Does a T790M mutation make retrying Tarceva unrealistic? - 1254582

judys
Posts:74

Now that a rebiopsy confirmed I do have an EGFR mutation but on exon 20 with T790M resistance, is there any value in retrying Tarceva either alone or with a chemo drug? I know people have had some positive results the second time around, but I couldn't tell if the T790M mutation makes this less likely. Waiting for afatinib approval might be the best thing to do. I have done pretty well on the various chemos with no lasting side effects.

Dr West, I wanted you to know how much I have enjoyed the videos from the conference you attended. Thanks for giving up your exercise clothes space for the camera stuff so we could hear from all the other experts!!

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Reply # - March 9, 2013, 05:46 PM

JimC
Posts: 2753

Hi Judy,

Normally a T790M mutation indicates that a patient's cancer will likely be resistant to Tarceva. For that reason, if you were newly diagnosed and trying to decide between chemo and Tarceva, chemo would most likely be the recommendation. But in your case it's not clear that the standard answer applies, because you took Tarceva for an extended period with success. Your cancer may have developed a T790M mutation and become resistant. If so, any of the agents currently being studied to overcome Tarceva resistance might be in order. Or perhaps much of your cancer was sensitive to Tarceva while some was not. Can you recap for us what led you to switch from Tarceva? Was it rapid progression or slow? If it was slow, perhaps you have a good number of cancer cells that would still respond to Tarceva. Fast progression would tend to indicate that much or all of your cancer cells had become resistant to Tarceva. Also, is this the only time your cancer has been tested and found to have an EGFR mutation?

Hopefully, your current treatment will be effective and you won't soon face any decisions about your next treatment regimen.

JimC
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Reply # - March 9, 2013, 06:30 PM

judys
Posts: 74

Hi Jim - I wasn't tested at diagnosis as Tarceva wasn't approved for first line in early 2007. My onc knew he'd use it for second line. I had two and a half years of stable disease and one year with slow progression. A tumor between two ribs that needed radiation was the event that caused me to stop Tarceva. I was pretty tired of the side effects and hoped Alimta would be tolerable. It was though it didn't do much disease-wise. And I quickly was reminded that taking a pill is much better than infusions!

Reply # - March 9, 2013, 08:05 PM

Dr West
Posts: 4735

I haven't seen any data on this. We just don't know if there's a way to obtain better results in the face of a T790M mutation, such as adding something to Tarceva (erlotinib). If the progression was rapid on Tarceva in the past, I don't think there would be much value in it, but if the progression was partial and relatively slow, there might be some transient response followed by a period of stable disease.

-Dr. West

Reply # - March 10, 2013, 04:59 PM

Jazz
Posts: 279

Judy,
You've been away from Tarceva for awhile, and have had quite a bit of chemo. I would think the resistant cells have been suppressed and the TKI-sensitive cells may now populate the growing tumor. Would you be up to adding Tarceva to your Taxotere regimen, or attempting a single agent re-challenge?

I am positive for T790m and successfully used Tarceva a second time. Now that I'm off the afatinib-cetuximab trial, I'm on Tarceva with Carbo-Gemzar. I'm thinking of dropping Carbo as it's really kicking me hard. But Dr. Camidge seems to think Gemzar + Tarceva would at least stabilize the progression while I wait to get on the CO-1686 trial (for T790 mutants).

Good luck,

Jazz

Reply # - March 11, 2013, 10:04 PM

laya d.
Posts: 714

Hi Judy - -

I have nothing more to add here. . .but was thinking along the same lines as what Jazz articulated. Is there any way you can add Tarceva to your chemo. . .or would that just be way too much to handle? I know that my Mom (and her doctor) were not too keen on combining Tarceva with chemo for my Mom (way too many compounding side-effects for her) - - but I know that it's OK and tolerable for some people.

Anyway, thinking of you often and hoping that whatever treatment road you go down that it is super effective for you.

xoxo,
Laya

Reply # - March 13, 2013, 09:45 AM

judys
Posts: 74

Jazz - Thanks so much for your thoughts and experiences with this. I'd love to take Tarceva alone but would certainly be willing to try it with Gemzar too. The mention of carboplatin causes shudders! I don't know about adding Tarceva to my current taxotere. I'll mention that after the next scan if I continue on it..... A big if!

I was starting to reply to you a few days ago when I got the call my almost 96 yr old mother was on the way to the ER with a pulse rate in the 20's... Long story but she's back in their retirement/assisted living facility. We're meeting with hospice later today. Thank goodness my retired nurse sister drove up from Oregon, took over all the details and insisted I stay home yesterday. It helps that she understands how chemo knocks you down those first days as she's a breast cancer survivor and has done her share of chemo.

Laya, thanks as always for your warm thoughts---

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