I would like to share with you all the case of my father and possibly get your views on the current situation.
My father is now 70 years old, never smoker.
This is the timeline of his lung cancer:
04/2009 - found a suspicious nodule in his upper left lobe
07/2009 - after lobectomy of his upper left lobe, confirmed 2cm adeno with no positive lymph nodes (T1N0M0). No adjuvant chemo.
01/2010 - found another nodule in his lower left lobe (possibly unnoticed in 2009)
04/2010 - after completion pneumonectomy, confirmed 2cm adeno with only a couple of regional limph nodes found positive (T2N1M0). No adjuvant chemo.
09/2010 - PET-CT fully negative
04/2011 - PET-CT shows a number of positive limph nodes in the mediastinal and sovraclavear regions.
05/2011 - biopsy of 1 sovraclavear lymph node confirms it is adeno met, also found EGFR mutation.
06/2011 - started therapy with IRESSA
09/2011 - PET-CT fully negative. Great response to IRESSA
02/2012 - PET-CT fully negative
07/2012 - PET-CT shows 4 regions with positive lymph nodes (right sovraclavear SUV 2.2, right axillary SUV 5.2, right paratracheal SUV 3.9, mediastinal SUV 2.2).
With these positive lymph nodes, his cancer is probably T2N2M0 now and, although the primary tumor was fully removed with the pnumonectomy, these are mets and we need to deal with them.
Not sure what the best approach would be here. We are still waiting for his oncologist to define some actions. I've been reading a lot on GRACE and there a number of different options.
Should we first understand the degree of progression before changing the therapy?
Is it really helpful in this specific case to biopsy the sovraclavear lymph node and check whether we have a T790M mutation or MET amplification? (this may add valuable information, but I still don't see a target drug)
Maybe the combination of IRESSA and chemo would be enough at this stage to keep the progression under control.
What do you think?
Thanks for your help and best regards.