Mother diagnosed with adenocarcinoma - treatment options

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Cancerfight2021
Mother diagnosed with adenocarcinoma - treatment options

Dear Cancer Grace Team,

Thank you for the amazing work you do to support families like us.

My mom (76 year old) was recently admitted to hospital with massive pleural efussion in her right lung.
They performed Thoracoscopy + Talc Pleurodesis and upon performing pleural biopsy they confirmed today it as Adenocarcinoma (IHC markers - TTF1 - nuclear positive and P40 - negative). 

Immediately after biopsy (before report came out), Doctors recommended to start Gefitinib or Osimertinib depending  on our finances.

Our family didnt act and took discharge and waited for the biopsy report (which came out today).

Our family has to take  a collective decision now and would greatly appreciate if you could please provide inputs on whether Gefitinib or Osimertinib works well in her case and which medicine has less side effects?

Also is general chemo an option for us? should we focus on palliative care only (considering her age and diabetic/high BP condition)?

This is my first post and first cancer experience in our family and just started researching more on this subject (so please excuse me if this question has already been answered)

Best Regards,

Romi

 

 

JanineT Forum M...
Hello Romi, Welcome to Grace.

Hello Romi,

 

Welcome to Grace.  I'm so sorry your mother is going through this.  It's true that when cancer cells are found in a pleural effusion it's normally considered treatable but not curable.  The type of treatment best for this depends on whether or not there is a specific mutation (for which there are targeted drugs) or an abundance of specific proteins known as PD-1 and PD L1 (for which there are immunotherapies).  Chemo with or without immunotherapy would also be an option if she has neither a driver mutation (mutation that drives the cancer and there's a drug that inhibits it) nor high levels of pd 1 or pd l1. 

 

Since her doctor suggested Gefitinib or Osimertinib it would seem she has an EGFR mutation.  If so, osimertinib would be the drug of choice.  Both Gefitinib and osimertinib have efficacy in those with an EGFR mutation.  Osimertinib is a later-generation drug that has several benefits over gefitinib, it has fewer/less severe side effects, it has efficacy in the brain which the other usually does not, and it keeps cancer in check for a longer period of time.  

 

If you are in the US and have insurance the insurance co will cover for osimertinib.  If there is a copay left that exceeds her ability to pay, the pharma co that makes the drug usually will help if you ask.  If she is outside the US there's usually government-paid health care that provides the "standard of care" treatment.  Osimertinib is considered the standard of care for people with advanced nsclc with an EGFR mutation in most countries. 

 

There is some confusion over the difference between palliative care and hospice care.  Hospice care provides comfort care for those who no longer use anticancer treatment like chemo and osimertinib and is considered a type of palliative care.  Palliative care is comfort care for anyone whether or not they receive anticancer treatment.  As long as the doctor and your mom want to use anticancer treatment there's no reason to move to hospice.  Since hospice care can provide excellent help when anticancer treatment is no longer providing more help than harm, it's a good idea to have that difficult conversation with the oncology team prior to when it's needed. 

 

Please let us know if we can be of more help.  I hope your mom gets what she needs.  She is already lucky, in that she has family searching for the best for her.

All the best to you and yours,

Janine

 

 

Cancerfight2021
Thank you

Hello Janine,

Thank you so much for your prompt and detailed response. Its very helpful to me.

I talked to my family members (I live in USA and my mom is in India) and they mentioned the doctors are currently assuming 40% chance for EGFR mutation and asked to start Gefitinib rightaway while waiting for other test results.

To confirm, they ordered two new tests - Molecular diagnostics - Next Generation Sequencing (NGS) and PDL-1 test. It will take 10 days for the results to come and based on the results, if its confirmed as EGFR they want to move us to Osimertinib or Immunotherapy if PDL1 > 50%. The recommended treatment matches with what you explained above and very assuring to know they are moving in the right direction. They also asked us to consider Guadrant360 test , but its costing out of pocket $5k and didnt made a decision yet.

I will keep you posted about the test results and will seek additional inputs/guidance based on the results. 

Stay Safe and thank you once again for all your help.

 

Best Regards,

Romi

 

 

 

JanineT Forum M...
Thanks for the update.  I'm

Thanks for the update.  I'm so glad she is getting good attention.  If she has the mutation osimertinib is the best bet.  Further testing isn't needed and as you pointed out very costly nor is there a reason to begin Gefitinib.

Keep us posted and best of luck.  I know being so far away is difficult to say the least so I'm glad you can confirm she is getting what she needs. 

Janine

Rowan
Tagrisso/iressa combination

Hello Janine, 

 

are you aware of stage 4 patients receiving Tagrisso and iressa in first line setting to increase PFS? Two patients at the "egfr resisters" facebook page mentioned it and they were going to speak to their doctors for more information. I was wondering if you knew whether clinics in the USA are trying this out already? I can only find the results of one study that supports this claim. 
 

Best regards 

JanineT Forum M...
I have not heard of anyone

I have not heard of anyone using both.  I seem to remember a mention of it in one of our videos (there's so much incidental info in those conversations I hate to miss any of them).  I'll look around but that definitely not something that's being used in the US, not by the most experienced lung cancer specialists. 

Hope you and yours are doing well,

Janine

JanineT Forum M...
The most up-to-date info will

The most up-to-date info will be found ASCO 2020 and 2020 Targeted Therapies Forum.  Many have transcripts so you could search transcripts for specific words or wording.  Because of covid the 2020 targeted therapies forum wasn't held until this past fall virtually. 

 

 

Jim C Forum Mod...
Jim C Forum Moderator's picture
Tagrisso in combination with Iressa

Hi Rowan,

 

There is one active (but not currently recruiting) Phase I study testing the efficacy and safety of this combination: Osimertinib and Gefitinib in EGFR Inhibitor naïve Advanced EGFR Mutant Lung Cancer - Full Text View - ClinicalTrials.gov No results posted yet.

 

Jim C Forum Moderator