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Tyrokinin 100Mg Tablet Questions

Hello, My wife is Chinese and her relative in Dalian, China is suffering from Cancer. We are traveling to China in March and they have requested to carry 2 bottles of Erlonat150, 30 capsules. They have provided the prescription but government hospital in China only provides prescription in chinese / mandarin language but with govt stamp. I need guidance on how can I buy the medicine in India and carry the medicine to China.

Dr. Jawahar Ticku 89% (733 ratings)
MBBS, MD - Medicine, MD - Oncology, Fellow of the Royal Society of Tropical Medicine and Hygiene (FRSTM & H)
Oncologist, Delhi
There is no problem in getting this medicine in India You can also take the prescription from any oncologist and by the drug. The basic name is Erlotinib 150 mg.
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Hello, my aunt is using erlotinib 150g. She's been taking it for a month now and is on the second month at the moment. Could you please let me know if she needs gaps in between the bottles? Many thanks.

MBBS, MD - General Medicine, DM - Medical Oncology
Oncologist, Mumbai
Hello Lybrate user patient do not need a gap between the two bottles. Please take tablet everyday after food look for side effects like diarrhea, rash.
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Hi Sir, My father-in-law's recent CT scan reports after 4 cycles of chemo suggest that there is a mild decrease in tumor size and there is no new lesion seen. Doctor suggested erlotinib for 1 month as he is having EGFR mutation in axon 19. He is absolutely normal. Is dat possible that blood reports are normal even if person is not responding after Chemotherapy?

Dr. Anand Narayan 92% (86 ratings)
MD - Oncology
Oncologist, Coimbatore
I infer that your Father in law has lung cancer. It is absolutely possible that the patient has a normal blood counts during disease progression.
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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 Poonia 86% (36 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 targeted medicines, which includes Erlotinib/Gefitinib or Afatinib. Usually patients with such mutation as in your case responded but unfortunately not for the indefinite period but averagely 6 to 10 months. On progression, you have to get the gene profiling to see the change in the mutational status. You can refer to NCCN guidelines or American cancer society information. 3. Your father should receive, targertd therapy only, no chemotherapy for sure. It is proven better than chemotherapy in terms of Quality of life and progression free survival (average duration to progress on Treatment) 4. Regarding etiology or causation of lung cancer, HBOT not implicated for such cancers. And more so any carcinogen if cause cancer, it has a reasonable time to show its effects, like you must have seen chronic (long term) smokers will develop lung cancer. HBOT cause local hypervascularization and produce free radicles, so many studies tried see its role as a carcinogen, but tilll date it is not proven carcinogen as per ICAR. Hoping it solves your query. It is nice to see a son is keen and read in-depth about his father's illness. Good luck for further treatment.
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My father (age 56 years & weight 70 Kg) has been diagnosed with Non-Small Cell Lung Cancer, Stage 4 with primary tumour in his Left Upper Lobe 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. It was categorised as Stage 3B as the pleural effusion was para-malignant and no metastases was noted in any other body parts. He was started with CCRT treatment which concluded on 05 May 17. During the treatment he was given daily dose of radiation therapy to his primary tumour site in his left upper lobe 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”. His doctor has started my father on Erlotinib 150 mg OD since 26 Jun 17. My father has developed Post Obstructive Pneumonia in his left lung and there is consolidation in his entire left lung. This is evident from a recent X-ray. He is having difficulty in breathing, takes short & fast breath, sweats a lot, feels cold, has irritation in his throat and gets tired very fast. He also has issue eating solid food and had greatly cut down his diet. He was started on Oral antibiotic for a week, but did not respond to it. He is admitted in the hospital and is being injected with antibiotics through IVs and injections. His condition remains to be same with no much improvement. His SPO2 level is also low at 90-92%. My father also has severe lower back pain and has also been diagnosed with progressive paraparesis. Because of the back pain he is not able to lie down on his back. A recent screening of the entire spine has confirmed that there is no evident compression of the spinal cord but clearly shows a number of metastasis in the vertebrae (Clivus, Dv2, Lv2, Lv4 & Tail Bone). There are plans to start him on Radiation Therapy for his spine. Is this:- 1.The right therapy for him? 2.What other option do we have for treating his spinal mets? 3.Can Radiation to treat his mets in the vertebra, damage his spine and cause further paraparesis? 4.Could you please suggest anything towards treatment of my father?

