Biopsy with genetic mutations completed but still unsure what to do now.. - 1255299

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Biopsy with genetic mutations completed but still unsure what to do now.. - 1255299

My dad was diagnosed two years ago with NSCLC adenocarcinoma stage IV. He had radiation of bone and brain metastases and completed two six-round cycles of combined carboplatin and alimta/abraxane. He had a severe allergic reaction to carboplatin in December 2012, so is now just receiving alimta. He also had a recent third biopsy to determine genetic mutations; results showed that he has ERBB3 amplification, actionable with pertuzumab, and PTCH1-P155S, actionable with vismodegib. As these medications are not yet approved for lung cancer, we wondered what to do now.

Dr West
Reply To: Biopsy with genetic mutations completed but still

There's no clear answer to that question, and the only clearly recommended tests are the ones for which we have a clear treatment to offer. Outside of a clinical trial with an agent based on the targets identified, or some other appealing novel agent, the main recommendations would be for an agent that has been studied and demonstrated to have efficacy in previously treated patients with advanced NSCLC, namely Taxotere (docetaxel) or Tarceva (erlotinib).

Otherwise, you can always ask the person who ordered the test what would be recommended now, since a core principle in medicine is to only order tests for which you know what to do with the results.

Good luck.

-Dr. West

Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

Reply To: Biopsy with genetic mutations completed but still

Hi wnderwo,

So Dr. West beat me to the "post" button, but I'll let this stand anyway.

If your dad's cancer is stable on Alimta maintenance, usually oncologists are reluctant to switch away from a drug that appears to be effective. If it's progressing, then the choice is between an established, approved second line treatment such as taxotere (docetaxel) or tarceva (erlotinib) or a trial drug such as the two you mentioned. Even though the new biopsy revealed mutations targeted by those drugs, the effectiveness of the drugs is not fully established. On the other hand, the entry requirements for many trials limit the number of prior regimens of chemo, so if you switch to an established drug now, you may close the door on the trials, but if you choose a trial then need to switch regimens the established drugs will continue to be an option.

Good luck with whatever path you choose.

Forum moderator

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>

dr. weiss
Reply To: Biopsy with genetic mutations completed but still

As Dr. West notes, the standard 2nd line therapies are erlotinib or docetaxel. The targets that you describe are drug-able, but only on clinical trials. As an academic doc, I spend a lot of time doing second opinions. Many patients come to see me specifically to "trial shop" -- to see if UNC has a trial to offer them that is promising. When I don't have a trial that is promising for that individual patient, I will then initiate a trial search for them. This kind of consultation is not a unique service that I or UNC offers; rather, it's what most academic docs do for patients. The easiest way to get an expert opinion regarding a trial match for you would be to get an opinion from a lung cancer expert. Alternatively, if you wanted to do some work on your own, the most robust search engine for trials is It's not in plain English like GRACE tries to be, but the vast majority of trials are on there.

As a minor aside, there's a molecule called DAF that's an antibody to both EGFR and HER3. The company that makes it has gone silent on communications with me regarding a trial I proposed ( :( that smells like rejection) but my opinion on the molecule is that it is promising and if I had a patient with HER3 amplification, I might do a search to see if there's a trial with it near where the patient lives.