What is Going On?

Back in October of 2008 Melissa started feeling pain in her tailbone. Through Thanksgiving and Christmas she was feeling pain in various location in her back. By January, the pain had become so severe that she had to be admitted to the hospital. The doctors initially thought she had Valley Fever (a lung infection found mostly in the southwest). They performed a series of test’s and found out that the pain was actually being caused by cancer that had metastasized (spread) into her bones. Melissa was diagnosed with Stage IV Non-Small Cell Lung Cancer (NSCLC), otherswise known as Adenocarcinoma. NSCLC’s make up about 75% of all lung cancers.  Adenocarcinoma is the number one cause of death of cancer each year in both men and women.

When Did This Start?

No one can really say when Melissa’s cancer started. She was treated at a hospital a few years ago for HSP and it was not detected then. She has not felt completely normal for almost a year and her pain started around four or five months ago. Here is a simple time line of her diagnosis.

• Back in 2005 – Melissa was in the hospital for approximately 10 days with HSP
  • Henoch-Schönlein purpura: causes blood vessels to get inflamed
  • This probably had nothing to do with her cancer
• October 2008 – Started feeling significant pain in her tailbone
• November 2008 – Started feeling significant pain down her back
• January 2009 – Was treated for Pneumonia, still had back pain
• 01/27/2009 Admitted into Saint Josephs Hospital
  • Went in because of severe back pain
  • Evaluated for pneumonia
  • Performed MRI (w/o contrast) of the spine
  • Abnormality seen on left lung, lower lobe
• 01/28/2009 Additional tests performed
  • CT Scan
  • Blood tests
  • Mass found on left lung, lower lobe (4.6 x 3.1 cm)
  • Extensive lytic bony lesions on scapula, right clavicle and sternum
  • Extensive lytic bony lesions throughout the thoracic spine and on ribs
  • Pathologic fractures T8, left 6th rib
  • Suspicious for disseminated coccodioidomycosis (valley fever)
• 02/03/2009 Diagnosed with Stage IV Lung Cancer, type Adenocarcinoma
  • Lesions in left lung, lower lobe
  • Lesions in spine, ribs, pelvis, tailbone and leg bones
  • Very small lesions in adrenal gland
• 02/04/2009 Additional detailed scans were performed
  • CAT scan (abdonomun & pelvis)
  • MRI (brain & bone)
• 02/05/2009 ‘Family’ meeting with Dr Roberts
  • No sign of cancer in the brain or major body organs
  • Asked questions and discussed possible treatment options
  • Bone scan performed
• Released from Saint Josephs Hospital

Why Wasn’t it Found Sooner?

Strangely enough, early stages of lung cancer do not cause symptoms. As the cancer grows symptoms may or may not include a cough, breathing problems, chest pain, a hoarse voice or fatigue. Often, lung cancer is not detected at all until it has metastasized into other areas of the body as in Melissa’s case, the bones.

What is Happening Now ?

The first thing that needs to be determined is the most effective treatment for Melissa’s lung cancer. The general treatments include Surgery, Radiation Therapy, and/or Chemotherapy. Once the cancer has metastasized from the lungs to other parts of the body, it is usually to late to attempt to remove the cancer with Surgery because it is simply not possible to remove all of the small cancerous cells. If the cancer has metastasized to a few areas outside of the lungs, and is in the form of a few large tumors, those tumors can be targeted with Radiation Therapy. Melissa’s cancer has spread fairly evenly through her spine, ribs, pelvis and upper legs, so Radiation Therapy will not be performed as a way to kill all of the cancer. This will likely be used as palliative care.  Chemotherapy is used to eliminate, or slow the growth of cancer cells using certain kinds of drugs. Unlike Surgery and Radiation Therapy, which are local treatments, Chemotherapy treats all areas of the body. This is probably the treatment Melissa will receive.

