To my knowledge, Lecia Sequist seems to be the only doctor who has studied patients whose tarceva resistance caused a transformation from nsclc to sclc back in 2011. Has she any updates that she can provide us with - i.e. learned anything about best treatment practices of those patients in the 2 years since she studied it?
I was diagnosed with such a transformation last May. I have had 5 rounds of cis/etoposide (then it showed growth again), 7 rounds taxol with 33 rounds radiation (waiting for results on it). I was trying to have PCI, but I have new brain mets requiring gamma knife again. I have been kept on tarceva except for the approximately two month period that I received chemo/radiation (which interestingly enough is when new brain mets developed).
My doctor is entertaining switching me to aftanib. At this point, since I have been off tarceva for two months, we are challenging again with tarceva.
Reply # - January 2, 2014, 02:20 PM
Reply To: Transformation to sclc on tarceva
Good to hear from you funnymom. I know you have to wait a while after radiation to know but I hope your next report is positive. I don't know that anyone has anything new to say about these transformations. I wonder how much of your cancer is sclc.
I'll ask Dr. Sequist to comment on how she's dealing with the changes these days.
I hope you've had a chance to celebrate this season.
Happy New Year,
Janine
Reply # - January 2, 2014, 02:33 PM
Reply To: Transformation to sclc on tarceva
Prior to the transformation, I had clean scans for over a year. Once I transformed, I had a 3 cm tumor when there was no tumor on scan only 6 weeks before. It was tested via ebus bronchoscopy. It took 9 passes to get cancer positive cytology because it is down in the hilar region. That came back sclc. Prior biopsy had been in June 2011, from pericardial tissue following a pericardial window. That came back nsclc. I'm not even sure if the doctors know if I have one hundred percent transformation or if tarceva is still holding back nsclc in my body. I see two different oncologists both with very reputable facilities and they have told me that in any particular practice there just aren't a lot of patients like me.
Reply # - January 2, 2014, 05:59 PM
Reply To: Transformation to sclc on tarceva
Hi there -
I wish I did have a comprehensive answer about the best course but your doctors are right - patients like you are few and far between. There have not been trials done that specifically focus on treatment of EGFR mutant SCLC transformations. The types of treatment you have had so far - chemotherapy together with tarceva - are generally the types of treatments we have seen work for patients with SCLC transformation. Also, as you mentioned, we think that often patients have a combination of some areas of SCLC and some areas of NSCLC in their body at the same time, so treatment often needs to focus on both aspects. Hopefully the taxol and radiation have helped.
All my best wishes,
Lecia Sequist
Reply # - January 3, 2014, 08:43 AM
Reply To: Transformation to sclc on tarceva
Thank you Dr. Sequist for your information. Although it does not contain any magic bullet, it helps me to know that we are following roughly the same regimen that you seem to use.
Out of curiosity, after treating for small cell, have you ever switched any of your patients from tarceva to aftanib and was there any success? I ask because it is an idea that my oncologist has, but not one there seems to be experience with. For now, since I was off the tarceva for 2 months during radiation, we have decided to just try to rechallenge with tarceva. I realize you cannot give specific advice, but I am wondering if you have had experience with such an approach and how it went.
Thanks,
Felicia
Reply # - January 3, 2014, 09:33 PM
Reply To: Transformation to sclc on tarceva
The limited available data suggest that the response rate with (Gilotrif) afatinib after Tarceva (erlotinib) or Iressa (gefitinib) is 5-10%, and the median progression-free survival is about 3 months.
I have had a few patients receive Gilotrif in the setting of acquired resistance (primarily in the setting of the expanded access protocol, in which I treated several patients referred to me for that specific opportunity) but unfortunately haven't seen particularly encouraging results in my limited personal experience.
-Dr. West
Reply # - January 4, 2014, 10:47 AM
Reply To: Transformation to sclc on tarceva
Thanks Dr. West. I knew the numbers were low although I thought a tiny bit higher. I think my oncologist was just thinking out loud. Once we started discussing, we decided for now at least, I may stand better odds by rechallenging with tarceva. Also, he told me that aftanib caused some stomach toxicity. I have had all sorts of stomach problems in the last few months from chemo and a hiatial hernia. It seemed to be taking too much of a gamble to put my odds in something that might cause even more stomach problems.
Reply # - January 4, 2014, 11:33 AM
Reply To: Transformation to sclc on tarceva
With your stomach issues and the low odds for efficacy I can see why your onc decided on tarceva instead. When afatinib was being studied we had several members on it and the side effects they described were more harsh than the side effects the same people had on tarceva. I know it was a small data pool but it was consistent.
All the best for a successful new year,
Janine