Progression on Tarceva - T790m negative

jewel75
Posts:3

Greetings all,
I am seeking any advice /knowledge the inspire community may have regarding treatment following progression on Tarceva.

I am been lucky enough to get 3 1/2 years out of Tarceva after being diagnosed with NSCLC stage 4 EGFR exon 19 deletion.  My recent PET showed progression and I was able to have a needle biopsy on one of the nodules.  This showed that I am still EGFR exon 19 but unfortunately am T790m negative.

I am currently have radiation to my right chest which covers the area of progression.  I can only have 15 fractions as this is a previously treated area (30 fractions in 2013).

My Onc is suggesting either Afatinib or Opdivo.....  I should also note there wasn’t enough tissue to run for MET or anything else.

I’m in Australia, so don’t have access to some of the recently FDA approved tki’s.

Does anyone have experience or thoughts regarding this.

Many thanks in advance.  Xx

Forums
Stage IV NSCLC

Reply # - November 5, 2018, 07:38 AM

Jim C GRACE Co…
Posts: 147

GRACE Community Outreach Team

Hi jewel75,

I'm sorry to hear about your progression after such a good run with Tarceva. There are a few considerations, but I think the first is the question of the extent of the progression. If there is cancer in multiple locations and only one is progressing, it's not unusual to treat that one area locally (radiation or surgery) and continue the initial TKI if it is well-tolerated. So you could finish radiation and continue Tarceva to see if the radiation successfully eradicated the cancer cells that weren't responding to Tarceva.

Afatinib has not proven to be particularly effective after progression on Tarceva, although it has shown better results in combination with erbitux (Cetuximab). The caveat with regard to that combination is that its toxicity profile can tend to be very difficult for a good number of patients.

I don't know where in Australia you are, but on clinicaltrials.gov I did find one study of an investigational EGFR TKI in Victoria: https://clinicaltrials.gov/ct2/show/NCT02335944?term=progression+tki&recrs=ab&cond=lung+cancer&cntry=AU&rank=2

The response rate for immunotherapy in patients with activating EGFR mutations tends to be lower than for EGFR-negative patients, but it is an option, especially if PD-L1 expression is at least somewhat high.

In this age of targeted therapies and immunotherapies, which tend to get all the press (and much of the research funds), it's important to remember that EGFR-positive patients tend to respond well to traditional chemotherapy, so that is an option that shouldn't be ignored. 

I hope that the area of progression responds well to radiation (keeping in mind that it can take some time, perhaps a couple of months, to accurately judge the effect of that radiation) and that whatever treatment you choose is effective and well-tolerated.

Jim C Forum Moderator 

Reply # - November 5, 2018, 04:49 PM

jewel75
Posts: 3

Thanks for your reply Jim.

i only have 3 spots of progression - the largest is 17mm.  They were unable to SABR unfortunately as this is the same area that was previously treated with radiation in 2013.  As it is a previously treated area, I can only have 15 out of 30 fractions which they explained was a palliative treatment and don’t expect it to completely wipe out the tumours - just slow growth somewhat.

Yes, I agree - neither the Afatinib or Opdivo seem like particularly good options.  My PDL1 expression is less than 1%.

 

i would be keen to try Targrisso, even though I’m T790m negative but it’s not approved in Australia at all yet.

I did have chemo back in 2013 when I was initially diagnosed and it only reduced my primary tumour by about 20%.  Following chemo, my right lung was completely removed and followed up with radiation.  I was in remission then for about 12 months before I had progression and went on Tarceva in 2015.

Thanks again, I appreciate you sharing your knowledge and support.

 

Many thanks

 

Reply # - November 6, 2018, 09:41 AM

JanineT GRACE …
Posts: 611
GRACE Community Outreach Team

Hi Jewel, 

I don't know if you've seen or heard some of the latest info on combo chemo/immuno treatments. This is a video by Dr. West explaining data from a recent trial, https://cancergrace.org/post/lung-cancer-video-library-does-immunotherapy-work-patients-driver-mutations

I hope you do well.

Janine

I joined GRACE as a caregiver for my husband who had a Pancoast tumor, NSCLC stage III in 2009. He had curative chemo/rads then it was believed he had a recurrence in the spine/oligometastasis that was radiated. He's 10 years out from treatment.

Reply # - November 6, 2018, 02:25 PM

jewel75
Posts: 3

Thanks Janine,

i have mentioned that combo to my Dr and he wasn’t keen...  I’ll discuss with him again, now that I have seen the video.

 

many thanks 

J

Reply # - November 6, 2018, 03:30 PM

JanineT GRACE …
Posts: 611
GRACE Community Outreach Team

It may be helpful to have this info from the link below.  To access most of the info (complete abstract and slides) one needs a subscription which your onc is likely to have.  

https://meetinglibrary.asco.org/record/160275/abstract

I joined GRACE as a caregiver for my husband who had a Pancoast tumor, NSCLC stage III in 2009. He had curative chemo/rads then it was believed he had a recurrence in the spine/oligometastasis that was radiated. He's 10 years out from treatment.

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