t790m negative EGFR positive lung cancer

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May 17, 2018 at 4:56 pm  #1294429    

freja

Hi. Last year I lost my husband after almost 2 years after he was diagnosed with lung cancer. I think that maybe he did not get the best possible treatment.
He had stage 4 cancer with spread to the brain (WBR due to multiple metastases), liver, bones and both lungs. He was EGFR positive both exon 19 and 21. After 7 months Tarceva stopped working, and he was following treated with Afatinib. When that stopped working a biopsy was taken and the new metastasis was EGFR exon 21 positive and t790m negative. He was treated with AZD 9291, Osimertinib, in a clinical trial. It did not work at all and 2 months later he had severe progression. He was treated with chemotherapy, but the progression could not be controlled.
I can’t stop thinking that maybe it would have been better to start chemo immediately after progression on Afatinib. Or at least start Osimertinib immidiately after Tarceva stopped working instead of Afatinib. Is Afatinib a good choice for exon 21 positive patients at all?
Is it common to treat t790m negative patients with Osimertinib after they have previously been treated with two other TKIs, when there is other possibilities such as chemotherapy or maybe immunetherapy??
Thank you in advance for your comments!

May 17, 2018 at 7:53 pm  #1294430    
JimC Forum Moderator
JimC Forum Moderator

Hi freja,

Welcome to GRACE. I am very sorry to hear of the passing of your dear husband at the hands of this awful disease. I lost my wife to lung cancer over six years ago and, as you and many others have done, at first I asked myself the same question you’re asking – could we have made better treatment choices?

When we ask that question, the choices not made always seem better. In your husband’s case, the duration of his response to Tarceva was pretty typical. Since you said that Afatinib “stopped working” I assume that it kept the cancer stable, at least for a period of time. That’s probably a better response than many patients get when they progress on Tarceva and choose Afatinib, but with stage IV lung cancer stability is a good result in second- or later-line therapy. So even though statistics may have said that Afatinib might not have been the best choice, those are numbers that apply to large groups of patients; the experience of an individual patient can be better.

Despite the lack of a T790M mutation, osimertinib can be effective, as Dr. West discussed here. The response may not be as good, but when you get to third-line treatment, response rates are lower. Although we can’t know for certain, it’s unlikely that osimertinib would have been more effective if it had been used immediately after Tarceva.

As far as immunotherapy, the response rate for EGFR-positive patients is pretty low. There’s no way to know whether chemotherapy would have been more effective than the targeted agents used. When diagnosed, your husband’s cancer was widespread, and there often comes a point when the cancer becomes so aggressive that no treatment can stop it.

That’s what happened with my wife’s cancer, and I’m afraid that’s what happened with your husband’s cancer.

Again, I’m so sorry for your loss, and I wish you peace and comfort.

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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