I received a response from Dr West of Onctalk.com yesterday in response to my question (http://onctalk.com/bbPress/topic.php?id=680). The idea of embarking on Chemotherapy whilst my father is not immediately suffering from serious symptoms is a scary one. In addition to this, the knee surgery element of this whole situation is distracting. We understand the DVT and Infection risks, but how soon after the surgery can we begin Chemotherapy? Or can we?
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
Filed under: Chemotherapy, Tarceva
