Alimta & cisplatin + radiation as first line treatment..

[DawnB]

My mother was diagnosed with 3A adenocarcinoma a few weeks ago, and she has just finished her first week of chemo and radiation. She's in a clinical trial, and I was just wondering if anyone has had experience with this regimen (or similar), or has any thoughts about it:

This week she had 5 days of Alimta and cisplatin, followed by radiation. She now has two weeks of daily radiation, and then the whole cycle repeats (one week chemo + rads, two weeks rads only.) She gets three weeks off, and then has two more days of Alimta a week apart.

This seems aggressive for a first line treatment based on what I've been reading, but that's a good thing, I think. (I'm a little worried that I'm kind of too optimistic at this point. I'm not really entertaining the idea that this won't work for her.)

Any thoughts on this, or similar experiences to share?

DB

[mhutch1366]

Hi,

I had a similar protocol for my pancoast tumor, I had cisplatin and etoposide (VP-16) for two rounds with two weeks in between; I had radiation 25 days = 5 weeks. I had a Pancoast tumor, a form of NSCLC in the upper lung, that had crept out and under my shoulder blade, into my ribs, and up my neck.

The tumor, upon surgical removal, was dead.

This was 7 years ago.

The tumor was 13 lbs.

I think the radiation/chemo is a powerful synergy, and I would certainly be hopeful, especially if your mother was having her hip met irradiated simultaneously with the chemo also (in that period of time).

There are other survivors here as well.

I think you have every reason to be optimistic.

I don't know what the Alitma will add to the cocktail, but that's why it's a clinical trial.

Good luck!

XOXOX

MaryAnn

[Adrian]

yes that is a fairly aggressive first line treatment. Alimta, however, is thought to be milder than gemzar ot taxol which are ofte the other drugs used in combination with carboplatin or cisplatin in the first line setting.

Cisplatin is a bit more effective than carboplatin but is condisred somewhat more toxic.

since youre in a clinical study, you cant mess with the regimen, but the only thing Id want added potentially would be avastin.

[DawnB]

Thanks so much for your replies, MaryAnn & Adrian. It's really great to be hearing form others who have bee/are going through the same things as my family.

[Adrian]

Out of curiosity, is it unresectable IIIa? By that I mean, did they tell you that they could not remove the tumor by surgery?

[DrWest]

Cisplatin and alimta with radiation is an aggressive but certainly appropriate option, especially on a trial. I'm actually participating in a similar trial with this combination, which appears to be as safe as we can expect for a cisplatin doublet with radiation, which has been the type of treatment that has shown the best results we tend to see in this setting. Cisplatin/etoposide has been one of the best studied standards, but it's been a cornerstone forever, and we would welcome an option that uses one of our many effective drugs that have been introduced for lung cancer over the past 5-10 years. However, only a limited subset appear to be safe when given at full dose with radiation. Treating with full dose chemo during radiation allows you to get a boosting effect with the radiation, plus potentially treat microscopic disease outside of the radiation field. Lower dose radiation that is often used instead of full dose cisplatin-based chemo is felt to be less effective in treating the rest of the body. And alimta seems to be one of the drugs that can be given at full dose with radiation, so it's worthy of being studied carefully.

Good luck with it.

-Dr. West

[DawnB]

Adrian, to answer your question, the tumour can't be removed surgically because of its location. Mom seems to be clinging to the hope that it will be operable if it shrinks, but I'm not sure if that is a real possibility.

Dr. West, thanks for your comments.

DB

[Connie B]

Surgery IS a possibility if the tumor shrinks. (depending of where the tumor is) I know of many who have had treatments first and then had surgery and are still here today, years later.

I had cisplatin & etoposide (VP-16) along with my radiation treatments as well 12 years ago. This too was and is an aggressive protocol. I had 36 sessions of radiation along with three days of chemo and then three weeks off, and repeat (four times of that) Aggessive is what you want. I'm glad to hear your mother's doctor's are being aggressive.

I wish your mom well and tell her that someone she doesn't know who is a stage IIIB lung cancer survivor is cheering her on. Best wishes.