preempting lepto, is this possible with thinking outside the box? - 1272135

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kempten
preempting lepto, is this possible with thinking outside the box? - 1272135

Hello,
I have posted this question before but don't think I got a satisfactory answer.
Under normal circumstances it usually is suggested to get the maximum benefit out of first line TKI treatment even when slight progression is observed , before moving on to the next generation drug.

If one was diagnosed with 9 brain mets right at the start, you already have a disadvantage compared to a patient that has no CNS disease at time of diagnosis.
I would assume the danger of developing Lepto is increased under those circumstances?

Would it be feasible to move from Tarceva to Tagrisso sooner than usually recommended , to delay the onset of lepto, even if that means that one will run out of the most effective agents sooner ?

I think someone with extensive CNS disease does not have the luxury to be patient with Tarceva in the face of slight progression, even when the CNS mets are " controlled " at this time.
Thanks , and please excuse my repetitive question.
Kempten

JimC
Hi Kempten,

Hi Kempten,

I'm sorry that you don't feel that you received a satisfactory answer to your previous question. No one understands your concern about LC more than I, but the problem is that there really isn't the answer you seek. No one knows why some patients develop LC while others do not, and though your hypothesis regarding increased incidence when there are brain mets at diagnosis, I can't point to any statistics to prove that.

LC has been said to develop in 1% to 5% of patients, and the incidence is on the rise as patients live longer. It may occur more frequently in patients with an EGFR mutation, but again the thinking is that this is because those patients are living longer.

No one knows whether switching to Tagrisso sooner will delay the onset of LC, but if LC only occurs in a few percent of patients, and you potentially shorten your survival benefit from EGFR TKIs by moving to Tagrisso sooner, you may be doing so on a low-odds wager that it will help you delay or prevent LC. Personally speaking, that doesn't seem like a good bet to me.

JimC
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<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>