My husband experienced progression on Tarceva after less than seven months. Stayed on Tarceva another five months and then stared chemo. Carbo, Avastin Alitma. After two treatments PET showed marked progression. We stopped chemo. Based on feedback from my prior post, my husband started back on Tarceva (as of today). I am wondering if because his biopsy indicates he has a "poorly differentialted carcinoma with adenosquamous carcinoma" if he might be a cadidate for the recently approved Obdivo?
and whether this drug might a viable option. Are they doing any specific tests around poorly differentiated carcinomas?
The other thing we are exploring is Clovis Tiger 3 trial, which seems to be opening up over the 3-4 weeks.
My husband showed marked improvement under Tarceva, so the thought was the cancer was adeno dominent. But his chemo had absolutely no impact, just the opposite. A biopsy completed two monthgs ago showed he was negative T790. Otherwise, the histology findings were similar to the original biopsy.
Reply # - March 14, 2015, 12:27 PM
Opdivo may very well be a
Opdivo may very well be a choice for your husband. If his oncologist isn't open to the idea a 2nd opinion at a research hospital might be an option.
I'll ask a faculty to comment.
Good luck,
Janine
Reply # - March 14, 2015, 12:38 PM
thanks for your response yes
thanks for your response yes clovis is open (ing) for non T790 i believe they have started recruiting in MN and i understand they are close to opening it up in northern ca
between the two, it opdivo is an option, which might be more effective with mixed histology?
Reply # - March 14, 2015, 12:52 PM
Oops after looking at
Oops after looking at clinical trials page and saw it was open to those without the T790 mutation I edited out my questioning of his being T790 negative. I've asked a faculty to comment so maybe he will have some thoughts on what might be most hopeful.
Fingers crossed for a good effective treatment sooooon.
Janine
Reply # - March 16, 2015, 10:46 AM
Yes, Opdivo (nivolumab) is a
Yes, Opdivo (nivolumab) is a reasonable option for adenosquamous lung cancer. It sounds like it would probably be approved by most insurance products, although this is new territory.
The nice thing about immunotherapies (like Opdivo or Keytruda) are that the responses seem to last a long time, compared to standard therapies like chemotherapy. As I recall, the Checkmate 012 trial showed that some patients with EGFR mutation and resistance could respond to nivolumab. Dr Gettinger presented this poster at World Lung Conference in 2013.
Reply # - March 22, 2015, 07:17 PM
Janine,
Janine,
thanks for your response. is there any data that would show if the Clovis 1686 for a non T790M patient would be less or more effective than Opdivo for a adenosquamous EGFR positive paitent that has had progression on tarceva (and chemo absolutely no effect).
Reply # - March 22, 2015, 07:19 PM
sorry - that reply should
sorry - that reply should have been to Dr. Creelan. Sorry
Reply # - March 24, 2015, 05:44 AM
angieb,
angieb,
That would require a randomized trial directly comparing response to each of those drugs in a single group of patients. I don't see any trials of that sort at present, and I'm not sure one would be expected since it would be difficult to find enough patients with similar histology and EGFR status. So it would not be easy to say whether one regimen would be likely to be better. Opdivo is certainly a good choice for the squamous component of your husband's cancer, while an EGFR inhibitor may help with the EGFR portion of the disease, but it's just too complex a histology to be able to draw conclusions.
I'm sorry that their isn't a better answer beyond trying one of the regimens and seeing what happens. I hope whichever choice you make proves to be very effective.
JimC
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