Clinical Trial Vs. Tarceva&Iressa

My father was recently diagnosed with non-squamous non-small cell lung cancer no stage offered, just advanced. It has been a roller coaster ride so far. I'm wondering if anyone out there has not opted for Chemo and went right for Tarceva & Iressa. We are currently faced with the option of participating in a clinical trial using a combination of gemcitabine, cisplatin and bevacizumab OR trying the Tarceva and Iressa. However, if we go for the latter, we are no longer eligible for the clincal trial if the drugs don't work. Upon some initial research, the drugs over the chemo sound more appealing as side effects and efficacy are more immediate. I also understand that being a non-smoker Asian increase his chances for success greatly. However, I am feeling like oncology is kind of against this choice. (Just an intuition) Can anyone shed some light on this?

Dear Nancy:
I was diagnosed with Stage IV non-small cell lung cancer in May of 2005. I have not had any traditional IV chemo yet - I have only been on Tarceva since day #1 as I am a female, non-smoker with the EGFR (Epidermal Growth Factor Receptor) mutation. My lung tumor initially shrank and now has stabilized as well as my other mets. Tarceva has a low toxicity level; common side effects are a pimple-like rash and occasional diarreha. So, I plan to continue using Tarceva until it stops working..

With regard to the clinical trial, I would find out all I could about the trial, like: what stage the trial is currently at? - there are three stages of a clinical trial and I would be wary if it is a Stage 1 trial as it has only been tested in animals and this is the first introduction to humans.... but, from your description, it does not sound like it. I would also want to know about the side-effects of the chemo - how toxic is it? If your father is in otherwise good health, you may not want to deplete his immune system when you could use a less toxic course of treatment with Tarceva.
In the end, it will have to be your father's decision, just make sure it is an INFORMED decision... Good luck and I wish you both well.... - Kim

Hi Kim,

Thank you for the information. My dad is 76 and leads a very active and healthy lifestyle...more like a 56 year How did you know you have the EGFR mutation? Is there a test for this? Were you presented with the options of chemo OR Tarceva before any treatment began? Best wishes to you, glad to hear that the drug is working.

Nancy

Nancy:
I have a met on my left, 6th rib. The doctor biopsied this met (rather than the tumor in my lung with associated risks) to determine the type of lung cancer - bronchogenic carcinoma (a sub-set of adenocarcinoma). They also tested the biopsy for the EGFR mutation.

My doctor told me that if the biopsy showed non-small cell lung cancer, then she would start me immediately on Tarceva b/c it is less toxic than traditional IV chemo. If Tarceva did not work, or if it stops working in the future, my doctor will prescribe IV chemo. I hear that the new IV chemos for lung cancer are pretty good at keeping the cancer in check - especially Altima. They are also working on approving Avastin for lung cancer patients in conjuction with traditional IV chemo. Avastin decreases the blood vessels to the cancer tumor and many patients have seen significant shrinkage of their lung tumors.... Although your father would be precluded from the clinical trial if he starts on Tarceva, I'm sure that he would still have "traditional" IV chemo available if the Tarceva does not work. Again, it is something to look into.

Hi Kim,

Thank you for all the great detailled info. The clinical trial is in fact for Avastin, the drug you mentioned. Hence our major dilemna in choosing between the 2 courses of treatment. Good luck to you.

Nancy

No kidding! I didn't recognized its medical name in your prior e-mail. I have been trying to get on Avastin - see web postings on this site dated 9/16/05 and on the non-small cell web-page dated 7/12/05 (started by yours truly...). Personally, I would jump at the opportunity if it becomes available to me. If you look on the internet, you will see lots of positive articles about Avastin shrinking lung tumors to almost non-existence! The only down-side that I have read about is hemmoraging - but that has mostly been in squamous cell lung cancer. My doctor told me that I am not eligible for any trials because I have a brain met - even though it has been treated by stereotactic surgery - because of the unknown risk of hemmoraging in the brain.

Again, I'm not trying to sway you one way or ther other - the decision is up to your father. I would advise you,however, as the caregiver, to learn as much as you can about Avastin, the trial, etc. so that you can help your father make an informed decision. Take care! - Kim