Afatnib after Tarceva resistance? - 1258349

Hello skneal, I'm very sorry your husband has been dealt this awful blow and at such a young age. I will ask a doctor to comment on your question.

One other thought is a trial drug such as the PD-L1 drugs that are showing promise. Following I've pasted a link to a blog post on second opinions that may be helpful, http://cancergrace.org/cancer-101/2011/11/13/an-insider%E2%80%99s-guide…

I hope he is able to find something that can stabilize the cancer.

Best hopes,
Janine
forum moderator

The results we have thus far are that afatinib provides a transient benefit of a few weeks in duration for a minority of patient but no survival benefit -- in fact, patients who received placebo instead of afatinib had a trend toward better overall survival by over a month. My personal experience has been that my patients who received afatinib after Tarceva experienced no benefit at all, just more toxicity in terms of skin rash and diarrhea than they had experienced on Tarceva previously, though I know a few patients here and there have had transient responses. I'm sorry to report that I personally have very little enthusiasm for it, based on my experience of treating patients with it in this setting.

-Dr. West

I too am sorry to hear about this. I agree with Dr. West that afatinib alone may not necessarily be the best option, but overall the treatments for tarceva resistance are rapidly evolving and there are some clinical trials that are looking promising. Your husband should consider going for a consult to a medical center that specializes in this and may have some trials available. I usually recommend going early for consultations, not necessarily waiting until the treatment he is on stops working - planning ahead can be helpful.

skneal - The main issue with acquired resistance, unfortunately, seems to be determining the cause - whether it's a new mutation (T790m), c-MET amplification, change in histology, or...? This is most often found out with a new biopsy/trial enrollment - so it's difficult/risky, but very helpful in guiding a course of action.

You didn't mention your location but there's likely an academic medical center in your vicinity (often a university, sometimes a major hospital with dedicated cancer center). There are a number of lung cancer specialists who are also willing to do remote second opinions for a reasonable fee. You send the medical and imaging records, the physician reads it and calls you to give their opinion. My previous oncologist at the Univ. of CO, Dr. Ross Camidge has done many remote second opinions, and I imagine many of the faculty physicians here do them as well, as do their colleagues. Something to consider if travel is not an option. I hope I haven't been too redundant with this information (much of which is probably in the link Janine gave).

Best of luck to you and your husband.

Jazz

Though side effects are potentially a big challenge, there's more enthusiasm for the combination of afatinib and cetuximab together. There may be sites within striking distance offering this trial or another specifically for patients with an EGFR mutation and acquired resistance to an EGFR inhibitor.

Good luck.

-Dr. West