Treatments for Stage IV Adenocarcinoma of the Lung
On October 2001, my dad was diagnosed with lung cancer (adenocarcinoma) Stage IV (brought on by asbestos contamination) with the tumor in his lung and liver. Last month, he finished 6 cycles of chemotherapy treatments (taxol and carboplatin) with mild improvements. Just this past weekend, though, he became very disoriented in his walk, lost consciousness temporarily, and vomited. We rushed him to the hospital and the doctors (his oncologist and lung cancer doctor) concluded that the cancer had spread to his brain (and to his liver), and that the only treatment for now would be radiation therapy for his head and to temporarily stop the chemotherapy. My question and concerns are as follows: 1) are there any other treatments we can pursue or is radiation therapy the only way to stop the cancer cells in the brain?, 2) at this stage, are there any curative methods? I want to make sure we are doing the best for my dad. Please let me know. Thanks.
Barbara Campling, MD, Medical Oncologist, responds:
I am very sorry to hear about your father's problems. Unfortunately, with few exceptions, when any type of lung cancer has spread outside of the chest, it is not considered curable. Taxol and carboplatin are commonly used treat lung cancer that has spread outside the chest. While these drugs are not always effective in all patients, they can sometimes make tumors shrink down, often make patients feel better, and often allow patients to live a little bit longer, but they do not eradicate the tumor. Unfortunately, lung cancers often spread to the brain, and this can be a very unpleasant situation. Surgical removal of the brain metastasis would not be an option in a patient who also had spread of the tumor to the liver. Chemotherapy does not work well for tumor deposits within the brain. Radiotherapy to the brain is really his best option. This treatment can often shrink down the tumor deposits within the brain for a period of time, and it can relieve neurological symptoms. In addition, a drug called decadron is often used to reduce the swelling in the brain caused by the tumor, and this can also help to relieve symptoms. However, radiotherapy is unlikely to make the tumor within the brain stay away forever.
We all wish that we could do more for patients with widespread lung cancer, but unfortunately there are no curative treatments available in this situation. If there were, I am sure that his doctors would have tried them. When "first-line" chemotherapy drugs such as taxol and carboplatin have failed, there are other "second-line" chemotherapy drugs available, which might help a bit if he is well enough to tolerate them. However, they are not curative. A tremendous amount of research is now underway to develop new agents to target lung tumor cells specifically based on molecular features of the tumor cells that distinguish them from normal cells. Some of these agents, such as erlotinib or crizotinib, have shown great promise in the treat of advanced NSCLC patients who have specific genetic mutations or translocations. We all hope that in the future there will be more effective treatments to improve the outlook for patients like your father. We only wish that we had something available today.