DM - Oncology, MD - Internal Medicine
Oncologist, Noida
If there is localized backache than radiation treatment may be the right choice for the time being. Though it won't cure lung cancer. It may help in resolving the local pain. Patient is on erlotinib since 26-6-17. The medicine should have shown some benefit by now. Continue it for another one month. It may be stopped for the time /days spinal radiation is given by your treating doctor. Add bisphosphonates taking care of creatinine and calcium levels. Ask for appropriate amount of analgesics. Given the history of spinal cord atrophy, yes there is risk of further damage to spinal cord by radiation. The dose, fractionation and the areas not to be irradiated will be decided by treating radiation oncologist. For EGFR mutant erlotinib is one of the best drugs. Take care of nutrition. It's important.
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Hello I am from dhaka, bangladesh. My mother (54 years) was diagnosed with lung cancer 4th stage (metastatic adenocarcinoma) one month ago. She was going through dry cough for like 3 months so further investigation like biopsy confirmed it's lung cancer. But we didn't rely on our country's (bangladesh) report. So we went to apollo specialty hospital, chennai, india an ran pet ct scan followed by tapping as she had fluid in her lungs and then again biopsy. This time during the biopsy, my mother caught pneumothorax. So the doctor admitted her to emergency and inserted a tube in her backside. They called it drainage system. This will let the fluid come out of her lungs along with air that entered through pneunothorax. They kept the tube for 3/4 days and then released it. Now the doctor asked to do the chemotherapy. I get scared whenever I hear about chemotherapy. Is it the only way out? will this chemotherapy be effective for a long time? I did few researches over internet about the survival rate of lung cancer patient and it seems to be very low. Now I will write you the comments of pet ct scan and biopsy. 1. Pet ct scan: a) hypermetabolic primary mass in lingula b) hypermetabolic pleural metastases with effusion in left hemithorax. C) hypermetabolic metastatic paraaortic with non fdg avid left hilar nodes. D) no other demonstrable metabolically active disease in whole body survey. F) imaging is suggestive of bronchogenic malignancy in lingula segment of left lung with nodal and pleural metastases (t2an2m1a- stage iv) 2. Biopsy report: a) biopsy from left lung mass: consistent with adenocarcinoma, grade ii: ct guidedbiopsy from left lung mass. So what do you think, is it controllable? it is very worse? I want her to live. What kind of chemotherapy would you suggest? apart from chemo, is there any other way to treat or control it along with the chemo? I heard there is some drug called terceva. Internet says it treated their fourth stage cancer. I don't know but I am seeking your help regarding this

Dr. Harris Mahammad Sepai 91% (483 ratings)
MD - Radiation Oncology, MBBS, DNB (Radiotherapy)
Oncologist, Howrah
Thanks for providing good patient profile. From your reports, the only site of distant metastasis is paraaortic lymph nodes. Yes you are right that stage iv lung cancer has a poor prognosis. However a certain subpopulation of these patients still have a chance of favorable outcome. However this depends on number of things 1. Histology (adenocarcinoma favorable) 2. General condition of patient (performance status) 3. Presence of egfr mutations (favorable prognosis) 4. Absence of solid organ involvement (good prognosis). So egfr mutation study is next step. You have also asked any alternative option to chemotherapy. Yes there is a option. That is erlotinib (tarceva). But the tumor has to be egfr positive. Erlotinib is now recommended for egfr positive metastasic adenocarcinoma of lung (without any concomitant chemotherapy) until progression of the disease.
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