BAC and MK 3475 trials - 1261818

It appears from a short search that MK 3475 is being studied for both adenocarcinoma (BAC has adeno. histology) and squamous as well MK 3475 being studied in other solid tumors.

BAC can be relatively fast moving within a month of treatment as you've described and can be appropriate to treat as adeno nsclc in general.

I'll ask a doctor to comment.

I'm sure you'll come to an understanding and make plans soon...Plans always ease some of the stress.
Janine

Hello--

I am sorry to hear that your cancer has returned so quickly. It is a very difficult thing to hear this when a person is still in the recovery phase from the chemotherapy that was aimed at keeping it from coming back.

MK-3475 is one of the anti-PD1 antibodies currently in development. These are a newer class of drugs, different than chemotherapy, designed to try to help the body's immune system recognize that the cancer is present so that the immune system can try to fight it off.
The immunotherapies have had some very promising results in multiple cancers in the last couple of years, including in lung cancer, even in patients with disease that tradiationally would be expected to be very resistant to further chemotherapies. There are several companies all developing their anti-PD1 or anti-PDL1 antibodies currenty.
There is evidence of activity of anti-PD1 antibody in adenocarcinoma, as well as in squamous cell carcinoma. It does not appear at this point to be a treatment that is dependent upon histology. I have not come across any data specifically about mucinous BAC, although this type of lung cancer falls under the grouping of adenocarcinomas, and is generally treated as such.

Docetaxel is an FDA-approved therapy for lung cancer that has progressed after prior chemotherapy, and is a reasonable consideration as well, as would be pemetrexed (Alimta), for adenocarcinomas (or erlotinib, Tarceva, for that matter). The anti-PD1 agents are not available outside of a clinical trial at this point, although the others are.

I am sorry that you have had such disappointing news. I hope the next round of news is better for you.

I agree with Dr. Sanborn. There are simply not enough patients with BAC who have been on immune checkpoint inhibitor trials (anti-PD1 and anti-PDL1) to say whether this line of treatment is more or less effective for people with BAC than other people with a lung adenocarcinoma. In addition, BAC can behave in quite varied ways, being very aggressive in some people and extremely indolent in others, responsive to many treatments and resistant in others.

As Dr. Sanborn suggested, conventional chemo agents can sometimes be effective, and I'd say that Alimta (pemetrexed) is one agent that has probably had the most reported success among conventional chemotherapy agents for BAC, including patients with both mucinous and non-mucinous BAC. That said, immunotherapies may be very effective as well -- we just don't know.

Good luck.

-Dr. West

I have seen some good results with chemo and the antiangiogenic agent Avastin (bevacizumab), and while I'm not sure if it's the chemo, the Avastin, or the combination, I think it's perfectly good to include.

It's really unknown whether a buckshot approach to looking for mutations is going to be helpful. With relatively few molecular marker tests that have a clearly useful target drug to go with them, there's a real chance you'd identify a target that may lead you down a rabbit hole searching for an undefined treatment for a new, rare mutation.

-Dr. West

Hi rjiliffe,

I have not been able to determine whether this is so; not even the FDA site seems to have any information. Since the data in its favor is still pretty slim, it seems that at this point the only way to get the drug to treat lung cancer (other than paying for it yourself) would be in a clinical trial.

JimC
Forum moderator

Yes, Merck is developing pembrolizomab as a treatment for PD-L1-expressing NSCLC. To my knowledge, they are not focusing on it for a broader lung cancer population.

-Dr. West