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    • Dr West I'm sorry to hear she's having such a difficult time. The short answer is that I've already posted all of my thoughts on the GRACE website. chemotherapy is the cornerstone for patients who don't have a driver mutation like EGFR, ALK, or ROS1. It's reasonable to try immunotherapy -- that's pretty clo (More)
    • I forgot to say she also has 25%PDL1 staining. (More)
    • Dr. West, My mom (71) had recurrent pneumonia for 10 months and since December DX mucinous AIS with BAC behavior stage IV. She has Kras and CDKN2A mutations, 6.5 lower left lobe and 3.5 lower right lobe tumors and of course other small nodes and multifocal ground grass opacities. After 2 cycles of A (More)
    • Dr West Not every patient has a good response to Tagrisso. The response rate is about 60% in this setting. It is quite possible that only a small amount of the cancer cells are actually positive for T790M. At this point, we don't know exactly why some patients respond and others don't. I can't give medi (More)
    • Dr. West, My over 80 year old mother had stage 3b disease with exon 19 deletion, did well on Tarceva for 10months, and then tested positive for t790m mutation in a recurrent supraclavicular LN that reappeared. She was on Tagrisso for 5-6wks and on follow up has rising tumor marker with new pleu (More)
    • Dr West Toxicity/metabolism differences between Japanese and predominantly Caucasian populations, I understand. However, the global ALEX trial results with full dose (outside of Asia) alectinib should be available in the next year. -Dr. West (More)
    • Dr West I haven't heard anything further about osimertinib combinations or any results from TIGER-3 -- in fact, my understanding is that all of the rociletinib clinical research has been shut down. My general approach has been to move to chemo-based treatment in patients with an EGFR mutation and T790M-n (More)
    • Thank you, Dr. West. I literally read and re-read every thing that you write to make sure I'm doing everything that I can for my mom! I can't thank you enough for this service! It's such an interesting field of medicine that we can have So many choices to choose from, although it's also stressful (More)
    • Dr West I don't know of anything in particular -- you or her doctor may be able to find something searching on I must confess, however, that I would consider it far more likely that chemotherapy will be beneficial than to try a clinical trial as the first treatment after Tarceva in a pa (More)
    • Dr West Good luck. Yes, I put together the algorithm to help give a framework to people that outlines how I and some other experts would be inclined to manage cases such as yours. -Dr. West (More)
    • Hello again, Thank you for your guidance with the T790 mutation testing. My mother's pleural effusion made the lung biopsy difficult to do and apparently the lung nodules were too small to biopsy (although there are a Lot of them), so her pleural fluid was tested. Apparently the pleural fluid had c (More)
    • Hi Dr West? Thank you for clarifying this for me. I also want to wait for my next CT before considering if SBRT is the way to go I do not believe it is. I have 9 spots 3 of which were considered significant until the pet scan showed an SUV of less than 1.9 in eight of the nine spots. I had a 4 (More)
    • Hello Dr. West, Thank you for your, as always, sage advice. I'm sorry that my second 'draft' reply didn't go through, and I forgot to mention in my first reply that my mom has a new large pleural effusion (which apparently makes the tissue biopsy difficult). An expedited T790 mutation is becomi (More)
    • Dr West Tagrisso will not be covered if the tests are negative for T790M, so it's not feasible to expect to just try it. It's perfectly reasonable to start with a liquid biopsy test of plasma. If it's positive, you can move to Tagrisso, but if it's negative, you can do a tissue biopsy. It's also often p (More)
    • Hello Dr West, Thank you for your continued education! My mother is a 72 yo non-smoker who developed stage 4 non-small cell lung cancer (pneumonic form; no mets outside of the lung) 1 year ago. She was EGFR positive, so was on Tarceva for the past 12 months. Unfortunately, she has now developed Tar (More)
    • Is there a particular reason the daily dose in Japan is only half of the current standard outside of Asia? (More)
    • Dr West The standard of care in this setting is very clearly combination chemotherapy with a platinum doublet for patients who are fit enough for chemo and don't have a driver mutation like an EGFR mutation or ALK or ROS1 rearrangement. A clinical trial is a fine alternative, but the standard of care is che (More)
    • We decided to have my mom tested for PD-L1 expression after reading a number of articles. The test came back negative. She is scheduled to start a clinical trial for nivolumab + ipilimumab as first-line treatment. My mom is NSCLC stage IV. Based on her negative result, are there other options we sho (More)
    • Dr West These are issues that are better discussed with your own oncologist, as I've not seen the scans and have none of the relevant details. -Dr. West (More)
    • Thank you very much ,I appreciate very much your quick response. Does your answer apply also to the fact that progression is evident in the previous ct. scan in March 2016,compared to a ct. scan 6 months earlier ? The no progression refers to the period,between April 2016 and July 21,2016 ? Thank (More)

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