So as the post notes, MIL on Iressa. It has worked very well.
She is 67, asian, non smoker - on anti rejection meds for kidney transplant she had going on 7 years ago. NSCLC (think part adino/scquamous).
Tissue came back as EGFR positive (I am not a technical person so not sure exactly on details) and so she continued and continues on iressa today in Ontario, Canada. Cost is fully covered.
We originally picked up the cost for the first month last year around this time as the tissue was sent for biopsy. Her symptoms started to improve within weeks and the tissue came back positive. Apparently if they start traditional chemo in Ontario they can not then switch to iressa.
Today the Dr. indicated that after being on iressa for about 12 months, her CT scan from earlier this month indicated that some tumors were smaller in size, the pleural liquid was almost gone but she noticed a few new spots on the CT scan - the largest one about 1.2cm. Said this is what they call a partial response.
She noted that they would have to determine if the iressa would be continued to be covered etc.
Also noted that the next step would be traditional chemotherapy.
I noted that, if it was her opinion that iressa was to continue, that regardless of funding, I would be prepared to pick up the cost for such time as in her clinical view, resistance had developed to the point where we needed to switch.
Next CT scan is in about 2 months.
My question is what questions should I be asking at the next appointment? Namely any technical questions so that we can understand what are the next treatment options and ask for additional tests to see if other drugs could be considered other than traditional chemo.
I'm pretty new to this stuff.
Reply # - July 17, 2014, 04:03 PM
Reply To: MIL, Iressa – 12 months – ON, Canada, Dr said Partial
Hello,
Welcome to GRACE. Good to hear that your MIL has responded so well to Iressa.
At this point in her treatment her latest scan results would be referred to as a "mixed response", in which some areas of cancer are shrinking or gone while others have progressed. You can read about mixed responses here: http://cancergrace.org/lung/tag/mixed-response/
I'm not familiar with the Canadian system, but it's clear there are significant differences. For example, in the U.S. if chemo is begun but then an activating EGFR mutation is discovered, just about any insurance will cover the switch to an EGFR inhibitor (Tarceva here).
I would probably want to ask her doctor whether there are any available trials of drugs designed to overcome acquired resistance to Iressa and whether those trials would require a new biopsy which could be tested for new mutations. The cost of trial drugs is normally paid by the manufacturer, while a new biopsy and testing would not - that would be another coverage question.
You might also want to find out whether there is any possibility of combining Iressa with a traditional chemo agent. In certain circumstances, especially when the EGFR inhibitor seems to be controlling much of the cancer, many doctors prefer to continue the EGFR inhibitor.
You may find helpful the comments of Dr. Rosalyn Juergens, an oncologist at McMaster University, as she discusses the issue of acquired resistance in the context of the Canadian system: http://cancergrace.org/lung/2013/03/14/juergens-ar-options/ That page also contains links to several other relevant podcasts by Dr. Juergens.
Best of luck with the next scan!
JimC
Forum moderator
Reply # - July 17, 2014, 07:28 PM
Reply To: MIL, Iressa – 12 months – ON, Canada, Dr said Partial
You might find it helpful to review some of the many, many things that have been said and written about acquired resistance to EGFR TKIs, starting with some of the links on the following URL:
http://cancergrace.org/search-results?q=acquired%20resistance
Please let us know if you have specific questions based on what you learn.
Good luck.
-Dr. West