Many types of treatments have been FDA approved for lung cancer that focused on different approaches. For examples: Targeted therapies for Alk and EGFR/T790 mutations that targeted specific molecules on the cancer cell; Keytruda focusing on removing cloaks of cancer cells to the immune system; Ketruda plus two other chemos, etc. Targeted therapy has also been re-introduced after the progression on the latest therapy. If those therapies worked for an individual, is there any reason why the treatments process cannot just continuously recycle the previous effective therapies, with the possibility of making stage 4 lung cancer a chronic condition?
Reply # - February 16, 2019, 09:10 PM
Making lung cancer a controllable, chronic condition is a widely-shared goal. Unfortunately, we don't yet have a treatment or series of treatments that will reliably produce that outcome. Rechallenging a previously effective treatment may help some patients, although usually not in as large a percentage of patients nor for as long a period of disease control. Though some patients find a treatment that is effective for years, those are the outliers; for the majority of patients, each particular therapy eventually loses efficacy.
The search for effective, durable therapies continues.
Jim C Forum Moderator
I discovered GRACE when my wife was diagnosed with lung cancer in 2008. After finding so much authoritative information here, I became a forum moderator and now serve as part of the GRACE Community Outreach Team.
In reply to Chronic condition by Jim C GRACE Co…
Reply # - February 18, 2019, 08:08 AM
Thanks Jim. I was curious as to whether the scenario I described a possibility for some patients to turn their stage 4 cancer situation into a chronic medical situation, especially when multiple treatments that focused on different treatment mechanisms were used sequentially....and the sequence recycled. For example: Targeted therapy-->immuno + chemo-->targeted therapy-->immuno+chemo-->........ I can also see the possibility of cancer cells, with time, evolving where targeted therapy and immuno+chemo might not work any more and other treatment that focused on different mechanism (that works) will need to be added to the recyclable sequence.
Reply # - February 18, 2019, 11:31 AM
That makes a lot of sense in theory but as the cancer is attacked by these targeted therapies and the immune system is opened to fight the cancer, the cancer in return creates its own defenses by creating new "workaround" mutations so these targeted therapies are no longer effective. When tki s are effective the second time around it's likely because there is still cancer that hasn't mutated; it's the same theory behind why oncologists try local therapies when a tki begins to slow its effectiveness (ablate the cancer that's mutated and continue the tki for most of the cancer that is still being controlled). There's not enough understanding yet behind why checkpoint inhibitor immunotherapies stop working to know how or if we can workaround its defenses. We still know so little about checkpoint inhibitors to say there's not a way to re-challenge them.
I hope researchers get there sooner than later. I like the leaps and bounds approach anticancer treatment has taken lately so maybe it won't be too long.
I joined GRACE as a caregiver for my husband who had a Pancoast tumor, NSCLC stage III in 2009. He had curative chemo/rads then it was believed he had a recurrence in the spine/oligometastasis that was radiated. He's 10 years out from treatment.