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mrsb

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Reply with quote  #1 
Well we did our best. I am truly blessed with my husband he is a warrior too.We met with my radiation oncologist who had been away last week.She was much more optimistic and had her boxing gloves on.She said this a a new chapter.... she was speechless when i told her i felt like i was treated by the other oncologist as a piece of garbage and was made to feel disposable. She went through MRI of head which has not significantly changed, the 1 tum ur is tiny and both her and the neurosurgeon/steriataxic specialist feel that it can be watched and monitored if needed they will go for it ( they feel i had good results from whole brain only 1 new tumor in 9 months.At this point as I am asymptomatic they would rather keep the options open.She reminded us that they have the means to control the brain activity.I have several nodules which are not focused in one area of the lung so radaion is not an option.
Then on to discussion of medical oncologist she gave hubby specific instructions to call her if her refused chemo and to tell him she can look after the brain his job is to look after the lungs. We both felt better after we met with her.
Yesterday we met with the lung oncologist first words were I am going to give you chemotherapy.... a real turn around.Then he went to great length to explain why i was wasnt offered chemo in the first place (standard treatment here in Canada. I think although i have been extremely grateful that i here in Canada i have never once had to worry about any medical test or treatments,, the shortcomings may be that the hospital has a set protocol and the Dr's have to work within that not allowed to think outside the box.
The lung oncologist felt that the first line chemo for lung cancer would be too much for me and given the biology of my tumor he offered me Tarceva, which has the advantage of being taken each day by mouth. He says they are seeing impressive results and he has one lady who is progression free after 4 years of continued use.
The necessary forms were completed  for  approval by our insurance companys for the drug and i am due to start april 26th
Constantine your comments would be appreciated should i be taking boswellic acid with this drug.
To my sisters here thank you for your support, your fighting spirit helped me fight for what i knew was right. we had to cancel our trip in a week to see new gran-baby but gran baby is taking a long plane ride to see her Nana tomorrow instead.
my other daughter is heading home also so we shall forget about our worries and enjoy our newly expanded family. Shelagh
Primel

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La Deesse
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Reply with quote  #2 

((((((((((((((Shelagh)))))))))))))

Thank you for posting this encouraging report... You sure got the spirit: NO SURRENDER!  This new chapter may even see new breakthroughs you'll benefit from.  Wishing you a lovely spring, filled with hope again. Catherine
DoreenF

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Reply with quote  #3 
Shelagh - my dear sister - you are in my thoughts and prayers - sooo happy that you have a good rad onc and that you were able to discuss everything openly with her and be treated by a compassionate doctor -  I love her attitude - she comes across as spunky,  smart and a don't mess with me attitude!

Happy that the lung oncologist had that turn around!

Enjoy your time with your family and especially with your new grand daughter -  babies are soooo special and can take all those negative thoughts and worries away while you're staring into their eyes and loving them ...

Love and Hugs,
Doreen


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nosurrender

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Reply with quote  #4 
Dearest Shelagh,
I am SO HAPPY you have your boxing gloves back on! I have heard only wonderful things about Tarceva... and if you can't get it in Canada, move in with me here and we will get it for you here in the US.

Have a wonderful holiday and remember We are ALL with you forever No Surrender!!!
love
g


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edge

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Reply with quote  #5 

Shelagh:


I agree: A new chapter! 

 

You stayed on the battlefield, and as a warrior-survivor completely changed the therapeutic stance of the lung oncologist who now seems to have finally done his homework and woken up to the fact the durable response and long-term survival is possible from brain metastasis, something I have been preaching - and documenting - through my CNS Review for years (I have several lung cancer consults with CNS disease who are survivors out to 6+ years, and the day is young still).  CNS  disease from both breast and lung cancer is highly treatable and with highly favorable responses.  In addition you have minimal CNS disease with a small tumor burden (I would hazard sub-centimeter, namely millimeter, size, of slight clinical consequence), and certainly SRS (stereotactic radiosurgery) would be available to you to remit this solitary lesion, if it is not remitted by the proposed biological therapy (BT).

