Poorly differentiated Pulmonary Adenocarcinoma – Stage IV

Portal Forums Lung/Thoracic Cancer ALK Inhibitors Poorly differentiated Pulmonary Adenocarcinoma – Stage IV

This topic contains 125 replies, has 6 voices, and was last updated by catdander forum moderator catdander forum moderator 6 months, 1 week ago.

Viewing 6 posts - 121 through 126 (of 126 total)
Author Posts   
Author Posts
February 5, 2018 at 8:00 am  #1293920    

DJ Nikkam

Dear Jim / Janine / all – hope you all doing well.

I had a question pertaining to my mother’s recent PET scan. She is stable, and all of the Lesions have shown NIL SUV activity, with the exception of one Lesion.

The particular sentence from the PET report where she has SUV activity reads as “soft tissue nodules along the right parietal and visceral pleura: SUV 2,4; Previously 2,3, 3.2 and 4.7″ (this is fourth PET scan). She is currently on Ceritinib for about 16 months now

My question is – what would be the best approach to tackle this particular spot. The SUV activity has gone up marginally from 2.3 to 2.4. It is possible this particular spot might have a different sub mutation. I am not sure biopsy is an option. At least the doctor has not suggested this.

Does it make sense to radiate only that particular spot, and continue on Ceritinib, or consider moving onto Lorlatinib (she has an option to be considered for Pfizer trail)

Pointers will be appreciated… btw my mother lives in India.. so alternate options are fairly limited.

Thanks much
DJ

February 5, 2018 at 12:23 pm  #1293922    

Craig

As you may know, sometimes one can use targeted radiation to extend the usefulness of the targeted drug by months (or even a year or more). This is especially helpful when one is doing well on a targeted drug and options for a next-generation targeted drug are limited,

The difficulty with this is that “most of the time” the progression is too diffused/scattered or in a difficult place, so targeted radiation isn’t really an option — a more systemic approach is needed. And there’s the issue of making swiss cheese out one’s lungs unnecessarily early if there is another systemic solution with high odds.

Her oncologist and a radiation-oncologist will need to assess the viability of doing this, and assess what other treatment option mike make sense (or more sense). E.g., for ALK-driven lung cancer, lorlatinib might work better overall and avoid making a spot of “swiss cheese” in that area of the lung, depending on whether & what mechanism of resistance is found in a a fresh biopsy of the new progression.

Ask the oncologists, and maybe have her oncologist contact an ALK/lorlatinib expert like Alice Shaw a MGH in Boston if the answer isn’t clear to him/her.

Best hopes,

Craig in PA
– ROS1 patient


- Stage IV never-smoker ROS1-driven m-BAC indolent adenocarcinoma
– Dr. Alice Shaw’s Xalkori (crizotinib) for ROS1 trial @ MGH, Boston (5 yrs)
– carboplatin + pemetrexed (7 mo)
– TPX-0005 for ROS1 trial @ MGH (starting June 2017)

February 5, 2018 at 2:18 pm  #1293923    
JimC Forum Moderator
JimC Forum Moderator

Hi DJ,

In addition to the very helpful response from Craig, I think one point should be emphasized – the change is SUV is so slight that it is of no consequence at all, and Dr. West and the GRACE faculty have often stressed that change-of-treatment decisions should not be made on that basis alone. In general, when a targeted therapy has the cancer under control, as your mother’s cancer is, the typical choice is to continue that treatment and get the maximum benefit from it.

That being said, it is possible, as Craig discussed, to use local treatment on a single remaining lesion, but that would require a thoughtful weighing of the advantages and disadvantages of such action.

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

February 5, 2018 at 3:09 pm  #1293924    

DJ Nikkam

Thanks Jim and Craig.. great inputs. I concur with Criag’s thought of avoiding a Swiss Cheese scenario.. and Jim your point on the SUV variation being small and hence not significant is appreciated as well.

Given the fact that my mother’s oncologist does not seem overly perturbed with the SUV reading, our current course of action is stay on Ceritinib, My mother has been able to tolerate the drug, at a reduced dosage of 2 tabs (300mg) per day.

Best
DJ

February 6, 2018 at 8:00 pm  #1293928    

Craig

I do recommend you allow the oncologist discuss it rather than making assumptions. For example, what if it turns out that no other systemic treatment has good odds in her particular case and currently the spot is nicely contained & targetable (lucky dog!). Some things we just don’t know and you need to hear the best educated guesses around (not necessarily ourselves) before deciding which bet to gamble on. If I could have stopped the resistance I currently have early before it started spreading I’d have been glad to have one bubble of swiss cheese effect in exchange for eliminating that problem that I’m now facing. (There aren’t many options for dealing with my drug-resistant ROS1, and the best option experimental trial drug that I’m taking might not yet up to the dose level that it needs to be for it to have its best shot at control.) On the other hand, my progression becomes hazy and diffuse from the start, so I’m not a good example.

Best hopes,

Craig in PA


- Stage IV never-smoker ROS1-driven m-BAC indolent adenocarcinoma
– Dr. Alice Shaw’s Xalkori (crizotinib) for ROS1 trial @ MGH, Boston (5 yrs)
– carboplatin + pemetrexed (7 mo)
– TPX-0005 for ROS1 trial @ MGH (starting June 2017)

February 7, 2018 at 11:03 am  #1293929    
catdander forum moderator
catdander forum moderator

DJ, it’s good to hear you’re mom is still doing well. I wanted to weigh in on what you and Jim already touched on, Lorlatinib. This may be your mom’s chance to give it a go. Like you said there isn’t as much opportunity to try new drugs as you’d like and once the trial is full she may not have another opportunity. It’s worth having that discussion with the onc.

All best,
Janine

Viewing 6 posts - 121 through 126 (of 126 total)

You must be logged in to reply to this topic.