Dear Members and Staff,
My sister, age 49, was diagnosed with NSCLC, stage IV, adenocarcinom, EGFR -mutation, exon 21(L858R), 4 years ago. She was on Tarceva for a little less than a year, followed by chemotherapy (carboplatin+ alimta). When she developed T790-mutation, she did very well on Tagrisso for over a year. However, this summer, her general well-being has declined and X-rays show tumour progression. A new biopsy of the main tumour has revealed that her tumour has transformed into squamous lung cancer. According to the mutational analysis, the tumour has the following markers: P40, CK7 positive and PD-L1-negative.
Her oncologist is now suggesting a second round of chemotherapy(carboplatin and gemzar).
We would very much appreciate any suggestions regarding further treatment that my sister could have. Please note that we live in Europe/Sweden.
Would it be a good idea to add cetuximab to the chemotherapy, considering she has been diagnosed with squamous lung cancer? Are you aware of any clinical trials that could be suitable for her case? I saw an article about LY3143921, phase 1 - trial in UK. Your advice would be highly appreciated.
Thank you for your attention and best regards,
Eva
Reply # - August 28, 2017, 07:34 PM
Hi Eva,
Hi Eva,
I'm very sorry to know your sister is going through this. P40 and CK7 are immunohistochemical (IHC) markers looked for to determine histology of the nsclc, P40 is found in squamous nsclc and CK7 in adeno. It makes since both would be found since she has both squamous and adeno. But it has little baring on treatment at this point.
Dr. Pennell talked about combing afatinib and cetuximab, "...in a large phase IB trial, we know that about a third of patients will have a major response to that combination, regardless of why their cancer developed acquired resistance. Sometimes this can last, on average, seven or eight months; I’ve used this and actually seen pretty good responses. It can be a little bit tough — both drugs cause diarrhea and skin rash, which can be worse when given together, but these tend to be manageable for most people." http://cancergrace.org/lung/tag/cetuximab/
Unfortunately the afatiinib/cetuximab combo hasn't caught on very well because of the toxicity of the 2 drugs taken together. In the following link members who participated in these trials document their experience, http://cancergrace.org/topic/afatinib-cetuximab-trial-user-group
There are many trials testing lots of new drugs and being tested. We don't have info on the trial you mentioned but if it's something your sister's onc and your sister believe to be a good match and she is up to travel I hope she's able to make the trips necessary.
Other than a clinical trial and chemo I'm afraid there aren't other options. Chemo can be quite effective for some time and gemzar is a drug that can be taken on its own for many months.
I hope your sister does well with her next treatment for a long time.
All best,
Janine
Reply # - August 29, 2017, 11:01 AM
Dear Janine,
Dear Janine,
Thank you so much for your kind words and your good advice. Cancergrace is a fantastic website.
We'll talk further with my sister's oncologist.
Best regards,
Eva
Reply # - August 29, 2017, 05:08 PM
I found the one trial you've
I found the one trial you've mentioned above in the UK. It's for squamous.You can check it out and see if it's worth pursuing further. Take care, Judy
https://clinicaltrials.gov/ct2/show/NCT03096054?term=LY3143921&recrs=a&…
Reply # - August 30, 2017, 11:56 AM
Thank you, Judy!
Thank you, Judy!
As I understand it, my sister's tumour is adenosquamous. Does that mean that she might not be eligible for a clinical trial on squamous cancer?
Kind regards,
Eva
Reply # - August 30, 2017, 05:54 PM
Hi Eva,
Hi Eva,
That would really depend on the inclusion criteria of the particular trial. Even if the trial description doesn't make it clear that adenosquamous patients are eligible, the best course is to contact the trial staff to find out. They tend to make individualized decisions at times.
JimC
Forum moderator