My husband, Bob, was diagnosed with SCLC Ext in August of 2016. His cancer was found in his left lung, medistanium, small tumor in right lung and a growth on his left adrenal gland. Two brain MRI negative for brain mets. He is 74 years old and has also had prostate cancer which was an aggressive type about 5 years ago. It was treated with surgery and hormone therapy. His PSI was remained very low. No cancer activity was detected in his PET scan in his abdominal area...so I think the prostate cancer is pretty inactive.
He had 4 rounds of Carbo/Etoposide and had a complete response after the 3rd round (NED) Finished with 4th round December 1, 2016. He then had 10 treatments of consolidated chest radiation. His last CT Scan (March 2016) showed growth in his left adrenal and a possible new growth on his right adrenal gland. The PET scan revealed that his left adrenal was active again for cancer and now his right adrenal has a small growth. There is one lymph node by his right clavical bone that also lit up in the PET.
His oncologist prescribed paclitaxel and he has had one round of paclitaxel. His doctor said he had been approved by the insurance company for Opdivo. He has not had any genetic testing done.
My questions:
1. Should he have the Foundation One testing done to see if his tumor has any mutations or expression for PD/L1?
2. Should he try immunotherapy if the Taxol doesn't work? Is sooner better than latter with trying the immunotherapy drugs?
He has held up extremely well through chemo and radiation. He has lost very little weight and if you didn't know he had cancer he acts and looks close to the same before his diagnosis.
Thank you for your help! It is so appreciated!!
Reply # - March 27, 2017, 11:48 PM
Hi binger,
Hi binger,
I'm sorry to read about your husband but glad to know he is feeling good. I'm going to direct you to a post Jim just posted about immunotherapy. There's no mutation that immunotherapy drugs target but there is a protein that is expressed that seems to allow the drugs to work better if you express a lot of it.
Usually people stay on a treatment as long as it's working and side effects are manageable. Most oncologists like to use up a drug before moving on to another treatment so as long as he does well he could stay put.
The only reason to do genetic testing for sclc would be for a clinical trial because there are no treatments for sclc that target a specific mutation. Those who are conducting the trial usually do mutation testing or have a specific test they use. Your husband's oncologist should be able to point you in the right direction for any possible trials available in your area. Otherwise there's probably no reason to do genetic testing.
Here's the post discribing immunotherapies, http://cancergrace.org/topic/failed-alimta-maintenace-for-stage-4-nsclc
I hope your husband does well well for a long time. Take care of yourself too.
All best,
Janine
Reply # - March 28, 2017, 06:15 AM
Janine,
Janine,
Thank you for your quick response!
My husband has not been able to get into a trial because of his prostate cancer history. Every time we've applied for a trial when it gets to the question about previous cancer he gets kicked out because of the prostate cancer. Even though it isn't really active he still gets rejected.
I now understand how the testing is used for establishing mutations. My husband was a lifelong smoker. He quit smoking about 5 years before his cancer appeared. Is it true that the immunotherapy drugs tend to work better in smokers than non smokers?
Once again, thank you for the information!
Binger
Reply # - March 28, 2017, 09:56 AM
It's not too surprising that
It's not too surprising that he would get excluded from trials because of prior cancer diagnosis though each trial has it's own inclusion/exclusion rules.
It's true true that immunotherapies tend to have more efficacy the more one smokes or smoked. The most simplistic theory is that a smoker picks up a lot of mutations while smoking so this treatment has many opportunities to work. This would also explain way people with egfr and alk driver mutations haven't responded as well. There are trials that want to answer the question of whether immunotherapy would be better than 2nd line standard treatment topotecan or in your husband's case taxol (which is a comparable drug).
This is a link to a video with transcript by Dr. Cathy Pietanza, http://cancergrace.org/lung/2016/01/26/gcvl_lu_immunotherapy_small_cell…
All best,
Janine