Afantinib - 1271978

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loupivac
Afantinib - 1271978

Hello. My mother in law was diagnosed with NSC lung cancer in 9/2012 aged 62, non smoker excellent health. T2, N1,MO, 1/3 lymph nodes positive, left lower lobectomy and three months of adjunctive chemo.

She then had no treatment until spinal mets appeared in Nov 2013 and her orignal lung sample was tested and EGFR mutation detected. She immediately began treatment with Afantinib and her response was described as "brilliant".

12/2014 spinal met to t9 treated very successfully with radiation and Afantinib continued.

May 2015 Cancer markers rising but no scans ordered. July 2015 new spinal lesion and no improvement in two existing lesions , mother in law complaining of side effects of Afantinib (sore toes) and when Oncologist stated she had become resistant to Afantinib and suggested she stop taking it she agreed.

August 2015 rejected for ADZ 9291 as disease was considered as "not progressed" but was able to join Nivolumab trial.

Sept 2015 right side hemisensory loss, MRI shows three lesions to brain, whole brain radiation suggested. Family questioned benefits of Gamma Knife, not available in Perth (Western Australia) but available in one hospital in Sydney. Strongly advised against this "risky procedure" however travelled to Sydney to get second opinion (Onco and Rad) and fine cut MRI found 5 mets and these were treated.

(Now) 3 months later still hemisensory loss, she says it improves and then worsens after Nivolumab.

Last week 800ml malignant pleural effusion, returned one week. Today pleurodesis undertaken (plus 1ltr fluid but not 100% successful as no lower left lung to adhere to pleura.

Last dose of Nivolumab due this week. Makers have come down from high of 50 to 30 now.

My question (finally): is there still a place for Afantinib in the treatment of what is now described by her medical team as late stage lung cancer? AZD9291 not available in a Australia except trials and no tumours to biopsy.

Many thanks.

catdander
Hi loupivac, Welcome to

Hi loupivac, Welcome to Grace though of course I'm very sorry for the need to be here. I'll ask a doctor to comment. One thought is there is sometimes enough cells in the pleural fluid for testing. If the testing would be for t790m and is found it would be worth speaking to the onc to see if it is appropriate and the makers of adz9291. The makers are usually generous to give treatment to those who aren't insured so maybe she'd be able to get it in Australia.

I hope she does well.

Janine

dr. weiss
We can't provide medical

We can't provide medical advice in this forum. Actually, even if we were allowed to, the kind of situation that you describe is too complex to give good advice without a full consult/review. That said, I think that I can provide some general information that I hope will be of use to you.

When cancer grows on an EGFR TKI like afatinib, often some of the cells have resistance while others don't. So, coming back to an EGFR TKI like afatinib, erlotinib or gefitinib again later can sometimes result in benefit. In my practice, I'm more likely to restart an EGFR TKI in a patient with EGFR mutation than I'm likely to re-use other drugs.

In the US, AZD9291 has FDA approval and I imagine that global availability should improve over time. If T790M can be found on biopsy or blood testing, this can be a good option.

loupivac
Thank you very much Janine

Thank you very much Janine and Dr Weiss for this information and your kindness and generousity in taking the time to provide it. We will definitely be renewing our efforts to find an Australian AZD9291 trial, it might mean more trips to Sydney, let's hope it receives approval for uses in Australia very soon.

Many thanks again,

Louise