My mom has been living with nsclc for 10 years. She has been on a 75 mg dose of Tarceva for 8 years with very little progression in her lungs but has had mets to 3 places in her spine over the last two years and most recently to a place on her hip. She is undergoing 10 days of radiation treatment to her hip and they feel very optimistic about alleviating her pain in that area. She has a lesion on T-8 that was \ treated last February with stereotactic radiation but she is having pain in the same area that is similar to how it felt before radiation. What can we anticipate in terms of options going forward? Are there any trials that would possibly be a good fit?
Thank you so much for your time and your information.
It’s remarkable that she has been doing so well for so long on Tarceva (erlotinib) — that’s terrific, though I’m sorry she’s having pain again after prior radiation.
The first issue is to get a better sense of whether this really progression. Of course, I understand your concern about her pain recurring, but we’d really want more conclusive evidence before undertaking a new treatment with potential side effects.
Often, if progression is limited to a single site, we’d want to clarify whether limited radiation, even repeat irradiation, would be safe and feasible. If not, we might favor a trial of an agent for “acquired resistance” to an EGFR inhibitor, like AZD9291, or AUY922, or afatinib/cetuximab in combination, etc. However, if the disease progression is limited enough, switching treatments might be something we’re reluctant to do in the face of overall remarkably good disease control for a very long time.