failed alimta maintenace for stage 4 NSCLC - 1290439

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molster
failed alimta maintenace for stage 4 NSCLC - 1290439

Hi. After a few months on carboplatin/alimta, a family member began alimta maintenance. After only a couple of months, the alimta has failed. She is now enrolled in a clinical trial for CMET 280, targeting her only identifiable mutation. If the CMET trial fails, does it seem like other options are out there, even if she has no other mutations?
I have heard that mutations can change and/or become apparent as time goes on.
Just trying to see what future possibilities might be.
My understanding is that immunotherpy is only for those with targeted rogue oncogenes.
Thank you very much.

JimC
Hi molster,

Hi molster,

Welcome to GRACE. I'm sorry to hear that your family member's cancer has progressed, and I'm hoping that she gets a good and long-lasting response to the trial drug. It is true that new mutations can appear, and it can also be said that new agents are continually being developed to target mutations for which targeted treatments previously did not exist.

As far as immunotherapy, it's true that testing for high expression of proteins such as PD-L1 can point to higher response rates, but as Dr. West has noted:

"These two agents, Opdivo and pembrolizumab, are both PD-1 inhibitors. Others such as atezolizumab and others are known as PD-L1 inhibitors. Does it matter which one you get — do the results differ? Well we don’t absolutely know because we have not yet seen the results or even done a trial that directly compares how patients do when they get one over another, but the results are remarkably similar regardless of which agent is tested in the same setting. Specifically they all seem to produce response rates of about 15% to 20% in the broad population, and if we look at patients who have significant PD-L1 expression, the protein that is associated with the more inhibitory effect, we see better results with any of these." - http://cancergrace.org/lung/2016/04/20/gcvl_lu_clinically_significant_di...

Though it seems that 15-20% is a low response rate (and we wish it were higher), it is good to remember that response rates for pre-treated patients (the subjects of most immunotherapy trials) are lower than for those getting their initial treatment. In addition, "response rate" is defined as tumor shrinkage of 50% or more, and treatment after first line usually does not produce such results. More often, lesser shrinkage or disease control are considered good results in that context. So the percentage of patients benefiting from a given therapy is always higher than the narrowly-defined response rate.

[continued in the next post]

<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>

JimC
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[continued from the previous post]

In addition to immunotherapy, there are other options. Standard chemotherapy agents such as docetaxel (Taxotere), paclitaxel (Taxol), Gemzar (gemcitabene) and Navelbine (vinorelbine) can be used. In addition, there are clinical trials of novel agents that may appropriate.

I hope that your family member doesn't need any of those options anytime soon.

JimC
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>

JimC
Hi molster,

Hi molster,

To underscore the point on immunotherapy: By coincidence, a couple of days ago we had a post from a GRACE member whose mom is doing well on immunotherapy despite testing negative for PD-L1 expression: http://cancergrace.org/topic/medi-4736mystic#post-1290435

JimC
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>

molster
Hello Jim.

Hello Jim.
I so so deeply appreciate your sending me these informative and hopeful messages. To realize that a very kind person as you are, would take the time and effort to reach out to me to provide this information is very comforting and I give you my heartfelt thanks.
Reading the words of your journey and that of your wife Lisa is really quite amazing.
Your words are so poetic and moving, and I would imagine that many, many people have benefited in deep ways from your messages through these past few years,
I will try to cling to hope, as my sister goes forward on her own odyssey. She was diagnosed with stage 4 advanced NSCLC in October, a non-smoker, about as healthy-living of a person as you would ever meet.
So, this has all been a shocking roller coaster, and trying to get up to speed on the emotional and intellectual learning curves has been a really painful path.
I will keep up to date on how others are faring through this forum, and I wish the very best to all who are reading this post.

scohn
Dear molster,

Dear molster,

I am so sorry to hear of your sister's struggles and I hope the new CMET trial works well for her. My wife was diagnosed with Stage IV NSCLC almost two years ago, equally out of the blue, and I remember well the shock and emotional turmoil in trying to come to grips with what was going on. But the people here at GRACE have been wonderful in helping me not only sort through the information, but more importantly knowing that there are people who care - that you need not go through this journey alone. So, just wanted to let you know that I will be thinking of you and your sister and hoping and praying for the best.

Also, a couple of comments with regards to the trial studies. I just wanted to let you know that in addition to the immunotherapy trials, there are also trials (like the one that my wife is currently on which has worked pretty well) that target the proteins that may be involved in the ability of the tumors to grow (as opposed to just the specific mutations that might drive the cancer cells and turn them "on"). While the current trial my wife is on (a Phase 1/2 trial) is no longer accepting patients, they will likely be applying for a full Phase 2 or Phase 3 trial with the drug in the future. In short, there are new trials investigating many aspects of cancer biology all the time!

All the best thoughts for you and your sister!

Wife, non-smoker, dx 4/24/15 adeno NSCLC stage IV. HER2 Exon 20. 6x Carbo/Alimta; effect. 9/15 Alimta maint; ineffect. 11/15 - Opdivo; ineffect. 4/16 - ptK7 trial; effective 1.5 yr. 9/17 Gemzar; effective 16 mo. 8/18 -TAK788 Trial. 10/18 start Abraxane. 7/19 start Kadcyla.