Hello,
My mom is a never smoker, diagnosed SCLC-ED (liver mets) in July 2010. First line carbo+etop with progression. Irinotecan starting January 2011 and STABLE since - amazing!
She is taking a break from - with some lung radiation for inflammation she is experiencing driving coughing (they said tumor looks stable but "inflammation" - unusual?) And then watchful waiting on tumors before resuming chemo. That's the plan anyway.
My question: Given how unusual (though not impossible) SCLC is for never smokers, and given her unusually long stable response to irinotecan, is there a case to re-biopsy her tumor to understand if its actually a different cancer type / other chemos we should be considering?
I've been so thrilled with her stable status that I haven't lifted my head to ask many questions of late (and stayed away from boards in general), but given she is unusual, wonder if there are more "creative" paths we should be considering, thus wondering about the re-biopsy.
Many thanks in advance for any input.
Reply # - March 28, 2013, 12:52 PM
Reply To: Re-biopsy for SCLC never-smoker coming up on 3 years?
Hello cbbax, What a wonderful surprise for your mom and family! Congratulations. I imagine with all those unusual circumstances I'd want to know more about possible options. Keeping in mind if it's not broke don't fix it. This is just me a wife of a man with nsclc speaking and not communicating anything from a doctor's perspective, given your mom's case is unusual.
I will ask a doctor to comment on your question. You should hear back within the day.
Much more luck,
Janine
forum moderator
Reply # - March 28, 2013, 05:57 PM
Reply To: Re-biopsy for SCLC never-smoker coming up on 3 years?
Hi Cbbax -
I am glad to hear that your mom is doing so well. That is great news. As you know, a lot has changed in the lung cancer field since 2010 when she was diagnosed, especially with respect to genetic testing. If she does have evidence of tumor growth in the future, I think your idea of doing a repeat biopsy to ensure that the subtype of lung cancer is correct and see if there are any driver oncogenes is a great idea, and it makes sense to bring it up with her doctor.
- Lecia Sequist
Reply # - March 29, 2013, 06:32 AM
Reply To: Re-biopsy for SCLC never-smoker coming up on 3 years?
Many thanks for the speedy response!
Do you know if that would likely mean getting a new sample (not ideal in terms of comfort for my mom) vs. re-running remaining tissue from prior sample?
Again, thanks for the input, such a valuable resource for patients and family members!
Reply # - March 29, 2013, 08:25 AM
Reply To: Re-biopsy for SCLC never-smoker coming up on 3 years?
Hi cbbax,
If you're looking to confirm that the original histology was accurately diagnosed, or whether there were any specific mutations that were present at that time, then using the original tissue would be fine, assuming it has been preserved and that there is enough of it.
On the other hand, if there is a concern that perhaps the cancer has a mixed histology and the biopsy simply didn't sample any of the non-SCLC cells, or if you're looking to see if any new mutations have appeared, then a new biopsy would be necessary.
JimC
Forum moderator
Reply # - March 29, 2013, 01:28 PM
Reply To: Re-biopsy for SCLC never-smoker coming up on 3 years?
When there is doubt about original diagnosis, getting a second opinion on the original pathology makes a lot of sense. If non-productive, a repeat biopsy is reasonable to consider. If you haven't already gotten a consult from an oncologist specializing in lung cancer, this might be a way to get a two-for-one: your path could be reviewed as part of the consult, and you could get an opinion on the merits of repeat biopsy.
Reply # - April 4, 2013, 07:37 AM
Reply To: Re-biopsy for SCLC never-smoker coming up on 3 years?
Dear Dr. Weiss:
A Lab in Europe offers HER2 or MET amplification tests as they believe my Kras mutation test was right .
Do you think it is worth to repeat all genetic tests or have these two tests done for the binifets sometime later?
Thank you.
Reply # - April 4, 2013, 01:04 PM
Reply To: Re-biopsy for SCLC never-smoker coming up on 3 years?
Hi huiyuan, I think what information there is on mutation testing for early stage nsclc is in the first few discussions of our early stage nsclc section of our library that I linked you to in your other post.
For now make sure they keep your tissue for later use if necessary.
Also feel free to start your own thread if you have more questions.
All best,
Janine
forum moderator
Reply # - April 4, 2013, 02:53 PM
Reply To: Re-biopsy for SCLC never-smoker coming up on 3 years?
Thanks. Janine.
:)
Reply # - April 4, 2013, 04:18 PM
Reply To: Re-biopsy for SCLC never-smoker coming up on 3 years?
I would say that I don't prioritize doing testing for HER2 or MET right now, since they don't have a clearly actionable result today, and they aren't standard recommended mutation tests for NSCLC or SCLC. I don't see a clear value in repeating molecular testing if it was by a good lab previously.
If there might be some actionable result based on mutation testing in the future for something that isn't routinely tested or even available today, I think it makes the most sense to obtain tissue close to the same time the question is being asked. It's always possible for molecular markers to change over time. But it's not so expected that I think it's valuable to resend the same tests again periodically just to go on a fishing expedition, so to speak, until we get a result we like more.
-Dr. West