Poorly differentiated adeno carcinoma. L858R mutation found.

Portal Forums Lung/Thoracic Cancer EGFR Inhibitors Poorly differentiated adeno carcinoma. L858R mutation found.

This topic contains 4 replies, has 3 voices, and was last updated by  masalovai 3 weeks ago.

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June 27, 2018 at 2:27 am  #1294665    


I very much appreciate your opinion on the following:

I was diagnosed in February with poorly differentiated adeno, TTF1, asolated squamous cells p63. I have tumor on left upper lobe, a few lips nodes involved and bone mets.

I had 4 cycles of Carbo alimta avastin and it didn’t work for me at all. Progression with another lymph node and two more bone mets.

Then I had surgical biopsy and stereotactic radiation for all bone mets. Biopsy results show only L858R mutation.

So I am starting Tarceva ,but not sure if it will work for poorly differentiated tumor with squamous component …?..

If it doesn’t work what could be the next option?

Probably immunotherapy would work better fo4 this type of tumor or combination of TKI and immuno drug.

My pd-l1 is negative, but I know that it is not indications of response to immunotherapy.

Could I have your thoughts please.

Many thanks


June 27, 2018 at 7:04 am  #1294666    
JimC Forum Moderator
JimC Forum Moderator

Hi Irina,

I’m sorry to hear that your cancer did not respond to your first line chemotherapy. Given the activating EGFR mutation (L858R) that was detected, there is a good chance that at least the EGFR-mutated component of your cancer will respond well to Tarceva, and that regimen would be chosen by most oncologists in this situation. Tumor grade (differentiation) is only one factor in how well a cancer responds to treatment, and may be less important that the EGFR status. Also, if the squamous component is small, it may not have a significant impact on response to treatment.

As far as immunotherapy and PD-L1 expression, recent evidence tends to show that even patients with low expression (greater than 1% but less than 50%) can respond to immunotherapy agents. In the past, a threshold for high expression was set at a chosen percentage, and everyone below that percentage was considered to have a negative PD-L1 result. If that is how your testing was interpreted, you may want to inquire as to the percentage (if any) of PD-L1 expression found.

Good luck with Tarceva!

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

June 27, 2018 at 8:37 am  #1294668    


Many thanks for your reply, Jim

Let’s hope Tarceva will work for me….

June 28, 2018 at 9:37 am  #1294677    


Just a short note to add to what Jim wrote,

as far as I know combining TKIs and immunotherapies at the same time has several studies that were discontinued early due to adverse side effects. That doesn’t mean that a safe combination that’s effective does not exist though and I would imagine there are clinical trials for that. it is something to keep an eye out for, after Tarceva.

Also EGFR+ patients are not thought to respond well to immunotherapies generally, but again it is probably a matter of finding the right one or the right combinations.

Squamous can also be EFGR+, although the chance is low it isn’t miniscule. There is some research in using some of the TKIs in squamous lung cancer. Again, that would be something to consider as an option after Tarceva when also the research may have matured a bit too.

10/2015 Chest xray found a nodule as part of a physical (no symptoms).
01/2016 Upper left lobe lingula preserving lobectomy stage 2b for 1.9 cm invasive adenocarcinoma with additional 2 mm AIS nodule found in pathology.
03-05/2016 Sixteen weeks of adjuvant cisplatin/vinorelbine.
07/2016 Durvalumab adjuvant clinical trial discontinued after 1st dose knocked out thyroid.
12/2016 Revised to stage 1b (due to VPI) after new guidelines for multifocal lepidic lung cancer.
07/2019 Next scan.

June 28, 2018 at 11:36 am  #1294680    


Thank you so much for such knowledgeable reply. I really hope that Tarceva will be working for me. I would feel more confident if I would have some plans B and C if Tarceva stop working……

Any ideas? I am not sure I can go another time for surgical biopsy. Two previous biopsies were unsuccessful because not enough sample.

Many thanks again for your time to answer my questions and all support.

Irina ❤️

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