MIL, EGFR Positive, T790 Negative. On immunosuppressants for Kidney Transplant? - 1274671

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yyzhawksfan
MIL, EGFR Positive, T790 Negative. On immunosuppressants for Kidney Transplant? - 1274671

Posted in the past following mixed response about a year ago.

My mother in law has Stage 4-NSCLC….started out on Iressa as first line because biopsy was EGFR positive. This was back in July 2013.

Was on for about 14 months and had a mixed response. Attempted to get on the Aura trial back in Nov. 2014. She was rejected because she had previously received a kidney transplant and was on certain anti-rejection/immunosuppressants meds.

They did three rounds of carboplatin/pemetrexed and then maintenance pemetrexed ever few weeks until about three or four months ago since she was in the hospital 3 times with pneumonia. They stopped, not because the pemetrexed stopped working but due to the complications….cancer progressed and tube inserted to assist with fluid…seems to have helped.

Dr. sent pleural fluid for biopsy as she obtained a compassionate use application approved for osimertinib, not yet approved in Canada as far as I know, but the results came back that she was negative for the T790 mutation. This was yesterday’s news. Dr., also indicate that biopsy seemed to show even less pronouncement of prior EGFR mutations.

Sorry for the long winded start, but my MIL is on various anti-rejection/immunosuppressants meds because she had a kidney transplant in November 2007.

Sounds like without being positive for the T790 mutation, the options for her are limited. Dr. plans to try three rounds of pemetrexed on its own and see what the response is.

The next option after that was taxotere? Dr. said this is much stronger and could have more side effects.

Just wondering if there are options out there for those on immunosuppressants other than the current course?

Dr. wanted to get in touch with the transplant/kidney Dr. to discussion options. Just wondering if there are some ideas I can send along to them...

So it was the three year anniversary of diagnosis on July 1 of this year. Appreciate the time

JimC
I understand your concern

I understand your concern about using immunotherapy along with the anti-rejection drugs, as such immunosuppressive agents are generally not recommended for immunotherapy patients. However, I did manage to find a case report discussing the use of immunotherapy in a melanoma patient taking anti-rejection drugs as a result of a liver transpant. His dosage of rapamycin was reduced, and he was carefully monitored, with no significant adverse effects seen. You can access that report here. Two other studies with kidney transplant patients are also mentioned.

An interdisciplinary discussion between cancer and transplant doctors led to this treatment plan, so it seems that your doctors are on the right path to making a well-considered decision.

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>