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1. kizeron
   Member

   Thank you for reading my email.

   I am desperatly trying to understand what options are available for my father who has none small cell squamous lung cancer and is at stage 4.

   Can you please look through the blood and PET scan results and also have a quick look through the blog and advise.

   At this moment in time, the NHS have are stalling wit regards to my father. They have recommended to address each symptom as and when it occurs rather than be proactive and help us fight this deadly disease.

   All I need is some ammunition to push the NHS in a direction whether it is Chemotherapy or Tarceva. In the case of Tarceva we will need to relocate to Scotland to get it on the NHS. I need help and some more information with regards to taking Tarceva as the first line of defense.

   I have included a link to my blog below and links to the various letters.

   http://www.azizlive.com

    

   Posted 2 years ago #

2. Dr. West
   Administrator

   The standard treatment for stage IV NSCLC is platinum-based doublet (2 drug) chemotherapy.  More frail patients are often treated with single-drug therapy.  Avastin is not recommended for patients with squamous cancers due to the rather considerable risk of serious and even potentially fatal bleeding complications.  Tarceva has really been studied best in patients who have already received chemotherapy, and it is not commonly used as a first line agent.  It is a strong consideration as an early (potentially first line) treatment in never-smokers, those with known EGFR mutations, and often those with bronchioloalveolar carcinoma, but those special considerations really don't apply here. 

   If there is a delay in the way the NHS doctors are pursuing this, I believe it is because of special circumstances about his case.  Standard treatment would be to start chemotherapy promptly.  I would have to defer to the doctors there who know his case.  I will also say that in patients who have no symptoms, it is sometimes reasonable to wait before starting treatment, because the treatment may well cause symptoms while the cancer is not, so by definition that will detract from quality of life. 

   -Dr. West

   Posted 2 years ago #

3. kizeron
   Member

   Dr. West thank you for your prompt reply.

   What are the risks of Chemotherapy in my fathers case? He has recently (yesterday) had a 2 unit blood transfusion and is due a knee replacement operation in 10 days. We are all struggling to weigh up the risks of the knee replacement operation and trying to understand how the PET scan results will impact this.

   The question is, how soon after the knee operation can we begin the Chemotherapy remembering the lung specialist has given Chemo 1 in 20 chance of success?

   Pet Scan Results > http://abdulazizuk.wordpress.com/2007/09/15/pet-scan-results-letter-to-gp/

    

    

   Posted 2 years ago #

4. Dr. West
   Administrator

   There are many types of chemotherapy, with a wide range of side effects.  Among the most common are decreased blood counts with some risk of infection, or bleeding, the need for blood transfusions, hair loss, decreased appetite, nausea/vomiting, kidney damage, liver problems, and neuropathy (numbness/tingling from nerve damage).  That's not a complete list, but the side effects are completely variable in different people. 

      Let me try to clarify a couple of key points.  From the reports on your website, I believe your father's case may be locally advanced but not metastatic.  Please refer to other posts on OncTalk for details about treatments for this, which generally include chemo and radiation, with some potential for cure, although it is not as high as we would wish it to be.  In that case, I would prioritize treating the lung cancer far, far ahead of the knee replacement. 

      The reference to a 1 in 20 success rate from chemotherapy doesn't make much sense to me.  There is a reference to this being based on a chest x-ray, which is a very unreliable measure of response.  I use CT scans for just about every response assessment.

       I can't go over the details of your father's documentation, but I can tell you that the standard of care for locally advanced NSCLC is a combination of chemo and radiation, often with curative intent.  My comments about treating with palliative intent apply to stage IV disease, which you mentioned, but I believe in looking at some of the reported results, it is the T stage that may be 4, not the overall stage, which can still be III (or 3, if you prefer, but we use Roman numerals by convention).

   -Dr. West

   Posted 2 years ago #

5. kizeron
   Member

   Thank you for your reply Dr. West.

   I have now also booked my father for a second opinion with the london oncology clinic.

   Also, in reference to the 1-20 statistic.

   The specialist was refering to the grapefruit sized mass present at the bottom left hand lung. Lymph nodes have also been infected and the growth is pushing against the lung lining. This was shown to us via a CT scan.

   After reading your last email, I am now reluctent to go through with the knee replacement surgery. It just doesnt make sense. However, its my fathers choice at the end of the day but I'll advise him not to go ahead with it.

   I have more of my father patient history if you require I can email this to you as long as it is confidential.

   Thanks

    

   Posted 2 years ago #

6. Dr. West
   Administrator

     I really can't provide personal medical advice to members on the site, so it makes more sense for your father to pursue that consultation and use the information I provide here to supplement that.  I try to provide the evidence to back up my approaches and how we have arrived at our current views of the optimal treatments for lung cancer.

   -Dr. West

   Posted 2 years ago #

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