immunotherapy for small cell lung cancer transformed from egfr

Portal Forums Q&A, Ask Us New Questions immunotherapy for small cell lung cancer transformed from egfr

This topic contains 4 replies, has 3 voices, and was last updated by catdander forum moderator catdander forum moderator 4 days, 13 hours ago.

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January 12, 2018 at 7:15 pm  #1293774    

kkh130

Hi,

I know immunotherapy drugs are not effective for egfr+ lung cancer patients. What if the egfr+ nsclc mutates the cell type and transforms to small cell lung cancer, will that increase the chance for the immunotherapy drugs to work? Small cell lung cancer has high mutations and high mutation burden, right? I’ve heard cancer with high mutational burden is more likely to respond to immunotherapy drugs. I would like to know if any oncologists have treated such patients with immunotherapy (mono or combo?) and what are the results.

I am looking for the next treatment options. I feel the chemo carboplatin/etoposide not working for me because I start having severe pain on my elbow (I guess that could be a bone met). I just finished one cycle of the chemo. The second cycle got postpone for 1 week because the nurse reported to my oncologist I have upper respiratory symptoms (they are afraid I might have viral or pneumonia infection). It is very frustrated for me this week. I hope I am able to get some helps from this website.

Thanks,

Kkh


Diagnosed in 2014 stage 4 nsclc. EGFR+ (also positive for t790m). 1 year on Tarceva, then 8 months on Rociletinib, then WBR following by 7 months on Tarcrva pulse/carboplatin/avastin/alimta, then 7 month on Tagrisso. Was diagnosed leptomeningeal metastasis Nov 2015. Now has 10cm big tumor and multiple nodules with different sizes. Most recent guardant test (Feb 2017): TP53 C277F 29.8  EGFR Exon 19 Deletion 20.1  EGFR AMP ++  MET H1112Y 0.1  MET AMP +  FGFR1 AMP ++  PIK3CA AMP +  CCNE1 AMP ++  BRAF AMP +  MYC AMP ++  Additional Alterations  BRCA1 R7C 0.3  MTOR K1197E 0.2  NF1 V1762V 0.2  MET E436K 0.1  JAK2 V617F ND  MAP2K2 E66K ND. Dec 2017 liver biopsy reports my egfr non small cell lung cancer got mutated and changed to small cell lung cancer.

January 13, 2018 at 5:56 am  #1293775    

cards7up

I don’t know of any treatable mutations found in SCLC and the TMB involves your cancer load not the type of cancer you have. Are you in the US? Wishing you the best. Take care, Judy
http://www.ascopost.com/issues/november-10-2017/tumor-mutation-burden-shows-promise-as-a-response-biomarker-in-small-cell-lung-cancer/


Stage IIIA adeno, dx 7/2010. SRS then chemo carbo/alimta 4x. NED as of 10/2011.
Local recurrence, surgery to remove LRL 8/29/13. 5.2cm involved pleura. Chemo carbo/alimta x3. NED

January 13, 2018 at 7:26 am  #1293776    

kkh130

Yes I am in U.S. Any doctors available to make a comment?

Thanks


Diagnosed in 2014 stage 4 nsclc. EGFR+ (also positive for t790m). 1 year on Tarceva, then 8 months on Rociletinib, then WBR following by 7 months on Tarcrva pulse/carboplatin/avastin/alimta, then 7 month on Tagrisso. Was diagnosed leptomeningeal metastasis Nov 2015. Now has 10cm big tumor and multiple nodules with different sizes. Most recent guardant test (Feb 2017): TP53 C277F 29.8  EGFR Exon 19 Deletion 20.1  EGFR AMP ++  MET H1112Y 0.1  MET AMP +  FGFR1 AMP ++  PIK3CA AMP +  CCNE1 AMP ++  BRAF AMP +  MYC AMP ++  Additional Alterations  BRCA1 R7C 0.3  MTOR K1197E 0.2  NF1 V1762V 0.2  MET E436K 0.1  JAK2 V617F ND  MAP2K2 E66K ND. Dec 2017 liver biopsy reports my egfr non small cell lung cancer got mutated and changed to small cell lung cancer.

January 13, 2018 at 7:41 am  #1293777    
catdander forum moderator
catdander forum moderator

Here’s a quote from the link ASCO post in Judy’s post, “In contrast to non–small cell lung cancer (NSCLC), programmed cell death ligand 1 (PD‑L1) tumor expression has not been a useful biomarker for SCLC, with most SCLC tumors being PD-L1–negative. Emerging data in NSCLC have suggested tumor mutation burden may be an important parameter of treatment response; this was further explored in SCLC.”

You may need to find a trial to be eligible to get an immunotherapy combo, but I’d work to find a way to get a chance to try it. In the US if there is a promising treatment that is FDA approved drug that isn’t specifically for a type of cancer without many treatment options like sclc but has shown efficacy promise then it’s reasonable to have you onc have to petition the insurance company more than once with permanent info like the article from ASCO to get an approval.

Please don’t assume anything about your arm pain. Mets to the bones in the arm are rare in lung cancer. As I said in an earlier post it’s important to notify your oncology team with new or worsening symptoms.

All best,
Janine

January 13, 2018 at 8:02 am  #1293778    
catdander forum moderator
catdander forum moderator

The following link is to several video posts on sclc. The first are most up to date on new trial info for treatment options. Note that the oncologists comment on the side effect profile being more harsh for those with sclc than other cancers and take that into account when planning with their patients who may have quickly advancing disease. Unfortunately it may be that your lung complications could preclude you from using these treatments or trying a single agent instead of a combo.

http://cancergrace.org/lung/tag/sclc/

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