TKI resistance correlations

Portal Forums Cancer Treatments / Symptom Management EGFR Inhibitors TKI resistance correlations

This topic contains 6 replies, has 3 voices, and was last updated by catdander forum moderator catdander forum moderator 2 months, 1 week ago.

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January 4, 2017 at 8:38 am  #1289702    

picklette

Have any correlations been made between the time taken to become resistant in patients who have received 1st, 2nd and 3rd generation TKIs?

For example, if a patient became resistant to Tarceva after 7months, would you expect a similar time frame for the patient to exhibit resistance when taking Afatinib or Tagrisso?

Thanks
Jackie

January 4, 2017 at 4:44 pm  #1289711    
catdander forum moderator
catdander forum moderator

Hi Jackie,

I’ve not heard of correlations per se. Taking afatinib after progressing on tarceva hasn’t shown to be effective in stopping cancer progression and vice versa. If there is a t790m mutation acquired while on tarceva or afatinib then there’s a good chance that tagrisso will have efficacy but any correlation to the timing is unknown. The mechanism of resistance to tagrisso is too new to have much of an understanding just yet.

You didn’t ask but I won’t hesitate to try to guess what else may be of help. Think of it as a bonus :)
This video has an excellent explanation of what nsclc specialists are doing today for their patients who’ve have begun to show progression on tarceva.

http://cancergrace.org/lung/2016/02/18/gcvl_lu_combinations_other_options_egfr_acquired_resistance/

All best,
Janine


My husband, 8/09 53 @ dx stage III squam nsclc R. pancoast tumor
Destruction of 3 ribs, touching brachial plexus.
6/09-8/09 2 core and 1 VATS undx biopsies. Open thoracotomy for 1 positive biopsy (unresectable)
9/09 Chemo/rads curative intent
11/09 MRI by pancoast specialist surgeon spine met found undiagnosed Rad to spine, Chemo continued thru 6 cycles
Tarceva maintenance 2/10
11/10 3cm tumor L lung, undx core bx w/collapsed lung. Gemzar, 12/10 through 7/12
NED 3/12, stop tx 7/12. Remains NED as of 9/16
Unanswerable question. Was it ever metastatic?

January 7, 2017 at 4:19 am  #1289722    

picklette

Thanks Janine and thanks for the bonus vid! :)

It took me 6 months to progress on Tarceva and never got to try Afatinib as Onc hadn’t seen good results with other patients so after some chemo & a try at Nivo I tested positive for T790M & was put on Tagrisso.

My last scan showed complete metabolic remission though the primary is still visible on scans but at the back of my mind I’m very aware that the average time to resistance on Tagrisso is 10 months and I’m in my tenth month now! Obviously all patients are different but my choices going forward are limited due to chemo induced kidney failure last year so I was just wondering what correlations if any had been done.

I guess these things will be looked at in time but when more data is available.

Thanks again for getting back to me Janine
All the Best
Jackie :)

January 7, 2017 at 7:07 am  #1289723    
JimC Forum Moderator
JimC Forum Moderator

Hi Jackie,

It’s great to hear that the latest scan shows no metabolic activity. As far as the median time to progression on Tagrisso, although it’s good to plan ahead, just remember that this is a statistic that applies only to a large number of patients, and is not necessarily predictive of how an individual will fare. And in any event, that median indicates that half of all patients get a longer response, some significantly so. No reason to think that won’t be you!

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

January 7, 2017 at 8:49 am  #1289725    
catdander forum moderator
catdander forum moderator

Hi Jackie,

I wonder if your kidney failure was due to a platinum drug. If so you will still be able to try a single chemo like alimta alone. People with EGFR mutations do very well with it. However, like Jim I hope you do very well on tagrisso for a very long time.

All best,
Janine


My husband, 8/09 53 @ dx stage III squam nsclc R. pancoast tumor
Destruction of 3 ribs, touching brachial plexus.
6/09-8/09 2 core and 1 VATS undx biopsies. Open thoracotomy for 1 positive biopsy (unresectable)
9/09 Chemo/rads curative intent
11/09 MRI by pancoast specialist surgeon spine met found undiagnosed Rad to spine, Chemo continued thru 6 cycles
Tarceva maintenance 2/10
11/10 3cm tumor L lung, undx core bx w/collapsed lung. Gemzar, 12/10 through 7/12
NED 3/12, stop tx 7/12. Remains NED as of 9/16
Unanswerable question. Was it ever metastatic?

January 8, 2017 at 12:48 pm  #1289732    

picklette

Thanks Jim. Thanks again Janine :)

The Kidney failure actually occurred after my sixth infusion of Alimta which I understand is quite a rare side effect of Alimta so I doubt they’ll prescribe that again but I know there are other options it’s just from what I can tell, they would mostly require me to have dialysis :cry:

I have read of people lasting a lot longer than 10 months on Tagrisso though so I’m hoping I’m one of those. Better to believe that I will be than worry I won’t :-D

Thanks again both
Jackie

January 8, 2017 at 1:11 pm  #1289734    
catdander forum moderator
catdander forum moderator

The assumption I’ll make is that you will do very well long after the next best thing is on the market. :)


My husband, 8/09 53 @ dx stage III squam nsclc R. pancoast tumor
Destruction of 3 ribs, touching brachial plexus.
6/09-8/09 2 core and 1 VATS undx biopsies. Open thoracotomy for 1 positive biopsy (unresectable)
9/09 Chemo/rads curative intent
11/09 MRI by pancoast specialist surgeon spine met found undiagnosed Rad to spine, Chemo continued thru 6 cycles
Tarceva maintenance 2/10
11/10 3cm tumor L lung, undx core bx w/collapsed lung. Gemzar, 12/10 through 7/12
NED 3/12, stop tx 7/12. Remains NED as of 9/16
Unanswerable question. Was it ever metastatic?

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