I have a couple of questions for the Good doctors here.I am from India and this query is for my uncle.
The patient(My uncle) is 60 yrs old and a smoker (PAD) for the last 45 years .
At the end of april(This year)CT assisted Biopsy done on right lung revealed “poorly differentiated adenocarcinoma”. The treating physician notes say it is Non-Small Cell Lung Cancer.
6 cycles of Combined paclitaxel and gemcitabine chemo therapy was administered to the patient over a period of 4 months and stopped at the end of last month.As per the physician since the patient was suffering from kidney impairment other chemo drugs were not considered .
Normal CT scan revealed that After 4 cycles of chemo the tumor size reduced by about 50% .
With this encouraging result the treatment was continued for another 2 cycles(total 6 cycles) up to the end of last month.
The PET scan done at the beginning of this month revealed that the tumour size has actually increased compared to the start of the treatment(“Irregular speculated mass legion”) .The left lung remained disease free.
My query is this;Is there a case for doing EGFR mutation test to consider using Tyrosine Kinase Inhibitors like gefitinib (Iressa) and erlotinib (Tarceva) ?.
If the answer is yes my next query is ; Is there a need for fresh biopsy or the 4 month old ct assisted biopsy tissue is adequate.
Reply # - September 11, 2012, 01:12 PM
Reply To: Nsclc treatment query
Hi Chandra, I'm sorry to your uncle is going through this.
I don't know the specifics of how insurance covers gefitinib or erlotinib in India. Some parts or the world offer these drugs as a second line option while others require a positive mutation testing.
If India requires testing then yes your uncle could use the tissue from the original biopsy is there is enough.
I hope this helps,
Janine
forum moderator
Reply # - September 11, 2012, 01:56 PM
Reply To: Nsclc treatment query
Dear moderator,Thanks for the prompt reply.
Keeping aside the requirements of insurance or doctor's recommendation i want to go ahead with the test.
Would it be prudent to start erlotinib (Tarceva) dosage pending arrival of results ?.
Reply # - September 11, 2012, 02:17 PM
Reply To: Nsclc treatment query
Hi Chandra,
If there is progression, it's usually considered a good idea to start a new line of therapy. And the doctors here have often stated that Tarceva is a valid second-line option regardless of EGFR status; it provides a benefit similar to other second line chemo options. Because of that it would make sense to stick with it regardless of the EGFR results. In that sense, doing the test is not essential -Tarceva's a good option either way. So if you can get insurance coverage for Tarceva before the results arrive (and Tarceva is an expensive option if you need to self-pay), it would be a good idea to start treatment sooner rather than later.
I hope he tolerates it well and gets good results from it.
JimC
Forum moderator
Reply # - September 11, 2012, 02:33 PM
Reply To: Nsclc treatment query
Jimc, thanks.
There is no problem wrt paying for the meds(Tarceva).
Now, i need a couple of dcotor posts to convince my uncle to start with Tarceva .
Reply # - September 11, 2012, 05:07 PM
Reply To: Nsclc treatment query
Overall, the evidence out there suggests that results are pretty comparable between EGFR inhibitors and the better tested chemo agents in previously treated patients, namely Taxotere (docetaxel) or Alimta (pemetrexed), the latter for patients with non-squamous non-small cell lung cancer (such as an adenocarcinama). For those who happen to have an EGFR mutation, an EGFR tyrosine kinase inhibitor is likely to be a very superior choice, but because Tarceva (erlotinib), at least, is also pretty comparably active as chemo, you can make an argument that it isn't clearly critical to do EGFR mutation testing after first line, where Tarceva is a correct option regardless of the result of the study.
-Dr. West
Reply # - September 11, 2012, 09:37 PM
Reply To: Nsclc treatment query
Dr West,
Thanks a lot for the reply.
Chandra.
Reply # - September 12, 2012, 10:28 PM
Reply To: Nsclc treatment query
Dr west,
Sorry to bother again.
There seems to be a problem wrt to diagnosis regarding the specifity or the lack of it .
The CT biposy slides were characterized as "poorly differentiated adenocarcinoma" .
Now, The radiolagist/doctor of the PET scan (This one is diff from the actual biopsy institution) who , after seeeing the tisue closely thinks that this is squamous nsclc.
Should we be concerned ?. Is there a very specific test to determine whether the adeno carcinoma is a squamous or non squamous variety ?.Or a mere visual observation is all that is requied.
I really don't have any medical knowledge and apoligize if the questions are irrelevant.
Reply # - September 13, 2012, 12:04 AM
Reply To: Nsclc treatment query
Hi Chandra. Sorry to hear about your uncle. I'm not a doctor but just drawing on my own experience: yes there are specific lab tests that can be done for various proteins and markers that confirm the "histology" (category/cell make-up of tumour), although I believe it is indeed the case that adeno and squamous cells do look different to an experienced eye. But tumours don't always fit neatly into one or other category - so you can get a "mixed" histology, meaning that the cancer could have a mix of cell, squamous in one area and adeno in another. So what you've been told needn't be worrying - I suggest you just make sure your uncle's doctors are all aware of it. Best wishes.
Reply # - September 17, 2012, 05:01 PM
Reply To: Nsclc treatment query
Sorry I missed this. The person reading a PET scan isn't remotely qualified to do anything more than wildly speculate about a cancer's histology (cellular subtype). That guess couldn't be less reliable compared with the judgment of someone looking at the cancer under a microscope.
-Dr. West
Reply # - September 18, 2012, 02:37 AM
Reply To: Nsclc treatment query
Certain spring, thanks for the info.
Dr west,Thanks for the reply.We will go with the original diagnosis.