Indivumed: Individual caner therapie through blood sample? - 1257707

jensmalte
Posts:13

Dear cancergrace team,

my father has lung cancer - adenocarcinoma 3b, never smoker. We are looking for new options that might improve the therapy and a friend told us about a company in Germany, which through blood samples could detect which kind of medication might work. The company is called indivumed and has the following website: indivumed.com/. I think they are related to a company doing something similar called inostics.

My question is threefold:

Do you know something about this kind of diagnosis and can it bee trusted ?

If it can bee trusted: Do you know if an analysis after driver Mutations and fusion oncogene would be possible
through a blood sample?

I ask because we already initiated an analysis of EGRF, ALK,RET, KRAS and BRAF. we wanted to know if he has ROS1 or HER2, but there was not enough material left from the Tumor sample. Would it bee possible to detect these through a blood analysis?

If it can‘t be trusted, or an analysis after Mutations isn‘t possible: Would it be possible to use Material from the pleural effusion in order to detect mutations?

Kind Regards

Malte Schuldt

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Reply # - July 3, 2013, 10:36 AM

catdander
Posts:

These are all new expert commentaries on the subject of molecular testing that may be of benefit.
http://cancergrace.org/lung/2013/06/25/wakelee-which-patients-markers-m…
http://cancergrace.org/lung/2013/02/22/sequist-molec-testing-nsclc/
http://cancergrace.org/lung/2013/02/25/kelly-on-markers-to-send-for-in-…
http://cancergrace.org/lung/2013/02/26/camidge-and-langer-on-who-to-reb…

We don't have information on the 2 specific companies you mention but there is a recent expert discussion on the subject though I'm afraid I can't find it at the moment. There still isn't a proven blood test that can predict the best treatment options for nsclc which insinuates that you could rule out a perfectly fine treatment for one that will end up not improving outcome. So until it's proven to be helpful it could do more harm than good. I believe there maybe new caveats to this but they don't include traditional chemotherapies.

I will contact a doctor for comment on your questions.

All the best,
Janine

Reply # - July 3, 2013, 11:48 AM

Dr Pennell
Posts: 139

Hi Malte, I am not familiar with the specific company that you listed but from their website they appear to be a commercial laboratory that can assay blood or tissue for a panel of genetic alterations. The same mutations (such as EGFR) that can be detected in tumor biopsy tissue can also sometimes be detected in blood by detecting DNA released from dying tumor cells that circulates in the blood. The only issue with this technique is that it is less sensitive than testing tissue directly, so not every patient will have detectable tumor DNA in their blood and the test may come back "normal" but simply be a false reading. In other words, if it detects a mutation, that is believable, but if it does not then you cannot trust that there are no mutations present. Another biopsy is sometimes necessary, but I suppose there is little harm in trying the blood test if it is covered by insurance or if you are willing to pay and reserve the biopsy if the test fails.

One important question, though, is whether any of this is needed now. If your father has stage IIIB, then this is usually treated with chemotherapy and radiation (even if there is a proven mutation), and there is no clear role for any of the targeted treatments in this stage of disease unless there are other circumstances that make it impossible to treat for possible cure.

Reply # - July 3, 2013, 02:37 PM

jensmalte
Posts: 13

Dear Janine and Dr Pennell,

thank you very much for the big effort in answering my questions so quickly and so in depth! This was really helpful. Though your answers raises new (but final) questions, and it needs a short description of my fathers course of disease in order to be answered.

The effusion actually showed cancer cells and the treatment is palliative and not curative, though our oncologist staged him 3b, while the pathologist staged him 4. My sources (German and english) also differ on that matter.

At time of the final diagnosis the oncologist also classified him: T2N2M0. The right side was affected with the tumor (3cm) one lymph node and the pleural effusion. It was necessary to aspire 1 liter before treatment with chemo. He has undergone 6 cycles (every third week) of chemotherapy with a combination of alimta/cisplatin. There has gone 1 month since the last treatment. He is feeling stable but not totally fit, he can breath normally and no aspiration of the effusion has been necessary in the time of therapy and beyond.

We are now waiting for the results of the CT scan and our talk with the oncologist next week. So because of your answer it would not be bad to get some kind of "second opinion" on some issues regarding the result of the scan.

If his scan shows that the tumor has decreased: Would it be better just to wait until next progression? Or are there methods like EGRF inhibitors which could prolong disease free time?

If the scan shows that the chemotherapy only stabilized the cancer: Would it make sense to wait, use targeted therapy or a new combination of chemotherapy? Regarding targeted therapies: Would it make sense to try an EFRG inhibitor if he is EGFR wild type?

I know the third possible situation - progression of disease - depends on the individual situation and can‘t be answered that easily.

Kind regards

Malte Schuldt

Reply # - July 3, 2013, 07:27 PM

Dr West
Posts: 4735

I would suggest that you check out the list of "Frequently Asked Questions" listed here:

http://cancergrace.org/faq

You touched on several in the collection on lung cancer, in the middle of the page. One link addresses the issue of whether to continue with maintenance therapy or take a break (debatable -- there's evidence it prolongs time until the cancer progresses, though it's not clear that people live longer than just doing the same treatment later). Another addresses whether there is value in EGFR inhibitor therapy in people who are EGFR wild type (yes, a modest benefit).

-Dr. West

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