I am a 59 year old female and, other than the cancer, in good health. On March 2013, I was diagnosed with NSCLC, stage 4, EGFR+, Exon 21. Four brain mets were treated with Cyber Knife (CK) a few weeks later and eventually resolved. I have been on Tarceva since April 2013. I had a VATS Lobectomy on November 2013. I was NED from the neck down since my VATS for more than two years. One more 4mm brain met was treated with CK in January 2014. I continued to work until recently.
Latest scans/MRI show progression. Two brain mets previously treated seem to be coming back. One is 4mm and seems to be stable since October 2015. The other one has grown from 4mm to 8mm. One lymph node is lighting up in the PET scan (SUV 3.4), one lung nodule is not lighting up but has grown and multiple tiny lung nodules are mentioned on PET report, but too small to show SUV. I have followed my CEA for a few months and it has gone from 1.5 to 3.4. I have had three Guardant liquid biopsies, which would only pick up .1% NF1 (nothing else). My doctor requested another liquid biopsy and a urine test (Trovagene) to find out if I continue to be EGFR+ and have the T790M mutation. I got results over the phone earlier today and was told the EGFR came up on one of the tests, but no T790M has been detected. He still wants to do a tissue biopsy to check for T790M. I had been offered the following: 1) If T790M negative: Laser Intersticial Thermal Therapy (LITT) for one brain met and chemo, or 2) If T790M positive: Tagrisso
HOW DO RESPONSE RATES COMPARE BETWEEN TAGRISSO (if no T790M) VS CHEMO (Carboplatin/Alimta)? COULD I TRY TAGRISSO FOR ONE OR TWO MONTHS BEFORE CHEMO AND LITT? DOES CHEMO PENETRATE THE BRAIN? OF COURSE, THE TISSUE BIOPSY WILL DEFINITELY THROW MORE LIGHT INTO THE MATTER, BUT IT WILL TAKE A WHILE. HE WANTS TO START TREATMENT NOW.
A multitude of thanks! Faith
Reply # - May 2, 2016, 05:02 PM
Hi Faith,
Hi Faith,
In the context of recurrent disease, it's difficult to pinpoint the difference in response between Tagrisso and chemo, but there is no reason you couldn't try one (or the other) and then switch if necessary. The main concern is being healthy enough to get to that point of switching. Keeping a close eye out for signs of progression can help a great deal.
LITT has not been discussed here, but is currently under study; its efficacy and risks have not been established, although as with any new technology you will find plenty of hype about it online. The standard of care for treatment of brain mets remains focused radiation. Although most chemo agents/targeted therapies cross the blood-brain barrier to a certain extent, the concern is that they do not do so in sufficient concentrations to adequately treat existing, progressing brain mets.
JimC
Forum moderator
Reply # - May 2, 2016, 08:04 PM
Thank you so much for your
Thank you so much for your prompt response!
Jim, is there any way that you could provide specifics about chemo treatment (Carbo/Alimta) response rates when used as second-line treatment, if available? Dr. Horn from Vanderbilt reports on a chart that if T790M is not found in the plasma or in a tissue biopsy, the response rate for Tagrisso is 27%. I am really interested in comparing the two.
Also, what can you say about chemo and brain mets? Does chemo penetrate the BBB? Is there any data available on the effects of chemo (if any) on brain mets? Is there any data on the effects of Tagrisso on brain mets?
Last, but not least, do you know why there are no studies on LITT yet? I cannot CK the same lesions again and craniotomies are so much more scary than LITT. Then again, chemo or Tagrisso could possibly work...
Thank you and take care,
Faith
Reply # - May 3, 2016, 04:39 AM
Hello Jim,
Hello Jim,
I have to apologize for seemingly repeating my questions after your excellent response. I am looking for some numbers about chemo response, if available. Also, I should rephrase my question about LITT. In your response about LITT, you do mention there are studies under way. I guess a better question would be: Are there any preliminary results on treating small lesions in the brain as they refer to the safety of the procedure and its efficacy?
This forum and the expertise of its members is invaluable!
Your support is greatly appreciated!
Faith
Reply # - May 3, 2016, 06:28 AM
Hi Faith,
Hi Faith,
Not a problem, I certainly understand how difficult it is to make choices and your desire to have as many facts at your disposal.
Response rates for second-line treatment can be a complex matter. First, for clinical trial purposes response rate is defined as tumor shrinkage of 50% or more, and treatment after first line usually does not produce such results. More often, lesser shrinkage or disease control are considered good results in that context. Also, it's not possible to compare the response rate of one therapy in a certain trial vs. another therapy in a different trial, as the selection criteria for each trial may differ, as may the demographics and trial plan.
I haven't found results for LITT in humans, only in animals, which is not always a true indication of well a therapy will work in humans.
JimC
Forum moderator