 

The Majesty of Erlotinib (Tarceva)

I am in lung cancer a strong advocate of EGFR TKIs (tyrosine kinase inhibitors), especially erlotinib (Tarceva) which I regard as our single best agent in this arena. We  know from numerous recent studies (reviewed by me as of beginning of this month) that

  1. the EGFR TKI erlotinib (Tarceva) is active in patients with brain metastases from NSCLC,
  2. in NSCLC patients with CNS disease, EGFR mutation status is associated with improved survival, independent of age, functional status, extracranial disease status, and even independent of the number of brain lesions, and
  3. EGFR mutation predicts unique sensitivity, response, as well as survival to EGFR tyrosine kinase inhibitors (TKIs) like Tarceva.

[And this is true also of patients with leptomeningeal metastasis (Hyeon Gyu and colleagues at Seoul National University)].

 

Reaping the Harvest

As  to the exceptional benefit of EGFR TKIs in CNS disease, let me first note that April Eichler at the Pappas Center for Neuro-Oncology (Boston) and colleagues recently conducted a large retrospective study, and of five patients with EGFR-mutant tumors and asymptomatic multiple brain metastases treated with erlotinib (Tarceva) as primary therapy, two had complete and sustained responses, and I should note one was for almost three years (32 months), and other trials show outliers even past this.


So pooling the overall response rate in these and in other prospective trials of erlotinib (Tarceva) exceed or equal at least 75% for all sites.  Thus, the Spanish Lung Cancer Group followed the CNS response of seven chemotherapy-naïve patients with an EGFR mutation given erlotinib (Tarceva) at the optimal dose of 150 mg/d. They reported four patients with a complete response and three with a partial response to this EGFR inhibitor, that is,  an astounding 100% response rate of brain metastases, demonstrating that in a molecularly selected population of EGFR+ patients with brain metastases, the biological agent erlotinib (Tarceva) can achieve high response rates in a metastatic site that historically has been refractory to chemotherapy agents.

 

In addition, Houman Fekrazad and colleagues at the University of New Mexico document the case study of a stage IV adenocarcinoma lung patient with multiple brain metastases, who after erlotinib (Tarceva) 150 mg/d, demonstrated at the 8 month follow-up a complete resolution of the brain metastases, and Chris Boshoff's team at Wolfson Institute for Biomedical Research present another such case study, with complete response of brain metastases 6 weeks after starting erlotinib.

 

Furthermore, Rut Porta with the Catalan Institute of Oncology, and colleagues found in a retrospective study of the Spanish Lung Adenocarcinoma Data Base that erlotinib (Tarceva) improves survival in selected patients with brain metastases from NSCLC.  In patients who harbored the EGFR mutation, the objective response rate (ORRR) was an exceptional 82.4%, with 47.1% of these patients having complete resolution of all brain metastases, while 35% had partial responses.  There  were no responses in any patient without EGRF mutation.  Median progression-free survival (PFS) in EGFR+ patients was twice that of the non-mutated EGFR controls, while median overall survival (OS) in the EGFR+ groups was four times as long as the controls.

 

Clinical Pearls

Finally, another bonus as it were: the efficacy of erlotinib (Tarceva) in brain metastases is paralleled by its efficacy in the lung primary lesions and in other metastatic sites; that is, erlotinib (Tarceva) is a highly active, all-site biological agent, operating not just in CNS disease, but also in visceral disease (lung, liver) among other sites.  Thus, all patients with EGFR mutations responding to treatment within the brain also responded in the extracranial lesions. In this sense erlotinib (Tarceva) is a pan-systemic biological agent of, I consider, breakthrough importance and clinical impact in lung cancer (and in other cancers, including breast cancer, as well, where it is now being heavily investigated. 

 

As to the boswellic acids/AKBA, yes, they can supplement the neural activity of your biological therapy, and mitigate the development of any cerebral edema  although with oligometastatic disease, I do not necessarily anticipate any such development.  In addition should erlotinib (Tarceva) not wholly remit the small brain lesion, SRS is always available subsequently for just that purpose, so you have many promising options (and more beyond even these, should they be needed).




