Immunotherpy for EGFR mutation patients

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This topic contains 3 replies, has 2 voices, and was last updated by JimC Forum Moderator JimC Forum Moderator 12 months ago.

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November 27, 2016 at 8:39 am  #1289267    

zhengchenji18

Hi,

My dad was diagnosed with stage IV NSCLC with bone metastasis about Sept 2013.
He started taking Irressa in Nov 2013.
In Feb 2015, he progressed on Iressa and entered the AZD9291 trial.
Currently, the 2nd EGFR inhibitor AZD9291 is working well and he is stable.
It’s been close to two year since he started taking AZD9291, which is amazing but also worring for me.
Eventually, he will progress on AZD9291 and we will have to explore options.

I understand most of the immunotherpy drugs are not effective for EGFR mutation patients.
Also, there are single agents like Keytruda and combination of agents.
Just wondering what are the options currently available right now.

Many thanks!
Fischer

November 27, 2016 at 9:07 am  #1289268    
JimC Forum Moderator
JimC Forum Moderator

Hi Fischer,

It’s great to hear that your dad has gotten such a good response from AZD9291. It is true that immunotherapy response rates for EGFR+ patients tend to be lower than for patients with more complex mutational characteristics, such as those with a significant smoking history. Dr. West and his colleagues discussed that issue in this podcast.

At this time, the preferred path would probably be standard chemotherapy, to which EGFR+ patients tend to respond well. On the other hand, there are trials looking at immunotherapy combinations, as well as research into overcoming EGFR TKI resistance and increasing immunotherapy response for EGFR+ patients. So at the time when your dad needs to change treatment (hopefully a long distance in the future!) we may have more data and better options available.

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

November 27, 2016 at 4:14 pm  #1289269    

zhengchenji18

Thanks for the fast reply.

Since my Dad have EGFR mutation, I just want to get a bit more information on what are the current research going on. I saw the video below where there are trails going on combining AZD9291 with other drugs.
Should he seeks these options right now? These are the research you are referring to, correct?

November 27, 2016 at 4:39 pm  #1289270    
JimC Forum Moderator
JimC Forum Moderator

Hi Fischer,

I can see much reason to join such a trial when the current line of treatment is keeping the cancer under control. If he did so, and his cancer remained stable, would you attribute the success to the combination, or the AZD9291 which is already providing that benefit? Adding another agent if the cancer begins to progress is certainly an option, especially if the progression is relatively slow. In the meantime, more data may become available to help determine which drug(s) may provide the greatest benefit in combination with AZD9291.

Finally, there is the general principle that you like to get the maximum benefit from each line of therapy, so staying with an agent that is effective and well-tolerated is usually preferred, even in the face of slow progression. “Bad brakes vs. no brakes”, as Dr. West is fond of saying.

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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