My 68 y.o mother recently had a lobectomy (tumor resected) . The pathology report indicates that it's stage 1A, subtype is acinar (70%), papillary (20%) and micropapillary (10%); PD-L1 moderately and diffusely positively in tumor cells; EGFR exons 18, 19 and 20 deletions. Is it a recommended strategy to go on EGFR TKI inhibitor treatment and/or (2) PD-L1 inhibitor treatment for prophylatic purposes?
I ask because of the recurrence probability and CNS metastasis probability of patients with EFGR mutations.
Ideally, the management is not merely a regular CT scan/PET scan, but also some prophylatic treatment but i would like to understand if there is a recommended clinical strategy. If not, why not? (E.g. adverse side effects from TKI inhibitor drugs ? Tumor has already been resected and the genetic mutation and/or T-cell PD-L1 overexpression is no longer present??)
Thank you very much.
Reply # - September 28, 2016, 06:14 AM
Hi meragihorse,
Hi meragihorse,
Welcome to GRACE. I am sorry to hear of your mother's diagnosis, and I understand the desire to do everything possible for her. Systemic treatment after surgery ("adjuvant" therapy) is not usually recommended, because the risk of recurrence is low. Follow-up scans at increasing intervals is typical.
Surprisingly, the data on adjuvant therapy with an EGFR TKI for a mutation-positive patient (usually with later-stage disease) tends to show that such patients fare worse than if they were given standard chemotherapy. This counter-intuitive result is not understood, but that's the reason it's not recommended if adjuvant therapy is to be pursued. And adjuvant chemotherapy is not usually recommended because of the combination of side effects and the significant possibility that the lung cancer has been cured with surgery.
JimC
Forum moderator