semone12
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Posts:42
Hello all! It's been a while since I posted here. My mom (aged 75, NSCLC, stage 4, Adeno, EGFR and ALK negative) continues to be okay. Diagnosed in early 2014, she has gone through Carbo-Alimta to Alimta maintenance to a 3 month chemo break and now 3 days into Tarceva due to some progression. Her performance status over the last 2 years, has been great.
We would like to find out if she may be a candidate for other targeted therapies / immunotherapy. So we need to repeat bio marker testing. The challenge is that we do not have any remaining tissue to test. Will we need to repeat the biopsy to get more tissue? How effective is the blood test process for detecting mutations?
Thanks as always for your guidance,
Semone
Forums
Reply # - September 30, 2016, 11:40 AM
Hi Semone,
Hi Semone,
It's good to hear your mom is doing so well. One of the best things to know is that responders respond and your mom certainly fits that criteria.
Blood based mutation testing is an exploding field. Genomic testing in general is. There are several companies that have these tests on the market are mentioned below.
Dr. Levine recently spoke with us saying, "There are some commercial tests out there — Guardant360 is one of them,
that’s based, again, on the technologies discussed in the NGS section, that
would be next-gen sequencing, and also OncoBEAM or Sysmex Inostics —
these are also commercial tests, and I can tell you there are many more that
are coming. Right now, I would not view them, necessarily, as your first
choice, over getting a tumor biopsy. However, a lot of the quality analytics
that have been done have shown that they can measure almost as accurately
in the bloodstream, using these technologies, as one would taking tumor
tissue through a procedure, using an interventional procedure like a
bronchoscopy or interventional radiology." http://cancergrace.org/lung/files/2016/01/GCVL_LU-B10_Blood-Based-Mutat… the transcript below the video doesn't correspond at the moment hence the 2 links but will be fixed asap.
this link is to a discussion on multiplex testing where several mutations are tested with a single biopsy or blood draw. http://cancergrace.org/lung/2016/01/20/gcvl_lu_blood-based_mutation_tes…
http://cancergrace.org/lung/2016/04/08/gcvl_lu_multiplex_testing_rare_m…
Good info here, http://cancergrace.org/lung/2016/07/13/urine-or-blood-testing-instead-o…
continued..
Reply # - September 30, 2016, 11:55 AM
While the serum marker
While the serum marker testing isn't the standard practice it certainly appears to be on the verge and I'd absolutely want to start my search for actionable therapies with a vial of blood before a broncoscopy or needle biopsy.
Your mom is in a good place in that she can move back to alimta if needed while still looking for the appropriate next step. If you've not read or listened to the newest discussions on the subject this is a good place to start.
I hope this will be helpful and don't hesitate to continue with your questions.
Janine
Reply # - October 1, 2016, 01:07 AM
Thank you so very much for
Thank you so very much for this detailed and informative response.
I appreciate it very much.
Reply # - October 19, 2016, 12:48 AM
Hi again & thank you for your
Hi again & thank you for your input.
My mom started Tarceva and is not coping with it too well. She has also started to feel a slight pain when she breathes deeply. It is on the left side where the nodules are. Per the latest CT scan in late Sept., the cancer is still limited to the left lung & involves a major lymph node now. The pleural effusion is not there any more.
I've heard from you and another credible source that she could potentially go back to Alimta (which suited her so well). She had discontinued it only during a 3.5 month chemo break. I'd love your thoughts as I will need to advocate for this, with her doc. Thank you so very much, Semone
Reply # - October 19, 2016, 06:18 AM
Hi Semone,
Hi Semone,
Even though the general thought is that you don't return to a previous chemo regimen, if a patient's cancer didn't actually progress on that treatment, it can certainly be reasonable to consider rechallenging that regimen, especially if it was particularly effective the first time.
JimC
Forum moderator
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Reply # - October 20, 2016, 11:18 PM
Thanks very much Jim.
Thanks very much Jim.
I'd love to know if any has done this, if there are any precedents & how it worked out.
Reply # - October 21, 2016, 09:48 AM
Oh yes many have tried
Oh yes many have tried rechallenging a treatment with differing outcomes. It's hard to believe but just a few years ago, 10 or so this wasn't done because there were so few options that the 3 or so were given in succession starting one after another failed, going backward didn't work significantly enough to benefit quality or longevity. Just 15 or so years ago and unfortunately even today to a much smaller extent (usually in general practices) a person was (is) sent home and told to put affairs in order with no treatment plan at all. I say this to let you know just how little real evidence there is to say what drugs or how often someone should retry a treatment.
I will say most lung cancer specialists have rechallenged a drug at some point with some success. The one I've heard most about is alimta because it is very effective for many people but becomes toxic after long periods. So people have taken breaks or moved on to another treatment then come back to it with success. Neil B comes to mind as a person who did that. Very sadly he is no longer with us but was an or the original moderator here on Grace.
I hope your mom is more comfortable very soon.
Janine
Reply # - October 21, 2016, 09:55 AM
With the previous post
With the previous post standing I wanted to add this quote from Dr. West, "I wouldn't want to be dogmatic about this, because nobody has real evidence to address the question, but my personal preference is to favor newer treatments over ones that a cancer has been exposed to previously. It's common for people to have a better response with their first line therapy than their second, third, and fourth line therapies, but that's not necessarily because it's a truly better treatment, and may well be because the cancer is simply more responsive early in treatment and becomes increasingly resistant over time and more treatment. I'm more optimistic that a cancer will respond to a new angle of a treatment it hasn't encountered previously." http://cancergrace.org/forums/index.php?topic=7514.0