Sarcomatoid carcinoma cancer of lung- stage 4 with metastasis - 1259683

trs925
Posts:3

My father has been diagnosed with Sarcomatoid Carcinoma of the lung, stage 4 with metastasis to both lungs and lymph nodes. He has failed to respond to one round of radiation and chemo of taxol & carboplatin and his performance status is a 3. We live in Augusta, Georgia, and are looking for some kind of anti-pd1 or other trials that he could qualify for. We are willing to travel anywhere. I've seen Merck, Bristol Meyers, and Roche all have trials going on for this now. What is this referral process to these trials?

If this is not an option, what other treatment/chemo options would you recommend? I

I know this topic has been previously discussed and know it is a very aggressive/treatment resistant tumor so thank you for your time and understanding. We appreciate any advice from Dr West or any one who could offer some insight and look forward to hearing something soon.

Thanks again,

Tara

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Reply # - October 6, 2013, 09:19 AM

JimC
Posts: 2753

Hi Tara,

I'm sorry to here of your father's diagnosis and the results of his treatment so far. It sounds as though you have found some trials; if so, I would first bring them to the attention of his oncologist to see if he/she has a recommendation. Otherwise the trial info should have a contact person listed; call that person to start the process.

As far as treatment options, although it's in the context of maintenance, Dr. West has said this recently about treatment options for sarcomatoid carcinoma:

"I’m sorry that I think you’re very unlikely to have anyone here who can comment on what to expect for sarcomatoid histology, since it’s so rare. Aside from the promising results in a few patients with this histology who received immunotherapies like anti-PD1 agents, there’s really no specific information about it.

Taxol (paclitaxel) is not commonly used as a maintenance therapy, since it has no proven value after 4-6 cycles and definitely leads to cumulative neuropathy.

Avastin (bevacizumab) alone is sometimes used, and it is the more studied approach after carboplatin/taxol/Avastin as first line therapy.

The hesitation about Alimta (pemetrexed) is understandable, since it definitely has some specificity for non-squamous histology and may not have activity in sarcomatoid histology…that’s just not known.

Otherwise, Tarceva (erlotinib) and Taxotere (docetaxel) have each been studied as a maintenance therapy and have some evidence for potential benefit as well. That said, there’s no established best approach in this situation." - http://cancergrace.org/topic/sarcomatoid-carcinoma-maintenance#post-125…

Sending positive thoughts for good results from the next treatment.

JimC
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Reply # - October 6, 2013, 11:30 AM

Dr West
Posts: 4735

I don't really have any insight about where to go, since you're so far from where I am. I do think that immune checkpoint inhibitor trials rank as by far the most promising avenue of systemic therapy for sarcomatoid carcinoma of the lung. I think it will likely be a challenge to find an immune checkpoint inhibitor trial for patients with a marginal performance status, since a performance status worse than 2 usually excludes patients. If you find one within striking distance, I think that's a quite appealing option, regardless of which agent or whether it's an anti-PD1 or anti-PDL1.

In terms of other options, I don't think that more chemotherapy is likely to be a fruitful approach for someone who has progressed quickly through prior chemo and has a very marginal performance status now.

Good luck.

-Dr. West

Reply # - October 6, 2013, 01:32 PM

trs925
Posts: 3

Thank you so much for your quick responses- I sincerely appreciate it. I just have a few follow up questions:

What is the difference between pd1 or pdl1?

And where might you suggest that I look to find a list of clinical trials/contact persons? Or would you be able to email me more information/anyone in particular that might be helpful?

Thank you,

Tara

Reply # - October 6, 2013, 04:32 PM

Dr West
Posts: 4735

Tara,

You should just do a search on the site for PD-1 or PD-L1 to find some of the many summary pieces on immune checkpoint inhibitors from the past couple of years. Just about all of these include a discussion of PD-1 and PD-L1, which are two sides of the same immune function process -- the PD1 is on the side of the body's immune cells, and PD-L1 is on the side of the tumor cells.

In terms of how to find trials, your best bet is to talk with your oncologist or a lung cancer specialist at an academic center in the region. Otherwise, there are sites like cancercommons.org and clinicaltrials.gov that are databases of clinical trials you can search for.

Good luck.
-Dr. West

Reply # - October 9, 2013, 06:33 AM

trs925
Posts: 3

Thank you so much for your helpful advice. I have a few more follow up questions after talking to the oncologist.

Unfortunately, my fathers performance level is not quite up to standards for the pdL1 trial yet and we found out that the trial takes 6 weeks to show some kind of improvement. - Is that true?

Our oncologist has decided to start us on chemo with taxotere and gemzar to stop the growing/spread of cancer and then hopefully start the trial. Do you think that is a good plan?

Could you tell me a little about ablation? Is that another option?

Also he has developed thrush in his throat. He is currently on diflukcan and if no improvement shows in a few days, they will begin amphotericin.

Thanks for all your support during this difficult time. I can't tell you how much I appreciate it.

-Tara

Reply # - October 9, 2013, 09:23 AM

JimC
Posts: 2753

Hi Tara,

I'm not sure why it would be said that it would take 6 weeks to show improvement, unless it was meant that the first scan to judge response would happen at the 6 week point. There are times when a new therapy can improve symptoms fairly quickly, but that's totally unpredictable.

Taxotere and gemzar are drugs that are active against lung cancer. Taxotere can be difficult for many patients, especially one who has lowered performance status, although it is better-studied as a second-line treatment than gemzar. My concern would be the combined side effects of the two drugs taken together. Also, would further chemo cause a problem with entry into the trial? Many trials limit the number of prior treatment regimens, or require a specific treatment-free period prior to entry.

JimC
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Reply # - October 9, 2013, 05:20 PM

Dr West
Posts: 4735

The immunotherapies have tended to take at least 6-12 weeks to demonstrate a response, but it is absolutely unpredictable.

We aren't in a position to weigh the chemotherapy options for an individual person who isn't our patient, but Jim is right to express concern about the doublet of Taxotere (docetaxel) and Gemzar (gemcitabine), which is known to be a very challenging combination even for people who are relatively fit. For someone compromised and relatively frail, it may be a quite difficult treatment option to pursue.

-Dr. West

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