AFAtinib as first line treatment

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This topic contains 4 replies, has 3 voices, and was last updated by JimC Forum Moderator JimC Forum Moderator 2 weeks, 6 days ago.

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July 24, 2018 at 12:12 pm  #1294926    

lablady

My husband was first diagnosed in 2014 with NSCLC . Stage1b with possible invasion of pleural lining. Rt upper lobe lobectomy 2014 with 3month of Chemo – Cisplatin and vinorelbin. He did a 1 year clinical trial of an immunotherapy PDL1 inhibitor. In 2018 he had a segmentectomy of Rt lower lobe for a growing nodule. A new primary cancer with an EGRF mutation. Lymphs were negative. After surgery, again on a clinical trial of the use of anticoagulant after lung surgery, a clot was discovered. In a CT to see if the clot was resolved 3 months later, the radiologist reported 2 new nodules in the right lung and 1 in the left lung along with enlarged lymph node, likely metastatic disease. EBUS revealed 1 positive node and MRI showed a 1.5mm possible brain met. The lung nodules are too small to biopsy. My husband feels totally well, no symptoms and if it was not for that clinical trial we would be none the wiser. Our oncologist has started him on AFAtinib and radiation oncologist is waiting 6-8 weeks to see what effect the drug has on this ?brain met. First week of AFAtinib was rough but he is now tolerating the drug well
I just watched DrWest’s video on the use of AFAtinib in combo with chemotherapy and it seems to give a pronounced improvement in the initial Progression Free time. 11mons vs 20mons with the combo.
Should I bring this study to the attention of the oncologist, who we like and trust? My husband is just in the first month of treatment and tolerated chemo well the first time. I don’t know if this combo approach has been tried here in Canada and we have yet to get government approval for the cost of AFAtinib, but that is only a matter of paper work. The new third generation of the drug has not yet been approved and I understand it has better brain penetration.
My husband is not as aware as I am about what he prognosis maybe and he has not made any attempt to ask, so that puts me in an awkward position if discussing # of mons.
Any suggestions?

July 24, 2018 at 3:55 pm  #1294927    

onthemark

Hi Lablady,

Welcome to GRACE. I also saw the video by Dr. West here: http://www.oncologytube.com/video/is-chemo-the-key-to-the-best-combination-for-egfr-mutation-positive-nsclc-the-data-too-good-to-overlook-(bmic-045)/10004401

and am also in Canada, stage Ib and did the cisplatin/vinorelbine adjuvant too.

I would ask your oncologist about the study’s result and if he or she could give concurrent chemo with afatinib at this point in your husband’s treatment. I would bring it up with my oncologist if I were in a similar position.

There is also the possibility down the line to get third generation Tagrisso by making a request to the manufacturer to pay for it. I think a person can get this after previous TKI treatment if they end up with the T790M mutation in Canada. Tagrisso has been approved by Health Canada for lung cancer but none of the provinces currently fund treatment with it. I have, however, read on inspire about lung cancer people receiving Tagrisso this way in Canada.


10/2015 Chest xray found a nodule as part of a physical (no symptoms).
01/2016 Upper left lobe lingula preserving lobectomy stage 2b for 1.9 cm invasive adenocarcinoma with additional 2 mm AIS nodule found in pathology.
03-05/2016 Sixteen weeks of adjuvant cisplatin/vinorelbine.
07/2016 Durvalumab adjuvant clinical trial discontinued after 1st dose knocked out thyroid.
12/2016 Revised to stage 1b (due to VPI) after new guidelines for multifocal lepidic lung cancer.
07/2019 Next scan.

July 24, 2018 at 7:16 pm  #1294928    

lablady

Onthemark,
Thanks for the quick reply. The one thing about Grace, it lets you know you are not alone!
Thanks also for some tips on how to talk to our oncologist. Our next visit is in two weeks. I will bring up the study to her in general term and try not to be specific about prognosis as I don’t think my husband wants details because clinical he feels totally well. That puts me in an awkward spot. I want the best chance for him but do not want to raise doubts about his treatment plan if it is his best option.
We don’t know what specific EGFR mutation he has, but I will try to get that info at the next visit.
I had not heard about Tagrisso. So that is something I will look into if he has the T790M mutation.
If I understand the study NEJ 009 , it was done using gefitinib , which is a first generation drug. AFATINIB is a second generation drug. Osimertinib is the third generation, which is used in USA , but not yet approved in Canada. I checked on the net, but could not find anywhere in Canada where the combo therapy was being done.
We are located in Hamilton, Ontario and are very lucky to have an excellent Cancer center right here in the city. That makes treatment a lot easier.

July 25, 2018 at 9:01 am  #1294929    

onthemark

Hi LabLady,

That’s a delicate situation with your husband. You know him best and no one on the internet can really give you advise.

Just to clarify Osimertinib and Tagrisso are the same third generation drug and was approved by Health Canada in 2018 for lung cancer.

“AstraZeneca Canada announces that Health Canada has granted full approval (Notice of Compliance) for Tagrisso¬ģ (osimertinib) for the treatment of patients with locally advanced or metastatic epidermal growth factor receptor (EGFR) T790M mutation-positive non-small cell lung cancer (NSCLC) whose disease has progressed on or after EGFR tyrosine kinase inhibitor (TKI) therapy. “

https://www.newswire.ca/news-releases/tagrisso-osimertinib-receives-full-health-canada-approval-for-targeted-treatment-of-non-small-cell-lung-cancer-671924123.html

None of the provinces will pay for it yet though, but it is possible to get in case of progression on Afatinib, so you do have another TKI backup down the line (in case the resistance mechanism that develops is T790M) rather than just chemotherapy.


10/2015 Chest xray found a nodule as part of a physical (no symptoms).
01/2016 Upper left lobe lingula preserving lobectomy stage 2b for 1.9 cm invasive adenocarcinoma with additional 2 mm AIS nodule found in pathology.
03-05/2016 Sixteen weeks of adjuvant cisplatin/vinorelbine.
07/2016 Durvalumab adjuvant clinical trial discontinued after 1st dose knocked out thyroid.
12/2016 Revised to stage 1b (due to VPI) after new guidelines for multifocal lepidic lung cancer.
07/2019 Next scan.

July 25, 2018 at 9:21 am  #1294930    
JimC Forum Moderator
JimC Forum Moderator

Hi LabLady,

As onthemark stated, you know your husband well and are in the best position to judge how he might react to such a discussion. From my own experience with my late wife’s lung cancer, there was just one discussion with her oncologist in which he mentioned that a certain regimen had provided a significant improvement in overall survival, three months. Her reaction to the concept of three months being something to get excited about was immediate and obvious to both me and her oncologist, and we never spoke of time frames again.

So perhaps you can bring the study results to the attention of your husband’s doctor by providing him/her with a link to Dr. West’s video and referring to better results without including references to time frames.

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

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