So enjoy the support and love of your sisters and husband and expanded family, one distinguished member of which is Hope. 

 

Onward for some more chapters!



Constantine Kaniklidis

Breast Cancer Watch

edge@evidencewatch.com

mrsb

goddess forever
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Reply with quote  #6 
Just a quick thanks. yesterday was my last day on Decadron and I started the Cortef as recommended by the endocrinologist. I am hoping for a real burst of energy.I start the Traceva on 26th april.I am little apprehensive has anyone taken this?? The drug insurance companies have approved 1000% coverage of Tarceva.
On a good note i met and fell in love with my granddaughter. I am so proud of my girls but it was such an an experience to watch the new mom. Only 9 weeks and she will be back for the Summer
Shelagh

nosurrender

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Reply with quote  #7 
Shelagh! WE need pictures of your new baby!!!
Good luck with the Tarceva- I have only heard GREAT things about it.
Love to you
g


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Limner

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Reply with quote  #8 

Blessings on you and your new Granddaughter, Shelagh.  It must have been a tremendous boost to see her!   - Sounds like you are in good hands and in line for an effective  treatment. What is Cortef?  Does it help you repair from the steroid?   As usual, Edge's explanation is worth at least 3 credits and he gets an A+ for effort.  Good luck, dear lady.  Mary


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mrsb

goddess forever
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Reply with quote  #9 
Update. I went for my 3 week follow up after beginning Tarceva. I had to see a different oncologist as mine(lung) is away teaching. The pre appointment chest xray is clear no white spots nothing. He said I had an excellent response to tarceva and it also works on the brain mets.
I am full of rashes and am surprised at my energy level although lack of activity and decaron has done a number on me. The endocrinologist changed me over to hydro-cortisone. Thank you Gina and fellow warriors who demonstrate daily our battles with Cancers of all kinds. Thanks to Constantine for his knowledge and commitment( my husband thinks your the best) me too.I am due another MRI in 2 months so look forward to getting some positive results there too. Shelagh
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La Deesse
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Reply with quote  #10 
(((((((((((((Shelagh)))))))))))

Thank you for this very encouraging report... keep fighting!

Love,

Catherine
edge

Chief of Research
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Reply with quote  #11 
Shelagh:

Great news! 

Thanks for the kind appreciation.

And note that erlotinib (Tarceva) is the darling of ASCO 2011, starting next week, with over a dozens positive reports singing its praises.

The rash will subside: data shows it tends to set in around week two, then begin to wane at week 4, with significant remediation at week 5.  You've probably been advised as to remedial interventions, but if not I'll in any case offer a few tips:

■ The Dermablend brand of makeup can cover a rash without aggravating it.
■ Avoid sun exposure, and always use a strong sunscreen when out, SPF should be at least 30, and the sunscreen should contain titanium dioxide or zinc oxide. It should be applied every two hours or more frequently if sweating or swimming.
■ Baths are better than showers.
■ Within 5 minutes of bathing, apply mild
hypoallergenic emollient moisturizer:  Neutrogena Norwegian Formula Hand Cream, or  Eucerin Aquaphor Healing Ointment or Vaseline Intensive Care Advanced Healing Lotion, or Vanicream, appear helpful.
■ Topical OTC steroids, like hydrocortisone 1% can be useful in reducing inflammation, and for severe areas, it can be applied occlusively (under a patch of cling wrap).
■ Use only mild non-irritating soap like Cetaphil.
■ Topical clindamycin gel (prescription antibiotic) can be used in any area suspected of infection (nails are common points), especially if there is evidence of pustule formation.
■ Vitamin k cream has shown some early benefit in Tarceva-induced rash (Roman Perez-Soler at Albert Einstein College of Medicine and colleagues, ASCO 2006).

Onward!


Constantine Kaniklidis

Breast Cancer Watch

edge@evidencewatch.com


nosurrender

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Reply with quote  #12 
(((((SHELAGH!!!)))) Yay!!!!!!!!!!!!

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