Tarceva after Gilotrif

Portal Forums Lung/Thoracic Cancer EGFR Inhibitors Tarceva after Gilotrif

This topic contains 2 replies, has 2 voices, and was last updated by  westcoaster99224 2 months ago.

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October 12, 2017 at 4:50 pm  #1293313    

westcoaster99224

a person receiving 40mg gilotrif as 1st line treatment for stage 4 egfr del 19 lung cancer starts to show progression after 12 months, could Tarceva be used as 2nd line treatment if biopsy shows negative for the T790 mutation. I have seen where people have had success with Gilotrif after Tarceva but have not come across anything on the reverse. Is there a rule about using a 1st generation TKI after a 2nd generation TKI.

October 13, 2017 at 7:28 am  #1293317    
JimC Forum Moderator
JimC Forum Moderator

Hi westcoaster,

Welcome to GRACE. We don’t have specific data to be able to say definitively whether Tarceva would likely be effective after Gilotrif, but the two drugs are similar, so there may not be a benefit to switching to a very similar therapy.

One question is whether the progression is significant enough to warrant a treatment change. It’s not uncommon for lung cancer to progress so slowly on an EGFR TKI that the best choice can be to remain on the current therapy. As Dr. Pennell has stated:

“The first thing to keep in mind is, not every patient who is developing acquired resistance needs to change what they’re doing. Sometimes, if the cancer is beginning to grow, it can grow in a very slow, asymptomatic way. In other words, it’s not causing symptoms, every time you do a scan it’s a little bit bigger, but the patient feels fine, is not having a lot of side effects from the drugs — you can continue to watch these. This can be anxiety-provoking, but I’ve watched patients for six months, nine months, sometimes longer before we really need to make a change. In the same vein, we know that about 20% of patients who develop acquired resistance don’t develop resistance everywhere in the body. Maybe only one or a couple of the tumors are growing, and if you biopsy those you can see that new mutations and mechanisms of resistance can arise in individual tumors while the rest of the cancer remains under control.”http://cancergrace.org/lung/2016/02/18/gcvl_lu_combinations_other_options_egfr_acquired_resistance/

As Dr. West is fond of saying, sometimes bad brakes are better than no brakes. It’s also good to get the maximum benefit from each treatment regimen, preserving other options for later use.

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

October 13, 2017 at 10:18 am  #1293319    

westcoaster99224

Jim, Thanks for the very informative response, it will definitely help guide me thru any future treatment decisions.
Best Wishes,
Bobby

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