My wife was on Tarceva for over 6 1/2 years. Then she developed acquired resistance to Tarceva with prevascular and supraclevical lymph nodes enlargement. Gene sequence on the biopsy of the large prevascula node revealed negative to T790M, PD-1 and PD-L1. Because the speed of which the lymph nodes are increasing in size she was quickly given 6 cycles of Carboplatin/Alimta. The cancer responded to the chemo exceedingly well. 7/24/2018 CAT scan of her body shown both lymph nodes reduced to negligible normal size. She was put on Alimta maintenance every 3 weeks. However, since Jan 2018, her former excision site in her right occipital lobe began to show signs of necrosis or recurrence. Question: Can Tagrisso be used in conjunction with the Alimta for better penetration of the BBB for potential brain/CNS involvement.
Tue, 10/02/2018 - 08:21
The results of a trial testing the safety of tagrisso and carb/alimta resulted in the conclusion that "The combination treatment was safe in the selected patient population". http://ascopubs.org/doi/abs/10.1200/JCO.2018.36.15_suppl.e21073 This would suggest alimta combined with tagrisso would also be safe.
I don't believe there is good data that proves the combo would be effective in cases like your wife's but oncologists are combining these drugs to achieve results like you're looking for.
Tue, 10/02/2018 - 08:38
Further thought behind the combo: It's possible the cancer cells in the brain haven't been introduced to a tki so tagrisso might reach the brain and be effective while alimta works on the cancer outside the brain.
If there are enough oncologists using the drugs together and believe them to work there's little reason for the drug company to finance a study.
Tue, 10/02/2018 - 09:35
<p>Because her occipital lobe have had two prior surgeries and each time followed with separate SRS and (IMRT 12 fractionized treatments) before. The Rad Occn pretty much said that with this recent signs of recurrence on the same site, there is no more viable option for localized treatment without causing "dangerous" consequences to her occipital lobe and possibly other part of her brain. However for whatever reasons, the build-up of necrosis and or recurrences have always being right on the same site where the original solitary nodule was removed. There is no other detectable cancer in the rest of her brain. Question: Is a third surgery and readiation treatment not a good idea?</p>
Tue, 10/02/2018 - 12:10
Obviously we can't tell you what you should or shouldn't do. That has to be left to those with personal knowledge of all the info. But it's very reasonable to believe that with all the prior treatments in that one spot it's too risky to do more. Usually srs and wbr is about as much radiation as a radiation oncologist is willing to risk.
Is your wife's onc looking at using both tagrisso and alimta? If you need documentation I'm sure we can come up with several instances of case based examples. It makes sense to try.
Wed, 10/03/2018 - 17:12
btlaw, When we talk about a particular systemic treatment not crossing the blood-brain barrier or not being effective against brain metastases, what we really mean is that, although most drugs cross the barrier to some extent, at standard dosages the drug does not tend to penetrate the barrier in therapeutic concentrations - not enough to be effective. For example, in some situations Tarceva has been used in a pulse-dose manner, with a much higher-than-standard dose given every few days (rather than daily, which would be tough to tolerate), so that in each pulse enough of the drug reaches the brain to be effective. In the context of using a TKI such as Tagrisso in combination with chemotherapy, each of the drugs may penetrate the barrier to a certain extent and be effective in combination. That would be the rationale for the combination therapy. Jim C Forum Moderator