I was hoping to get some opinions from the Doctors on my Wife's treatment as what we are being told at our appointments is not meshing with what I've read online.
My wife just completed Cisplatin/Etoposide/Radiation after a R1 borderline R2 resection for stage 2B Squamous. Because she has EGFR exon 21 the Oncologist told us today that he wants to start her on Tarceva after her first scan in a couple months.After he said this I questioned his reasoning and he said that in my Wife's case they consider her a high risk of recurrence and that if she was his wife he would put her on Tarceva. He had mentioned this in a previous appointment so I had done some research. Has anyone heard of them giving Tarceva this way? I thought they reserved that for stage 4 ? .
She is being treated at St. Joseph's Hospital in Orange, Ca. and we have been pretty happy with everything , we are close to UCI Medical Center and would like to get a second opinion there but have been running into some roadblocks with our insurance, when we asked for a second opinion before they would only refer us to St. Jude's , another community Hospital that is affiliated with St. Joe's.
My wife leaves these decisions to me as she doesn't want to know to much about her prognosis. My concern is that even if it helps now what happens down the road if she has progression when she could really benefit from Tarceva and her body has already built up a tolerance. Any insight would be appreciated, thanks!
Steve
Reply # - August 24, 2016, 11:41 AM
Hi Steve,
Hi Steve,
You are correct in that the value of using Tarceva in the adjuvant (post-surgery) setting has not been clearly established, but there is some evidence that long-term treatment with Tarceva may be beneficial. There is a very thorough discussion of the use of Tarceva in this setting in this GRACEcast video. Of course, as is stated in the discussion, there is the possibility that the lung cancer has already been cured with surgery, radiation and chemo. There's just no way to know.
Although I tend to be a strong supporter of obtaining second opinions, as you can see from the discussion reasonable oncologists can differ in their assessment of the available data, so I'm not sure that if you get a different answer you can assume that the initial opinion is wrong.
As far as developing resistance sooner, that certainly is a concern. However, there are now third-generation EGFR inhibitors available to treat EGFR inhibitor resistant disease, and research continues to develop new treatment agents.
JimC
Forum moderator
Reply # - August 25, 2016, 02:54 PM
Jim, how likely is it for
Jim, how likely is it for squamous cell to have an EGFR mutation? Take care, Judy
Reply # - August 25, 2016, 06:17 PM
Judy,
Judy,
It's really not that likely, but since many oncologists don't test squamous patients (although that is starting to change), the mutation may be seen more often.
Of course, it's also possible to have a cancer that is mixed in histology, with the adenocarcinoma portion bearing the EGFR mutation.
JimC
Forum moderator
Reply # - September 1, 2016, 12:52 AM
Jim, my next questions would
Jim, my next questions would be what dosage of Tarceva would be appropriate for her setting? And for what lenth of time?
Thanks for the reply's
Steve
Reply # - September 1, 2016, 05:40 AM
Jim, that was my thought too
Jim, that was my thought too that it was mixed adeno-squamous.Thanks!
Take care, Judy
Reply # - September 1, 2016, 06:26 AM
Hi Steve,
Hi Steve,
Whatever the proportion of the cancer cells that bear the EGFR mutation, you would likely start with the standard Tarceva dosage of 150 mg, reducing it if side effects warrant. There's no set time period; often Tarceva users continue, if well tolerated, until progression occurs. Of course, if the squamous component progresses, stopping Tarceva may allow the adeno component to progress also.
JimC
Forum moderator
Reply # - September 1, 2016, 06:15 PM
Our Oncologist has never told
Our Oncologist has never told us that her histology might be mixed, I checked her pathology report and it just says Squamous cell carcinoma. Also she has had two biopsy's, one a liquid biopsy thru Biocept it says L858R detected second biopsy a tissue biopsy thru Clarient it says Cobas Exon 21 L858r detected, 20-50%of neoplastic cells. Looking over all her paperwork it only refers to Squamous cell, I will ask about a possible mixed histology at our next appointment.
Thanks
Steve
Reply # - September 2, 2016, 08:57 PM
I believe the main thinking
I believe the main thinking behind the possibility your wife's cancer is of mixed histology is there are so few people who have an EGFR mutation with squamous cell nsclc it's just as likely she has both but only squamous has been biopsied. Having said that there was a woman here on Grace who went by the name certain spring, she had squamous nsclc and EGFR positive. She was tested several times during her journey and never a sign of adeno found. She responded well to tarceva for several years. Speaking of certain spring she was an eloquent, tough, caring person who contributed tons here on Grace. It would be helpful to search her on Grace even if the topic isn't histology. She is now gone but her words, so wise and forth coming shouldn't be lost.
I'm afraid there are far too many answers that start with, "it depends" and "we don't know" when it comes to cancer care. Everyone's cancer is a different disease and all this makes oncology as much craft as science.
I hope your wife is cured and this is all a mute point.
Hoping for the best,
Janine