When to start target therapy after lobectomy

Portal Forums Lung/Thoracic Cancer NSCLC Early Stage/Surgery When to start target therapy after lobectomy

This topic contains 6 replies, has 4 voices, and was last updated by JimC Forum Moderator JimC Forum Moderator 3 months, 1 week ago.

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May 3, 2018 at 9:34 am  #1294367    

qding5

Hi everyone,

My mom just had lobectomy two weeks ago. From her pre-surgery PET scan, hilum lymph nodes on both side and mediastinal lymph nodes were all positive. During the surgery, the tumor, which is only 1.5 cm, the tumor side lymph nodes and mediastinal lymph nodes were removed and pathological result showed the lymph nodes are positive too. Mom’s surgeon thinks that the lymph nodes on the opposite side are also positive, but unfortunately, they cannot be removed.

The stage was reported as IIIA, but quite possible IIIB actually.

My mom has L851R mutation, so we are considering using Tagrisso.

My question is when can my mom start to use Tagrisso. She is still under recoveryand, and still have a lot of effusion now. Tagrisso is a EGFR inhibitor, so my concern is that Tagrisso may have adverse effect on the healing (both inside and skin excision).

Anybody have any idea on when to start Tagrisso and the potential impact of Tagrisso on the surgery recovery?

Thank you so much!

Qian

May 3, 2018 at 10:46 am  #1294368    

onthemark

Hi Qian,

I am sorry to read you going through this with your Mom. The situation you are in is very complicated and there are no clear answers yet as far as I know for whether your Mom would benefit most from Tagrisso or even just standard chemo at this point in time. There are a lot of options and one is when is the best time window to start systemic treatment and/or radiation and what that treatment should be. I hope to learn a lot in this thread.


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.

  • This reply was modified 3 months, 1 week ago by  onthemark.
  • This reply was modified 3 months, 1 week ago by  onthemark.
May 4, 2018 at 7:21 am  #1294376    

cards7up

I would think she’d start with Tarceva and not jump right to third line treatment of an EGFR mutation. Tagrisso is used after first line treatment and the EGFR mutation has mutated to T790M.
As an example, stage IIIA with surgery of LRL and started chemo in October. But this was chemo and a big difference from taking a targeted TKI pill.
Better to discuss what stage first and then treatment options with her oncologist. Only her own doctors can know by seeing and checking her out if she’s ready for treatment or not. Good luck!
Take care, Judy


Stage IIIA adeno, dx 7/2010. SRS then chemo carbo/alimta 4x. NED as of 10/2011.
Local recurrence, surgery to remove LRL 8/29/13. 5.2cm involved pleura. Chemo carbo/alimta x3. NED

May 4, 2018 at 8:04 am  #1294377    

qding5

Thank you Cards7up. So in your example, the chemo started one to two months after the surgery? My mom still has severe shortness of breath now. Hopefully she can recover soon from the surgery.
Another question is why target therapy was not considered in your case? Thanks!

May 4, 2018 at 8:08 am  #1294378    

qding5

Thank you, Onthemark. My mom is very healthy before she found the cancer. We are worrying about the adverse effect chemo. But definitely I will consult with other doctors too.

May 4, 2018 at 8:36 am  #1294379    

onthemark

Hopefully your Mom can regain her good health soon. Is she in hospital or on O2?

What Judy wrote about agreeing on the stage first, makes sense. I am not sure if her doctors would consider her to be going for adjuvant treatment as a stage IIIa (i.e. she is currently not showing evidence of disease after surgery) or treatment of locally advance, non-resectable cancer that is currently present. If your doctors think that disease is currently evident, then this would not be adjuvant treatment.


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.

May 4, 2018 at 8:46 am  #1294380    
JimC Forum Moderator
JimC Forum Moderator

Hi Qian,

As far as I can recall, Judy’s cancer never tested positive for an activating mutation, so she was not treated with targeted therapy. As she said, it’s typical to start with Tarceva, get as much benefit from it as possible, then move on to later-generation EGFR TKIs if appropriate. Usually you don’t see patients using Tarceva after Tagrisso, so you get maximum benefit by using Tarceva first.

As said in previous replies, timing of systemic therapy will be a judgment call by her oncologist, based on how well your mom has recovered from surgery.

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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