Chemotherapy for lung cancer focuses on longevity and quality of life. At this time there are no FDA approved cures. However, there are many people working on cures and researchers are more confident then ever they will find one. So the purpose of the treatment is to stop the cancer from progressing, while allowing Melissa to live close to a normal life. There are many people that have been able to achieve this.

Chemotherapy for lung cancer is an out patient process usually given through the vein (some drugs can be taken orally) in cycles (a treatment period followed by a rest period). The number of cycles, the strength of the drugs, and the length of the rest period varies with treatment.  Melissa has a portal (’porta-cat’) inserted into her chest that makes injecting the drugs easier. The initial Chemotherapy ‘cocktail’ was a mix of Carboplatin & Ulimpta.  As part of Phase 2 starting June 3, 2009 Melissa’s new chemotherapy is a targeted chemotherapy called, tarceva which is a pill that is taken on a daily basis.

Other drugs may also be administered as part of her treatment which include drugs for pain, to reduce the side effects of the chemo drugs, to re-generate bone caused by the cancer, and to fight anemia.

What Can We Expect Next?

Melissa’s initial treatment period will establish a ‘baseline’ measurement. As Melissa goes through a few treatment periods, the doctors will take ‘measurements’ to compare against the baseline. The doctors may make adjustments to her treatments to improve her condition as compared to her baseline. The primary goal is to stop the cancer from spreading further while living a normal life. The secondary goal is to put the cancer into remission. If the Chemotherapy is not producing the desired results then there are more advanced, non-standard treatments that can be tried. It is important to ensure we are always prepared for the next treatment type if the current one is not working. We want to know what it will be, where it will be, who will be performing it, and what they require ahead of time so they can be prepared to start a new treatment regimen. Melissa started with the traditional Carboplatin-Ulimpta cocktail for three cycles until the doctor decided to move onto Tarcevea, the daily targeted chemotherapy pill. This was a welcome change for Melissa because the side effects are much less than the traditional chemo drugs and instead of going to infusion labs every three weeks, she took a daily pill. After six weeks of being on Tarceva and being transferred to a new oncology doctor, the decision was made to move forward with the third round of chemo called Taxotere. Taxotere is a traditional chemo drug that is administered through the IV port in the infusion lab. The common side effects include: low blood count, hair loss, nausea, fatigue, and more. Melissa did not experience all of these side effects, but the nausea and hair loss seemed to affect her the most. Melissa finished her 6th round of Taxotere and Erbitux with 2 positive petscans under her belt. The tumor in her lung shrunk down to 2.7cm. At that point, she took a needed break from Taxotere and remained on Erbitux for maintenance. She received another petscan after her trip to New Zealand in March, which showed regrowth of the cancer. This was disheartening news, but she began radiation daily for palliative care and to hopefully shrink any tumors. Melissa began her 4th line of chemotherapy treatment in May that will consist of weekly infusion with Navelbene.

Melissa was encouraged to have a second meeting with T-GEN to discuss options for clinical trials (from her Oncologist). T he issue of an MRI of the brain was mentioned, so Melissa requested to have an assesement to ease her worries of possible mets to the brain. Unfortunately, there were 3 mets that were discovered with the largest on the brain stem (1cm). Luckily, these were caught early, although she could have had these mets for months and months.

The decision was also made to have an updated CT scan. Her filter that was placed in her body to keep from having a Pumonary Embellism was found to be clogged and there was no way to replace, unclog, or clean the filter. The good thing is that since this is clogged and essentially part of her body now, the chances of getting a PE could be smaller.

This next phase will be determined by the outcome of the full brain radiation (started round 1 of 10 on 6/6/10), as well as what is exhibited on the next scan (probably take place in August). There are other options for chemotherapy and a tissue sample will be sent off to possibly determine what chemo may work best. Phase 1 clinical trials are also a viable option, although the number of studies in AZ are very limited so most likely any participation in a trial will be somewhere outside of her home State.