Hi Friends,
I have come to ask your advice regarding treatment decisions.
Background. I have Stage 3a NSCLC adeno, had VATs lobectomy in early May 2017. I am also EGFR+ I also have Stage 3c Melanoma and am currently NED (resected last week) and BRAF+. I'd rather think of myself as an overachiever than complicated... but I digress.
I am working with an amazing Melanoma ONC. Right now we're looking at two adjuvant treatments: 4 cycles Carbo + Pem (or VP16) and 6 weeks of radiation or 6 weeks of radiation and then Gefitinib for 2 years. As I understand it, the Carbo + Pem/VP16 will lower my immune system that is currently keeping the melanoma at bay (I've had extensive immunotherapy and it has worked... somewhat). The gefitinib is easier to do and has had better disease free progression times, but is relatively untested in a adjuvant setting (but initial clinical trial data looks good CTONG 1104) and in the world of research, tested on a small data set (n=200). It's also two years and we'd run into all kinds of new territory if Melanoma came back and I needed to do systematic therapy again.
So my questions for you all are:
1) I recognize the that treatment choices are in some ways a crapshoot, but I don't even know how to make this decision. Am I thinking about this in the right way?
2) Is it really this even in the pros and cons? Or am I missing something.
Thank you friends for your help!
Julie
Reply # - June 13, 2017, 06:17 PM
Hi Julie,
Hi Julie,
Welcome to GRACE. It seems that you are doing about as well as possible to think through the options. Treatment choices are almost never clear cut. You work with the (often limited) data available but at some point it's an educated guess.
On the other hand, while chemotherapy can depress the immune system, it's not clear that it would be depressed in a way that would diminish the effect of the immunotherapy you are receiving or have received. As an example, there are trials testing the efficacy of chemo/immunotherapy combinations, and as you can see in this discussion by Dr. West, there is preliminary, small trial evidence for a better response rate from such combinations, which tends to indicate that the effects of chemo on the immune system do not lessen the effect of the immunotherapy.
As you say, there is some evidence that an EGFR inhibitor may benefit EGFR+ patients in the adjuvant setting, but as Dr. Neal suggests in this podcast, two years of adjuvant EGFR inhibitor therapy might not be enough.
As you point out, the adjuvant chemo is limited to 4 cycles, which makes subsequent systemic therapy for your melanoma less problematic. In addition, any harm chemo may cause to the immune system should fade over time.
Good luck with whichever option you choose, and please let us know if you have further questions or updates.
JimC
Forum moderator
Reply # - June 14, 2017, 09:04 AM
Thank you Jim! I really
Thank you Jim! I really appreciate having someone a little further down this road take a look at this and tell me I'm not crazy.
I'll find out more info on Monday, but I expect that I'll join the ranks of the ranks of those who have done chemo. At this point in time though, I just want it all to be over with!
Thanks again for your help!
Julie