showmei
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My mom was taking Tarceva for 6 months before she stopped responding to it. She tested positive for the T790 mutation. She started Tagrisso 6 weeks ago (was on an open access study right as it got approved). Her recent scans showed it was working in some areas, but not in her liver. Dr. suggests chemo or immunotherapy (Nivolumab). Is 6 weeks considered a significant enough amount of time to determine that Tagrisso is not working?
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Reply # - January 6, 2016, 02:52 PM
Hi showmei,
Hi showmei,
I don't have the answer to that but I'll make sure a doctor comments.
I hope your mom does well,
Janine
Reply # - January 6, 2016, 03:02 PM
I would say yes. Though
I would say yes. Though immunotherapy agents are known to potentially demonstrate a delayed response after the start of treatment, the pattern for chemotherapy or targeted therapies such as Tarceva (erlotinib) or Tagrisso (osimertinib) is very clearly to see the most shrinkage early on (I sometimes refer to it as a "front-loaded" response), then diminishing effects over time. It's not impossible to see a more significant change in the second or later scan after starting a new targeted therapy, but it's very, very unlikely.
I personally don't change treatment if some of the cancer has responded and other areas are just stable, but if an area is growing, especially if growing significantly, I think it makes good sense to pursue a different angle.
Good luck.
-Dr. West
Reply # - January 7, 2016, 05:47 AM
Thank you so much for your
Thank you so much for your quick response. Yes, he is changing treatment plans because it is growing in her liver (same reason she had to switch from Tarceva to Tagrisso). She tried one individual treatment of pemetrexed before getting her EGFR + test back and starting Tarceva, but did not tolerate it well which is why we are giving immunotherapy a try. I just wanted to make sure we had truly given Tagrisso enough time to work since we had such high hopes for the med, and she tolerated it so well. Anyway, thank you again, I really appreciate the additional support.
Reply # - January 7, 2016, 02:32 PM
Is it possible to have focal
Is it possible to have focal treatment to the one tumor that's causing all the change. That's the trending treatment for those on 1st gen tki like tarceva but not 3 gen tagrisso. Plus I don't know if it's possible to use sbrt for the liver but it may be worth the conversation with the onc. We have tons written on the subject. http://cancergrace.org/lung/acquired-resistance-patient-forum-2014-vide…
Janine
Reply # - January 8, 2016, 08:46 AM
The tumor in her liver
The tumor in her liver progressed from 2.5 x 2.1 cm to 3.8 x 3.5 cm. Would that be considered rapid or slow growth? I watched some of the videos you recommended (thank you for the links), and it did mention stating on the targeted meds seemed beneficial with slow progression, but not sure whether her liver tumor growth is considered slow or rapid. Any additional info. would be greatly appreciated. Thanks again.-Fawn
Reply # - March 12, 2016, 01:15 PM
Dr West,
Dr West,
My mother had stage IV lung cancer and was on Tarceva for 2 years. It started to stop working but her oncologist kept her on it, she had a biopsy and a chest drain and we discovered she did have the mutation. Unfortunately, she was in such pain after the biopsy and chest drain, was sent home with paracetamol, was back in hospital to have the fluid drained from her lung and caught a hospital borne infection. The trial closed (we are in UK) and she only got the drug in January this year. We thought AZD9291/tagrisso would be her lifeline but she passed away two weeks ago. I remember after Tarceva, she felt better within 8 days, would this have been the same with Tagrisso if it had been working?
Thanks
Reply # - March 12, 2016, 08:06 PM
coco1,
coco1,
I am so very sorry to hear of your mother's passing. There really isn't any way to know if Tagrisso would have been effective for her; despite the presence of activating mutations, some patients do not respond well to targeted therapies. In addition, second line treatment is usually not as dramatically effective as first-line, so a repetition of her experience with Tarceva would not necessarily be expected.
I am sending my deep condolences and wishes to you for peace and comfort.
JimC
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