Treatment Options for Late Stage NSCLC - 1289338

afi203
Posts:6

Diagnosis - adenocarcinoma NSCLC with mets to adrenal gland and possibly liver; positive for 858R and negative for 790M, ALK, KRAS, ROS, PD-1, PD-L1, MET
Treatments - 1st carboplatin/pemetrexed with shrinkage; 2nd Tarceva with shrinkage at 6 weeks and progression at 12 weeks; 3rd pemetrexed/Avastin not tolerated; 4th Opdivo stable at 6 weeks and progression at 12 weeks; 5th docetaxel not tolerated; 6th just beginning Tagrisso.
Questions
Is Tagrisso a good alternative for a 790M negative never smoker. If not, what are other alternatives?
Current treatment is at Yale by Dr. Roggerio Lilenbaum. Can you suggest suitable clinical trials in CT, Mass or NY?
Can you suggest a doctor for a second opinion?

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Reply # - December 4, 2016, 02:52 PM

cards7up
Posts: 636

Have you tried gefitinib or afatinib? I can't answer about taking Tagrisso without having the T790M mutation, because everyone I know who took it had the mutation. And I don't think insurance would pay for it without the mutation. You can look up trials at clinicaltrials.gov.Good luck!
Take care, Judy

Reply # - December 4, 2016, 04:22 PM

JimC
Posts: 2753

Hi afi203,

With regard to Tagrisso, my first question would be whether it was only the initial biopsy at the time of diagnosis that was negative for T790M, or whether there was an additional biopsy after progression on Tarceva. Most EGFR-positive patients do not have the T790M mutation at diagnosis but develop it after treatment with Tarceva. So in your situation one could exist now, and Tagrisso would be an excellent choice. If not, it's still unclear how much benefit it might provide.

As Judy stated, afatinib might be an option; after progression on Tarceva, it's more likely to be effective in combination with cetuximab (erbitux), but that can be a challenging combination for many patients. Docetaxel can also be tough to tolerate, as you experienced; some patients fare better with a similar drug called Taxol (paclitaxel), and even easier to tolerate is a newer form of paclitaxel called Abraxane.

Since carbo/pemetrexed (Alimta) produced shrinkage, it's also possible to return to pemetrexed without Avastin. Other standard chemotherapy agents which might be used include gemcitabene and navelbine.

Also as Judy suggested, the best place to find clinical trials is clinicaltrials.gov which allows you to search based on location. You might want to bring a list of your results to your doctor, to see which of them might be appropriate.

Finally, there are many excellent oncologists in the area you've delineated; Massachusetts General Hospital/U. Mass. and Memorial Sloan Kettering in New York have especially strong lung cancer programs.

JimC
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Reply # - December 14, 2016, 07:49 AM

afi203
Posts: 6

Sorry for the delay in replying but I had difficulty figuring out how to reply to a post. In reply to your question, the biopsy that was 790M negative was taken after progression on Tarceva.
I watched a video on YouTube by Dr West that showed promise for Tagrisso in negative 790M patients. Also it mentioned two trials recruiting negative 790M patients.
Any additional comments?

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