My mother was diagnosed with stage 4 NSCLC in September 2014. She is EFGR+ and T790M+.
History:
She was first on Tarceva, then carboplatin/alimta plus tarceva, then tagrisso. Progression on tagrisso started in December 2016. She then tried one round of Keytruda because her PD-L1 expression was 60%. Due to extreme coughing and to rule out pneumonitis, a CT scan was done right before her second round of Keytruda. Scans show very large growth on existing tumors and new growths. The oncologist thought it would be better to switch to chemo to try to control the growth as soon as possible because immunotherapy tends to take weeks to months to be effective. By then, the cancer could have grown too much. So she had 2 rounds of docetaxol, which did nothing and the cancer continued to progress. Now she had 2 rounds on navelbine and CT scans show mixed results. Some tumors are slightly smaller but others have remained the same or grew a tiny bit. She will continue on navelbine until much clearer progression shows.
But what options does my mom have after? The oncologist thought it would be worth a shot to retry tagrisso because she is still T790M positive. The oncologist thinks there is a higher chance of tagrisso working than to retry any type of immunotherapy? She said that most EGFR positive patients do not have good results on immunotherapy and that my mother was a rare case who was EGFR positive and had a high PD-L1 expression.
Reply # - May 25, 2017, 08:40 AM
Hi chinchin,
Hi chinchin,
Welcome to GRACE. I am sorry to hear that your mom's cancer has progressed through several different treatment regimens. But it's good to hear that navelbine has kept her cancer basically unchanged; with previously-treated stage IV lung cancer, stability is a good result. It is certainly reasonable to stay with navelbine until there is clear evidence of significant progression.
As far as a later return to Tagrisso, much would depend on how long she responded to it the first time. In most cases, oncologists do not return to a previous regimen unless there was a sustained response initially, usually at least six months if not longer.
With respect to Keytruda, as you've said it can take a while for efficacy to become clear, so it's really hard to say that it was ineffective. Although it's true that EGFR+ patients have a lower response rate to immunotherapy than those without an EGFR mutation, that response rate is not zero, so the fact that your mom has high PD-L1 expression may make a difference in her case.
In planning for a possible therapy after navelbine, you might want to discuss clinical trials of novel agents with her oncologist. You can search for such trials in your area at clinicaltrials.gov.
In the meantime, I hope your mom gets a long-lasting response from navelbine.
JimC
Forum moderator