My wife 70/ y/o nonsmoker.
1) dx’d stage IV NSCLC, left lung, EGFR + 3/2011.
2)Tarceva continuously for 5 years 2011-2016-excellent response for 1 year.
3) Chemo with Carbo/Alimta/Avastin for local recurrence 8/2012–good response.
4) Repeat chemo Carbo/Alimta/Avastin for local recurrence 11/2014–again good response.
5) Avastin maintenance 12/2014-12/2016
6) Needle bx 12/2016 for local recurrence-results include EGFR+, T790M-, PD-1 0%
7) All Rx (Tarceva, Avastin D/C’d 1/2017 pending Rx decision.
Disease is still confined to left chest.
What would be options when systemic Rx is again indicated–Tagrisso? Checkpoint inhibitor,(one or two agents), chemo (again),. . .other????
We are very grateful that my wife has responded, at least temporarily to each Rx thus far. We never would have expected her longevity to date when dx was first made.
I’m sorry to hear that your wife’s cancer has recurred. After six years and so much previous treatment, there is no clear cut option. Of those you mentioned, immunotherapy would probably be least favored, given its low response rate in EGFR+ patients. Returning to chemo is a strong option, whether that includes Alimta or another agent such as docetaxel. And a third-generation TKI such as Tagrisso may be effective despite the lack of a T790M mutation. The other possibility would be a novel agent in a clinical trial, if she can qualify for entry.
If the disease is limited to one or two spots, some oncologists would even consider radiation.
Good luck with the chosen path.
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