Hello Cancergrace community (and hopefully Dr. West),
I have read Dr. West's estimations of the efficacy of Afatinib in his posts back in 2013, and have not been able to find anything written by him since. My father, stage IV NSCLC Squamous with EGFR mutation (non-smoker), had a good run on Tarceva (almost three years) before his lung cancer returned to his lymph nodes, adrenal gland, lung and atop his liver. His oncologist gave him one Alimta/Keytruda infusion 5 weeks ago, but he experienced such severe side effects the doctor declared it would kill him to do anymore. Now he is starting every other day 30 mg. of Afatinib, and so far no side effects (only two doses so far.) He is still extremely weak, sleeping throughout the day, and is on low-dose morphine to manage the cancer pain. My fear is that he will take Afatinib and will suffer terrible side effects, as his health was terribly comprised with the last infusion, and it will all be for nil. I've tried showing him Dr. West's appraisal of Afatinib as a single agent after Tarceva, but he refuses to consider not taking it, even though the placebo group fared better? Has Dr. West written anything more recently about Afatinib, or found there have been more favorable results since 2013?
Thanks so much!
Afatinib efficacy after Tarceva and Alimta/Keytruda attempt - 1290884
deeperfreedom2
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Reply # - June 20, 2017, 04:19 PM
Hi,
Hi,
I'm sorry to hear that your father's cancer has progressed. There hasn't really been much more news about Afatinib in the second-line setting, although it did seem to provide some benefit when given in combination with cetuximab. The main problem with that regimen is that the side effects were often quite challenging.
The reason that the focus has shifted away from Afatinib in the second-line setting (apart from its disappointing results) is the introduction of third generation EGFR inhibitors designed to overcome the acquired resistance to Tarceva that most EGFR+ lung cancers eventually develop. A good percentage of these patients progress due to the development of another mutation, T790M, which these third-generation inhibitors target. In most cases, an oncologist will order a new biopsy to determine if T790M is present. You can learn about these drugs in this podcast by Dr. Pennell.
JimC
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Reply # - June 20, 2017, 06:27 PM
Thank you so much, Jim! I
Thank you so much, Jim! I believe his oncologist has tested him for theT790M mutation and we are just waiting now for the results. I appreciate knowing the reasons Afatinib doesn't get much attention anymore.
Reply # - June 21, 2017, 09:13 AM
Hi deeperfreedom, I hope
Hi deeperfreedom, I hope your father is able to benefit from a 3rd gen tki by way of having the T790M. Too with his histology of squamous immunotherapy may be another excellent treatment to keep in his back pocket.
I hope he does well moving forward on all treatments he tries.
Janine