road? She wouldn't be able to take it again, would she? Another thing is I saw Dr. West comment that it could possibly be harmful. So many thoughts racing around in my head, I wanted to pick your all's minds.

But, as for now, I am VERY happy, relieved, and just overjoyed that it's over. I want it to stay that way for a very, very long time (Hezekiah was a wuss in the Bible when he asked for 15 years, I want 30 for Mom!!). :P

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I am happy for you today too :lol: ! I am not certain what protocol is for f/u. I thought 3 months for a couple of yeaars was the norm.........but not certain all docs subscribe to that. I went every 3 months for 2 years. Only now I am on a 6 month schedule. Also I had CT's ~ not only x-rays, BUT I was a later stage than your mom...........so don't really know. However, for today, I am going to celebrate this wonderful news.

Kasey

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there are many here who take Tarceva on regular basis but not sureif it is clinical trial or not. Deb had it for a while. Moisturize, hydrate and you may want to get something for possible diarhea. Do not be alarmed if that happens. Just a little heads up and Great newes, So happy for both of you, and sending prayers tonite.

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Congratulations. I'm so happy for your Mom and also for you. My husband is in a clinical trial with tarceva but it's in conjunction with avastin for advanced, unresctable nsclc so I know that's not the info you're looking for, but it's great news tht she's come this far. Good Luck & God Bless

wendy

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Just to try to offer some perspective, we don't know whether the tarceva will be helpful or not in this setting, and it is possible that it could be harmful. I wouldn't imagine that's likely, but the very similar drug Iressa appeared to have somewhat of a detrimental effect compared to a placebo after chemo and radiation for stage III, locally advanced NSCLC. This is a little different. The patients in the Iressa trial, which is known as SWOG 0023, were not selected in any way as particularly good candidates for EGFR inhibitor therapy. The RADIANT trial is including only patients with EGFR protein expression on the tumor cells, or overexpression of the EGFR gene by a process called FISH (fluorescence in situ hybridization, so you can see why we call it FISH). It gives Tarceva, or placebo, for up to two years.

We definitely can't say that Tarceva is better -- if we knew that, we couldn't ethically do a randomized trial. It's possible it will add nothing but side effects, usually mild, but still potentially some negative effects in people who may already be cured. On the other hand, it may convert some people with viable residual micrometastatic cancer cells to being completely cured.

In terms of whether it "burns bridges" for using tarceva later, I definitely wouldn't recommend using the same drug if someone developed a recurrence on a given treatment, whether adjuvant chemo or tarceva. On the trial, you wouldn't necessarily know if you were getting the active drug or placebo, but if you developed an acne-like rash and loose stools, it would be easy to guess.

In general, though, our highest priority is to do whatever needs to be done to keep a cancer from recurring, because if it does, it's much less likely it could be treated with curative intent. In other words, if a cancer comes back after surgery with liver or bone or brain metastases, the benefits of our treatment are much more limited than after surgery, when we are trying to boost the rates of being completely cured.

Overall, this is a clinical trial that asks an important clinical question, but one that we really don't know the answer to. I would expect the tarceva arm to be better or maybe just equal to the placebo arm with no benefit, but there's a real possibility the placebo arm could do better. We won't know for sure until we get the trial done.

-Dr. West

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That sounds good for your mom. I would assume that your mom shows NED by what the doctor has said. She has already had chemo and there is no sign of cancer, I wouldn’t think they would not want to give Tarceva. Long term side effects have not been determined with Tarceva and then side effects seem to differ from one person to another. If it was determined that Tarceva would be the way to go, then I would want to get the Tarceva and not gamble on not getting it in a trial. It is true what Dr. West says that you most likely would know that you were getting the Tarceva by a rash and other things. For this reason I don't know how blind this study could really be. In some cases there are no side effects. I would not have been able to tell in my own case. I had no side effects from the Tarceva. I only had 100mg which could make a difference. I have been on Tarceva for 20 months from the beginning of my chemo and can not determine if it was the Carboplatin, Taxol or the Tarceva that put me into remission. I believe it can be used any way your doctor wants to use it. If he wanted to give it to your mom, I believe that he could regardless of the trial. This is only what I think, I am just a not too smart retired airline pilot, and Dr. West and your mom’s doctor knows a lot more.

Stay positive, :)

Ernie

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Thank you all so much! This journey has been made so much easier by all of you great folks. It's amazing how much comfort and support I've found in this forum.

Teresag, everyone comments about how much we look alike. The first time my boss saw my mom, she knew exactly who she was just by the resemblance. People have long mistaken me for her brother instead of her son, too, which always disturbed me.

Mom's pathological stage was 2b because the cancer had reached one hilar lymph node only and it was larger than 3 cm. So, surgery removed all evidence of the cancer, so I assume she was considered NED even before chemo. I'm hoping for it to remain that way for many, many years.

As for the trial, her oncologist very highly recommended it, so they're testing the resected tumor to see if it is EFGR positive (which is a requirement). After that, the decision is hers to make. He told her that, if it were him, he would definitely get in the trial, and that he couldn't prescribe it for her because it's not an approved therapy for her stage.

We'll wait and see, but for now, there's much joy in the house! I'm going to take her to Kentucky to see my aunt and our extended family this weekend and she's very excited.

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It may be that they can only use it for a more advanced stage IIIb or IV, but they can use it early on. If the trial is the only choice and your doctor is recommending it then that may be a good choice and like DR. West said most likely you will know by the rash etc.

Stay positive, :)

Ernie

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