sunshine1960
![]()
Posts:2
My 54 year old wife has stage 4 non-small cell lung cancer (NSCLC) with mets to the brain and spinal cord. She was diagnosed in Sept, 2012, was EGFR positive and been on Tarceva since October, 2012. She is now experiencing progression. Is tumor stability in the spine or brain while in a trial for AZD9291? Thank you!
Forums
Reply # - January 9, 2015, 09:18 AM
Hello,
Hello,
Welcome to GRACE. I am sorry to hear of your wife's progression. Many trials exclude patients with "uncontrolled" (untreated or progressing after treatment) brain mets. You would need to check the exclusions of the specific trial you are considering. If it appears that such mets are not excluded, you would probably still want to contact the trial staff to be sure, as the exclusion listings are often not complete and some patients are evaluated on a case by case basis. The preferred and most effective treatment for brain mets is radiation, while the efficacy of AZD9291 in that context is not established.
If by the phrase "mets to the spinal cord" you mean cancer cells present in the cerebrospinal fluid, this is a complication known as leptomeningeal carcinomatosis, for which unfortunately there are few effective treatments. For some patients with an activating EGFR mutation, pulsed Tarceva can be helpful.
If instead the mets to the spine are in the bones, radiation would normally be used to alleviate pain or prevent fractures; otherwise systemic therapy can be effective.
Good luck.
JimC
Forum moderator
Reply # - January 9, 2015, 10:28 AM
Hi Jim, thanks for your
Hi Jim, thanks for your response. There is a tumor actually in the spinal canal, stabilization and even some shrinkage occurred during the last 2 years and 2 months while on Tarceva. We are searching for someone in one of the AZD9291 trials that also has a tumor in the spinal canal, trying to find out if AZD9291 has stopped progression in the spinal canal while in the trial.
Radiation was originally done on the spine at the time of diagnosis, and the oncologists do not feel that the spine could withstand much more radiation.
Thank you.
Reply # - January 9, 2015, 01:35 PM
"The spinal canal (or
"The spinal canal (or vertebral canal or spinal cavity) is the space in vertebrae through which the spinal cord passes.", http://en.wikipedia.org/wiki/Spinal_canal
A met on the spinal canal would be treated and be expected to react as other bone mets might, systemically as Jim described above. That is if radiation hasn't killed it, as an example my husband's pancoast tumor reached a foramen (next to the canal) which seems to be completely irradiated over 5 years ago, fingers crossed. It's hard to know because radiation causes scarring that clouds the ability to read scans.
.
Dr. West stated in his Top Five 2014 post, “This year, both AZD9291 and CO-1686 (rociletinib) broke out as 3rd generation EGFR inhibitors with great activity (response rates ~50-60% for both) in patients with T790M mutation as the mechanism of acquired resistance. Trials are rolling out around the world.” http://cancergrace.org/lung/files/2014/12/Top-5-Highlights-in-Lung-Canc…
including an impressive " 'Waterfall plot' of responses to AZD9291, T790M+NSCLC (Janne, ASCO 2014)"
All Best,
Janine
Reply # - January 9, 2015, 08:50 PM
I'm sorry about your wife's
I'm sorry about your wife's recent issues. As Jim noted, I think one leading barrier is whether she could participate in a trial with one of these agents in the face of active disease within the nervous system, as this is usually an exclusion point. However, if she could pursue AZD9291 or rociletinib, I would have to say that we don't have results reported for her situation yet, so we really couldn't predict what to expect. I would caution that even if there might happen to be one person who received one or two people who received one of these drugs in the setting of growing brain metastases or spinal cord disease, I'd want to be cautious about predicting much on the basis of such extremely limited clinical experience.
Either way, I think the first step is clarifying whether she would qualify to pursue one of these trials.
Good luck.
-Dr. West