PDL1 negative and ROS1+ on Alimta and Keytruda?

Portal Forums Lung/Thoracic Cancer ALK Inhibitors PDL1 negative and ROS1+ on Alimta and Keytruda?

This topic contains 3 replies, has 2 voices, and was last updated by JimC Forum Moderator JimC Forum Moderator 4 months, 1 week ago.

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July 12, 2017 at 9:26 am  #1291053    

fanos

My daughter has Stage 4 adenocarcinoma NSCLC (ROS1+) dx in December 2015. Standard chemo, then Xalkori gave positive results. The Dr wanted to try Opdivo even though she tested negative for PDL1.This resulted in all masses tripling or more. Then the Dr returned to chemo: Carboplatin and Alimta, then Alimta for maintenance now for 5 months. The Dr has recommended a new combination for an unusual growth? around a previously radiated spot in the lung. I am not sure why this combination when the growth (?) is not identified. Is there any evidence that this should be the next course of treatment given the history of results and unknown cause of this smear in the CT scan?

July 12, 2017 at 9:40 am  #1291054    
JimC Forum Moderator
JimC Forum Moderator

Hi fanos,

I’m sorry to hear about the possible progression on chemotherapy. It seems to me that my response to your previous thread applies in this situation as well. You would like to get the maximum benefit possible from each line of therapy, so if the progression is not clear or significant, continuing with chemo might be a good idea.

Also, either returning to Xalkori, or another inhibitor, might be a good choice.

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

July 12, 2017 at 9:52 am  #1291056    

fanos

What I am really asking is if there is evidence that ADDING Keytruda to a PDL1 negative patient on Alimta has shown to be significantly effective in any progression? Is this a clinical trial or approved treatment?

July 12, 2017 at 11:34 am  #1291058    
JimC Forum Moderator
JimC Forum Moderator

Hi fanos,

Those types of combination therapies, including an immunotherapy agent plus either chemo or another immune checkpoint inhibitor, are being tested in clinical trials, but none of these are approved yet. Here’s a post on that subject: http://cancergrace.org/lung/2015/12/08/gcvl_lu_immunotherapy_combinations_future_treating_lung_cancer/

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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