Xovoltib 50mg Tablet Health Feed

Asked for Male, 46 years old from Noida

My mother age 68 years has been diagnosed for Metastatic poorly differentiated adenocarcinoma as per report dtd 12-Mar-2018. The Mri dorsal spine dtd 13-feb-2018 shows collapse of d3, d7 vertebral body. Lesions on D3, D7, D12 spinal area. PET CT report 23-feb-2018 is also available. She is under the treatment of Doc. from Dharamshila hospital. According to them all treatment is going to be palliative, no cure is available. Accordingly, she was advised 10 RT and 6 chemotherapy. RT has been completed. EGFR, ALK, ROS1 by fish, PDL1 by ihc reports have come and EGFR mutation is positive. The doctor has advised Xovoltib 40 mg (afatinib dimaleate)/ Geftib 250 mg (gefitinib). No CT is to be done. After RT she has difficulty in swallowing food. Earlier she was taking Dexona 4 mg/Forcan as advised by once radiologist Dr. , after RT was done. She Has intermittent fever around 100. Has started reported pain and stiffness in back for the past few days. Right now, she has pain in her upper back and shoulder, though not very acute. She has difficulty in holding up things, but is currently active and mobile. Food habits are moderate to light, there is no change in that. No significant weight loss is observed as of now. She is a patient of High BP, has glaucoma and cataract also. She has developed slight incontinence now, and bowel movements have become very irregular. If any more information is required please let me know. I shall be extremely grateful for your support and advise in this matter.

Dr. Nikhilesh Borkar94%(1011 ratings)

MBBS, M.S. General Surgery, M.R.C.S. Eng...read more

Oncologist•Mumbai

I presume she is lung cancer patient, although you have not mentioned the same (as you wrote she is EGFR positive, ALK4 and ROS1 and PDL1 are done in lung) Geftinib is an EGFR inhibitor given in lung cancer EGFR +ve, with good response rates. It does cause diarrhoea and rash in a few patients though.
If she has other symptoms, treat her symptomatically. We try to prolong their life by giving palliative treatment, which may be months to few years in exceptional cases. But cure is not a target...more

Health Query

Hi doctor, my father is diagnosed with ca. Lung - adeno carcinoma with egfr mutation stage 4 advanced with plural effusion as origin. He had severe cough and also fluid formation in left lung which almost half filled the left lung. The fluid is removed by surgery and then further tests are carried out. Ct, histopathology, ihc, and gene analysis were done. Medical oncologist suggested afatinib 40 mg and it is working fine since 3 years as his gene analysis showed above 90% mutation that can be controlled by gefitinib and only 3% comprises of t790m which may not work and develop resistance later. Last week pet scan shown no signs of tumor, however cea continue to be above 24-26 over last 6 months. However, afatinib 40 mg is too expensive drug and to continue using and has become problematic for the family to support using this medicine. Can we can switch to erlotinib 150 mg or gefitinib instead of afatinib? Will this give same results now as afatinib? What are the risks involved? Please advise alternatives that are cost effective.

Dr. Guru Prasad Mohanty87%(195 ratings)

MD - Radiotherapy

Oncologist•Vadodara

Sorry to know about the condition of your father. Afatinib is better than erlotinib or gefitinib with respect to results but is costlier. I would suggest you discuss with your treating oncologist and plan ahead.

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Asked for male, 57 years old from Mumbai

My father has been diagnosed with Non-Small Cell Lung Cancer, Stage 4 with primary tumour in his Left Upper Lung and metastasis in Liver and Bone. The biopsy report has confirmed it to be adenocarcinoma. The cancer was detected while he was admitted at a hospital in Mumbai and was undergoing treatment for Acute Paraplegia which happened on 02 Nov 16, due to arteries-Venous Fistula at D-10 level resulting in oedema/ ischemia of the spine from D-5 to Conus. After two failed attempts of embolization, towards treatment of the AVF, surgical clipping of the fistula was undertaken on 10 Nov 16. As part of post-operative rehabilitation therapy for his paraplegia, he was given 65 session of Hyper-basic Oxygen Therapy at 2.4 ata pressure for about two and a half month and about two hour of Physiotherapy for the same duration. My father was recovering well and had started walking with the help of support (walker). MRI of the spine taken in mid Jan & Mid June 2017 indicates that the spinal cord oedema had improved significantly, although atrophy of the spine cord is still present. He complained of wheezing and breathing difficulty and towards ascertaining the cause a X-ray was taken on 23 Feb 17 which showed massive pleural effusion in his left lungs. A series of tests followed with the ultimate result as NSCLC Stage 3B. He was started with CCRT treatment which concluded on 05 May 17. During the treatment he was given daily dose of radiation therapy using IGRT (60 Gy/ 30 #/6 weeks) and weekly chemotherapy with paclitaxel (150 mg) & Carboplatin (300 mg) for 6 weeks. Despite the treatment, the cancer is advancing and has now spread to Liver and Bones as brought out in his latest PET CT report. Lung tissue which was obtained during CT guided biopsy conducted in the month of Mar 17, before the CCRT treatment was started, has tested positive for EGFR mutation – “E746_A750del is detected in EXON 19 of EGFR gene”. The medicine oncologist has however said that the gene profiling of the primary tumour tissue is not sufficient for starting Targeted Therapy and gene profiling of a tissue obtained from any of the metastatic site is necessary for the same. Three procedures have been undertaken to obtain tissue sample from the metastases site, twice from the liver and once from the pleural deposits, and all the three times the cancerous tissue could not be obtained. Due to non-availability of conformed cancerous tissue from the metastases site, a firm treatment plan has yet not been made for my father. In the meantime, the doctor has recently started my father on Erlotinib 150 mg OD as there has been considerable delay in his next phase of treatment due to non availability of metastases cancerous tissue. Could you please help me by answering the following:- 1.Can you suggest anything towards treatment of my father? 2.Is gene profiling of tissue from a metastases site absolutely necessary for starting targeted therapy for my father? 3.I read online that Erlotinib or Afatinib can be used as Targeted Therapy for patient with EGFR Lung cancer mutation. Is this true? If yes, will a daily tablet of these drugs be sufficient for his next phase of treatment, or a concurrent conventional chemotherapy is also required? 4.Can 65 session of Hyper-basic Oxygen Therapy at 2.4 ata given at a stretch of about 80 days, with a daily dose of 02 hour be a cause of his cancer? I have read it online that the oxygen free radical produced during HBOT treatment can cause cancer.

Dr. Dharma Ram Poonia87%(38 ratings)

MS, DNB (Surgical Oncology)

Oncologist•Jodhpur

Hi lybrate-user, You summarize the case very well. I understanding of your case says, he has Ca lung adenoca, treated with dCTRT, that progressed and now disseminated disease, which is not curable by any means. The goal of the treatment in such cases would be palliative only, which means to increase longevity without causing much side effects of the drugs and reduce his problem. Now going towards your questions, 1&2. At this juncture, Gene profiling is not necessary for me but to start the EGFR ...more

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