New Stage IV NSCLC Diagnosis

Hello, I'm new to this site and this is my first post. Today was my husband's first chemo treatment for the Diagnosis of stage iv lung cancer we received on dec. 14th 2012. Today he was treated with alimta and carboplatin. The plan is every 3 weeks for 3 treatments then rescan. EGFR was negative but they say there wasn't enough tissue to do ALK or KRAS tumor markers and besides it really wouldn't change the plan of treatment at this time. This is all new to me, does that sound right or should we try and get another biopsy, (his lung collapsed during the last one)

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l-r,

Need more details, size, location, mets, etc

G

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Make sure he takes nausea meds round the clock and stay hydrated! Best of luck to him!

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At this point I would follow the doctors plan. Occasionally the chemo can cause additional mutation of the cancer cells. Best to wait and see if this works. If it doesn't and there is progression I would have another bx then.

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Thank you much

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Hi Lynn, I completed 4 rounds of Carboplatin/Alimta on December 26th (every 21 days). I'm starting my Alimta maintenance program today. My chemo followed 5 weeks of radiation on the primary tumor. I'm happy to report that my December scan results noted remarkable and significant response to the therapy. As far as the chemo was concerned, I experienced mild nausea for approximately 7 days following each chemo, slightly unpleasant but NOT unbearable. I also see a naturopathic MD and he prescribed a Vitamin C infusion prior to each treatment. Also, the Alimta drug manufacturer instructs patients to take Folic Acid (800-1000mg) daily AND a vitamin B12 injection prior to the first dose of Alimta and then again approximately every 9 weeks. My naturopath advised me to inject myself with B12 every other day. Between the chemo and vitamin regimens, I'm back to my old self and feeling great! If your husband has not seen a Naturopath MD - i would highly recommend that he does.

I'm with Atootsie on the importance of staying hydrated and I would also like to add the importance of staying active too.

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Hi Lynn,
I completed 6 rounds of carbo/Altima/avastin
And have had two rounds of maintenance of
Altima/avastin. My last scan showed remarkable
Dramatic improvement. When checked for
Mutations they all came back negative.

Keep a positive outlook, eat right, and stay hydrated.

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I just started carbo/Alimta on Monday January 14th. Getting Decadron, Aloxi to prevent nausea, magnesium 500mg in 500 cc of normal saline. Locally advanced nsclc. Had cyberknife radiation for one week at Moffitt in June 2010. Recurrence in november 2011 with more rad at Moffitt in February of 2012. Last CAT and PET on 11/02 showed progression and that's why I am now on chemo. So Lynn, good luck to you and your husband. Sounds like we'll be going through this together. The general consensus above seems to be positive outlook, eat right and stay hydrated. So far, so good. Take care

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lynn-rich ,

Most oncologists who specialize in lung cancer would probably first treat stage IV adenocarcinoma with an inhibitor drug if it had a useful driving mutation (EGFR or ALK or ROS1 or maybe even the experimental RET) . . . unless they had a reason to assume chemo might cure it (which is very rare for stage IV).
Here's a review of 5 studies of 1st line use of inhibitors for EGFR (and the concepts is believed applicable to other inhibitors, too, like Xalkori):
http://171.66.121.246/content/29/15/2121.full

When will they be able to get a biopsy sample to test for the others?

KRAS isn't so useful, but it is very common in smokers and would rule out rarer ones. Is there a smoking history? Smoking would also significantly reduce the odds of ALK, ROS1, or RET.

I see you've described it as an adenocarcinoma. By any chance is he a younger-than-average never-smoker? If so, I would recommend pushing for that mutation testing sooner rather than later.

Best hopes,

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Thanks to everyone for the responses.

CraiginPA- He had his first chemo treatment and very very slight nausea. He is 60 and has smoked since he was 18, he quit on dec 14th, ie. day of diagnosis and has remained so. He also had hodgkins lymphoma 16 years ago for which he had IV chemo and it has not returned. The doctors say the lung cancer he has now is a primary tumor not from the hodgkins. At the moment he is golfing. He is eating better and staying hydrated. I hope this works...

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So my non-professional guess is that his oncologists made the right call to proceed with chemo. It doesn't sound like he fits the most-common profile of someone who's cancer is driven one of the rare useful mutations, although there are sometimes lucky exceptions (about 10% of these are found in smokers, and cases have been found even in their 70's).

If later testing finds a useful driving mutation (not KRAS yet), they can switch to the drug for that. If it is KRAS or something they can't identify, you'd focus on chemo approaches, sometimes radiation, sometimes surgery, and experimental approaches that don't depend on a particular driving mutation. (For example, an anti-PD1 drug like MK-3475 if he's got the PDL1 marker the mechanism for that depends on.) There are experimental treatments for KRAS, though not much promising yet. (ganetespib shows some early benefit from some KRAS patients, but it's hard to guess how many benefited until more research results are disclosed.)

Best hopes,

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My husband went through a similar Avastin/Alitma course
when it was not the standard treatment. He is alive and well 8 years (January 15, 2005 diagnosis).

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Hi BisBat
Your posting was very informative. I am about to start a four cycle programme on Altima/Carboplatin.
Three years ago I had four cycles of Gem/Carboplatin with a pretty easy ride and am hoping the Altima/Carboplatin will be similar in experience. Your experience helps me a lot, many thanks!
I am not able to have radiotherapy again as it is in the same area so this regime has to work!
Best wishes
Bolter

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