CO 1686 vs. BKM120 - 1251340

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heartspy
CO 1686 vs. BKM120 - 1251340

Husband has acquired resistance to Tarceva after about 7 months. Searching clinical trials and discussing possible options. Wondered how a patient would determine if a trial geared toward T790 inhibitor or geared toward PIK3 inhibitor would be of greater value? Is a biopsy the only way to determine this or does having the EGFR mutation make him fair game for either trial. I realize these are trials and the information is limited, I just wondered from a professional perspective what the determining factors would be to place an EGFR patient in one trial over the other. We remain hopeful and grateful.

certain spring
Reply To: CO 1686 vs. BKM120

Hallo heartspy. I'm sorry your husband is experiencing progression - disappointing after his good results.
I think I'm right in saying that the trial investigators would do the testing for you (for the P13K or T790M). There seems to be only one (phase 2) trial for BKM120 in NSCLC, with a site in Florida as you probably already know:
http://www.clinicaltrials.gov./ct2/show/study/NCT01297491
(which says 'archival or fresh tumour biopsy must be available for profiling' - ie not necessary to have new biopsy if old one available)
and also only one trial for CO 1686:
http://www.clinicaltrials.gov./ct2/show/NCT01526928
(where I think a fresh biopsy would be necessary to find out if your husband has the T790M mutation - the most common resistance mechanism to EGFR identified thus far).
It will be interesting to hear what the doctors say about how to choose. Dr Weiss wrote a post about this:
http://cancergrace.org/cancer-101/2009/11/21/how-to-vet-a-treatment-idea/
By the way, your profile isn't showing up on the forums, so I have taken the liberty of cutting and pasting it. All best.

My 42 y/o Native American Non-Smoking (never) Husband dx on 3/20/12 with NSCLC- Stage IV with mets to bones. T7 radiated for 16 days. EGFR+ lung biopsy in 04/12. Started Tarceva protocol @ 150mg which resulted in some excellent tumor shrinkage, but recuduced to 100mg in 06/12 due to overwhelming side effects. Last CT report on 11/8 revealed some progression. Considering options and hoping for miracle!

heartspy
Reply To: CO 1686 vs. BKM120

Thank you, Certain Spring. The EGFR mutation was located at Exon 19 according to the original biopsy on 4-11-12 and negative for T790, but wondered if that mutation could be present, now. We are aware that clincal trial sites will do all sorts of screening to include/exclude my husband as a potential participant, however, hoping to do some homework in order to avoid over taxing/stressing my husband with too much information and presenting only the best options for him, in order to make a decision. Having an uninvolved Dr.'s input helps with the facts, without wondering about anyone's professional or monetary gain, in selecting one over the other. I appreciate the link to the post by Dr. Weiss - I had not stumbled upon that and found it to be an interesting read.

catdander
Reply To: CO 1686 vs. BKM120

Hello heartspy, I'm very sorry your husband has progressed on tarceva.
Perhaps one of our doctors will have the insight into the questions you've asked. I will ask for input. You should hear back within a day.
certain spring has given you some links to look over in the mean time.

I hope your husband has a chance to benefit from a promising new treatment.

Janine
forum moderator

P.S. It will be quite helpful for our doctors and others learning from your experience if you paste you bio into the "forum signature" area. You can find that by clicking your user name, heartspy to the left of your posts. Then click "edit forum signature" top left and paste in and click submit.

I too will copy your bio here one more time for the doctors,

heartspy's bio, My 42 y/o Native American Non-Smoking (never) Husband dx on 3/20/12 with NSCLC- Stage IV with mets to bones. T7 radiated for 16 days. EGFR+ lung biopsy in 04/12. Started Tarceva protocol @ 150mg which resulted in some excellent tumor shrinkage, but recuduced to 100mg in 06/12 due to overwhelming side effects. Last CT report on 11/8 revealed some progression. Considering options and hoping for miracle!

dr. weiss
Reply To: CO 1686 vs. BKM120

There are many options for the EGFR mutation + patient after progression on erlotinib. Most standard would be chemo, +/- continued erlotinib. As you mention, there are multiple 2nd line trials. Generally, rebiopsy to ascertain mechanism of resistance is not standard of care. When done, it is typically done by institutions that have trials open specific to particular resistance mutations; stated more simply, only do it if you can use to improve care (after all, biopsies do have real costs, side effects, and risks). Another alternative for patients who have 5 or less spots of progression is my clinical trial of stereotactic radiosurgery to sites of progression, followed by re-initiation of tarceva; you can read more about this approach at http://cancergrace.org/lung/2012/04/03/radiation-to-address-cells-with-r...

heartspy
Reply To: CO 1686 vs. BKM120

Thank You, Dr. Weiss, for providing more good information to consider.