Mom- 3B adeno progression, 2nd line ideas? - 1268625

Hi Roy, It's good to hear your mom is doing well on the trial of course no one wants to see any progression.

Staying the course on the trial is probably the safest bet. She is being monitored more carefully than if not on a trial. More importantly the trialists expertise and individual monitoring tell more than anyone could possibly do who doesn't know you mom. Trials have strict standards written out. They keep people on the study only as long as they fit into that situation.

Looking at next trials testing immunotherapies may be a bit more problematic. Most immuno based trials are looking at those who haven't had that type of therapy. That info for any particular trial can be found in the exclusion list included in the description on clinicaltrials.gov such as in the following one. Look toward the bottom of the pg under Eligibility, https://clinicaltrials.gov/ct2/show/NCT01460472?term=nsclc+immunotherap…

Something else to keep in mind is new studies using immunotherapies coupled with other anti-cancer drugs will be studied in the near future (from the immunotherapy videos in our library). So keep an eye out for those.

All best,
Janine

Dear Roy, thanks for sharing your mom's story. While I (and the other docs here) cannot give you advice about what your mom should do, I agree with Janine that doctors with patients on clinical trials generally have the patient's best interests at heart and are less concerned about the trial itself. In other words, if the doctors offer to continue treating someone on a trial despite growth, that often means they think the treatment is still helping even if it technically meets criteria for progression. This is often written into newer trials, that docs can continue treatment if they feel the patient is "clinically benefitting" from the drug despite progression. This would be a good conversation to have with her oncologist, i.e. why do they feel continuing is a better idea than switching to something else?

Please also remember that while "shrinkage" is gratifying to see, stability and ultimately living longer free from symptoms may be a better goal.

When and if the time does come for another option, though, another clinical trial could be a good choice. Janine is right, many immunotherapy trials would not allow prior treatment with anti-PD-1 drugs but it is possible that some might so checking trials on clinicaltrials.gov under "Exclusion criteria" for prior treatments can be very helpful. Whether it would be the best choice to try another, similar trial if the current immunotherapy stopped working is a larger question, and I think there isn't enough information on this group of people to know the right answer. I would probably worry about simply trying another PD-1/PDL-1 drug on a patient who progressed on nivolumab as these drugs seem to work pretty similarly, but combined with another drug such as epigenetic modifiers? Maybe that could be worth considering if it was available. But there are also other clinical trials outside the immunotherapy realm that have potential so trying something completely different might be reasonable as well.

Hi Roy,

Two contributors to the GRACE site are at Massachusetts General Hospital/Harvard Medical in the Boston area and are leading names in the field: Dr. Lecia Sequist and Dr. Alice Shaw.

JimC
Forum moderator

Hi Roy,

Thank you for your sentiments. As far as we're concerned, Dr. West and GRACE have at least one miracle to their credit.

JimC
Forum moderator