Multi focal BAC - 1294611

Mon, 06/11/2018 - 01:52

I have started Tagrisso on Mar. 8 2018, 80mg for 64 days and 40mg for 365 days,
After these days my PET/CT scan has shown progression of 10mm GGO at LLL, color-fading away of one GGO at LLL and another GGO at RLL, on May 24 2018.
On the other hand gene mutation analysis had shown mutation T790M and L858R, at a surgery three years ago.
The 10mm GGO at LLL is in the deeper place of lobe.
My onc. said radio frequency ablation is possible.
Can I expect Tarceva?
What is the next choice?

80 Japanese
2003   (photograph a very low contrast image (not diagnosed)  X-ray LUL S3)
2004 DX a GGO LUL S3
Feb 17 2005  progression to three GGOs RUL RLL
Feb 23 2005 partial resection a 1cm BAC RUL S3
lobectomy a 3.3cm AD mixed BAC LUL S3
Jan 25 2008 progression max 1 cm multi focal GGOs RLL S8 S9
development primary max 1 cm multi focal GGOs LLL S9
Feb 8 2008 partial resection two max 1 cm multi focal GGOs RLL S8 S9
Apr 25 2008 progression multi focal GGOs RLL
May 2 2008 progression LLL
development primary GGO RLL S9
May 11 2008 a round of Carboplatin Paclitaxel
Jul 11 2008 start Tarceva
Sep 26 2008 stable RL
stable or shrinkage LL
Nov 18 2008 NED
Dec 2012 development new GGO LLL
Jan 19 2015 progression an 8mm primary GGO LLL
Apr 20 2015 development a 4mm primary GGO RLL
May 7 2015   progression to two GGOs (8mm) LLL
progression to two GGOs (4mm) RLL
Jun 8 2015 stop taking Tarceva
Jun 26 2015 partial resection a tumor (11mm) RLL S6  EX20 T790M+ EX21 L858R+
watch and wait a GGO LLL
Sep 28 29, Oct 1 2 2015 SBRT 48gray X ray a GGO (12mm) RLL S6
Dec 4 2015 Radio Frequency Ablation a GGO (16mm) LLL
Jan 5 2016 lung capacity 3.55L predicted vital capacity 3.27L
Mar 8 2016 progression to multi focal GGOs RLL watch and wait
Jun 7 2016 progression to two GGOs LLL
Sep 27 2016 progression to multi focal GGOs (13mm 5mm

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Hi homeofheart,

Although we can't give specific advice on your next treatment choice, we can discuss some of the options. It appears that the overall pace of your cancer has been slow. If I read your post correctly, there is only one new or growing GGO, which tends to indicate that Tagrisso has been fairly effective. If there is just a spot or two, then local therapy, as suggested by your oncologist, is a reasonable option, while continuing Tagrisso. Does your doctor suggest continuing Tagrisso?

I would not expect Tarceva to be a leading choice, if you progressed on it previously and if prior mutational testing showed the presence of a T790M mutation. Of course, over time it is possible for your mutational status to have changed, but to find that out you would need a new biopsy.

Other options include standard chemotherapy or immunotherapy. Although immunotherapy tends to have a lower response rate for patients with EGFR mutations, if your PD-L1 expression is high, that might be a viable option. If it's been quite a while since tissue was collected, that would also require a new biopsy.

Finally, waiting and watching would also be a reasonable option, to see if the GGO grows over time or if other GGOs appear. The current GGO is relatively small and in general the pace of growth of your cancer has been slow, so the risk in delaying new treatment should be small.

I hope that you can have a thorough discussion of your options with your oncologist, and that you can agree on a treatment plan with which you are comfortable.

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Hi homeofheart,

Your history is heartening to me since I have a similar condition and hope it can be managed long term while maintaining lung function. Just to add a bit to what Jim wrote, it would be helpful if you could clarify your present situation. I am not entirely sure how many nodules you have of what size and how many are actually growing or are stable. Hopefully you can continue to be managed with Tagrisso and local treatments. If your situation were to progress beyond that then I might look at clinical trials for Exon 20 if they are available where you live.


Hi JimC
Thank you for your thoughtful and kind advice.  
Probably I can argue about an option of the treatment with my oncologist.

Hi onthemark
I like to know size, number, growing rate, mixed status of mutation, classification of adeno-carcinoma.
Thank you for your advice.