First line of treatment for 3 months-standard chemo- no progression
Second line of Treatment for 3 1/2 months-Crizotinib- all symptoms improved remarkably but CT scan showed slight progression in the mass in the liver so determined not working
Third line of Treatment for 2 months-Opdivo-original symptoms return (cough, fatigue, breathing difficulty). Pending CT scan to determine if working.
Question- Is it possible to return to the Crizotinib after Opdivo? Is there any data suggesting that it would either not be effective or could result in serious problems?
I’m sorry to hear that symptoms have increased while on Opdivo. In general, it isn’t recommended to return to a previous treatment on which a patient had progressed, but if there was only “slight” progression in the liver, and shrinkage or no growth elsewhere, it would certainly be a consideration, especially if there is any doubt as to whether the scan truly showed meaningful liver progression.
Another possibility is a second-generation ALK/ROS1 inhibitor such as Zykadia. It’s use in patients who have progressed on crizotinib is discussed here. It’s also possible to return to standard chemo, even the first-line regimen if there was no progression on it.
One thing to keep in mind is that it is always good to get as much benefit from each line of therapy as possible, so if progression is minor it may be best to stick with a treatment until progression is more significant than, in the words of Dr. West, a change so small that you need to squint to see it on a scan.
Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
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