njliu
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Posts:142
Many thanks to Janine, Jim and Dr. West on the responses to my questions on the topics of immunotherapy and vision loss. We are now at a critical juncture. There seems to be more convincing evidence the disease is progressing in both the lung, after a 3 1/2 years on Iressa, and the brain, after a 2 1/2 years since WBR. The option being considered now is the combination of Afatinib and Cetuximab. I read from a post by Dr. West here in August 2013 that it was promising and pending the result of a larger trial. May I ask if there is any update? Thank you.
NJ
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Reply # - June 14, 2015, 09:56 AM
NJ,
NJ,
I've looked and looked for new information on the subject and can't find anything new. There are still trials going on to for the combo for nsclc. One new trial for treatment naive patients and one for dose escalation. https://clinicaltrials.gov/ct2/results?term=+Afatinib%2C+Cetuximab%2C+n… and very little new at ASCO. This shows 2011-2015 most significant coming from 2011, http://meetinglibrary.asco.org/search/site/Afatinib%2C%20Cetuximab%2C%2… Everything still sounds very preliminary.
We'll make sure a faculty replies but perhaps tomorrow.
I hope your wife is feeling alright as well as you. Please know you both are in my thoughts.
Janine
Reply # - June 15, 2015, 05:46 AM
Hi NJ, Janine is correct that
Hi NJ, Janine is correct that there is nothing really new to report about this combination. In 2014 the single completed trial of this combination was published in Cancer Discovery "Dual Inhibition of EGFR with Afatinib and Cetuximab in Kinase Inhibitor-Resistant EGFR-Mutant Lung Cancer with and without T790M Mutations", which included 126 patients with EGFR mutant lung cancer who had progressed on prior Tarceva or Iressa. The response rate was about 30%, and was about the same whether patients' tumors had the acquired resistance mutation T790M or not. The average duration of response was about 6 months, and there was no mention in the paper of how active this combination was for brain metastases. The skin rash and diarrhea with this combination were generally more severe than with Tarceva or Iressa alone.
I have used this combination myself and seen it work well for some people, although I am not sure how effective it will be for progressive brain metastases as cetuximab is an antibody and these do not cross into the brain very effectively. However, combining effective treatment for the rest of the body with focused radiation to brain lesions can be effective for some patients for quite some time. There are next generation EGFR inhibitors that have significantly better penetration into the brain being developed.
The other thing some patients and doctors fail to consider is standard chemotherapy, which can be quite effective in EGFR mutation+ lung cancer. This is what I usually recommend to my patients when first-line EGFR inhibitors stop working and there are no clinical trials available. While many patients are dismayed to have to resort to this option, I have a number of patients who have had longer duration of control on chemo than on the EGFR inhibitors. Just another thing to consider!
Reply # - June 15, 2015, 07:04 AM
Dear Janine and Dr. Pennell,
Dear Janine and Dr. Pennell, thanks a lot. Yes! The plan is to do this combo plus focused radiation to the brain mets. Originally the plan was to switch to standard chemo. This was changed in view of the recurrence of brain mets with the hope that it can keep micro metastases at bay while visible mets are to be zapped by radiation.
NJ