neuroendocrine lung cancer - 1268985

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hammer
neuroendocrine lung cancer - 1268985

My 45 yr old, nonsmoking sister was diagnosed with stage IV neuroendocrine lung cancer. Mets to brain and spine. Hers appears to be very aggressive. She received 4 rounds of avastin, carboplatin and paclitaxil. Developed resistance during 4th cycle. Cancer spread to bones in spine. Now on Tarceva for 3 weeks. Also currently receiving radiation to spine for severe nerve pain and is on morphine. Her lungs are hurting so she thinks the Tarceva might not be working. She has a lot of tumors in her left lung. She wants to give up.

What are some options we might consider at this point to ask her doctor about?
1) Back to some other sort of chemo? I noticed that the chemo she received is not the one they usually do for neuroendocrine? Could cisplatin and episode be an option?
2) If she has a primary resistance to Tarceva is it likely that another EGFR inhibitor is worth trying or applying for compassionate use of one of the 3rd generation TKi's?
3) Immunotherapy?

She does not appear to qualify for any trials due to pleural effusions, brain and spine mets.

Kaiser will not approve for her to go to Stanford or UCSF for an academic opinion unless we find a clinical trial at one of these locations. So she hasn't been able to see a specialist in either lung cancer or neuroendocrine cancer.

Thanks for any suggestions.

catdander
Hello hammer,

Hello hammer,

I’m so very sorry to meet you under these circumstances, your sister is so young.

Unfortunately the usual course of nsclc is that if it doesn’t respond to one of the typical chemotherapies it’s not likely to respond to another, especially with progression on a 1st line platinum doublet. Neuroendocrine is often treated more like a sclc, both being neuroendocrine, one large cell like your sister’s the other sclc. So treating with a platinum with etoposide, or irinotecan is possible. However, if she has already had 4 or 6 cycles of carboplatin that may be her limit for platinum drugs since they create a hypersensitivity that cause significant side effects. Still a single agent line of etoposide or irinotecan might be a possibility.

The 3rd generation EGFR TKIs are being tested on those with an EGFR mutation and it isn’t known what if any benefit it might have for someone EGFR wildtype even if it were available.

If your sister’s brain mets are controlled it’s likely she wouldn’t be excluded from many of the trials. All trials have their individual criteria. A 2nd opinion is never a bad idea especially since Kaiser doesn't appear to have any ongoing immunotherapy trials. Read through the trial info in the link below, each gives what condition is being treated, with what drug/s, whether it is being compared to standard treatment or just the one, inclusion and exclusion criteria, and where the trials are located (with names and numbers).

Do some reading, ask us questions when you have them and put together an argument if you feel there is one to get your sister in for a 2nd opinion at one of the large research or teaching hospitals. I hope I’m not being too presumptuous in saying a 2nd is what your sister needs but it’s never a bad idea.

continued-

catdander
I didn’t go through all the

I didn’t go through all the trials posted below but there's at least one in that area that didn't exclude brain mets.
https://clinicaltrials.gov/ct2/results?term=pd-1%2C+pd-l1&recr=Open&rslt...

I hope this is helpful. Let us know if you have more questions.

All best,
Janine

hammer
Thanks Janine.

Thanks Janine.