My Wife who was diagnosed 4/16 with Squamous Lung Cancer with L858 Mutation was doing well after initial treatment of Chemo/Radiation that finished 8/16 , she had a brain lesion that was cyberknifed in 12/16 and started Tarceva 1/17, since she has had several clean brain MRI's and several NED Pet scans until this week , her Pet scan this week shows a 1.6 X 1.8 CM local recurrence in the original tumor bed, our question is what the protocol now? its tough to find anything online as all the information is geared toward Adenocarcinoma with EGFR not Squamous. Do they test again for other mutations? what can we expect going forward? Thanks
Fri, 08/18/2017 - 17:55
It is rare to have an EGFR mutation with squam histology but since she does you'd treat it as any EGFR+ nsclc. Checking for T790M would be the typical next step. There are blood tests that have a fairly high degree of accuracy when looking for t790m. It's a lot easier to draw blood than retrieving tissue from a tumor. It the blood tests negative for t790m she can always talk to her onc about a tissue biopsy.
I hope your wife does well.
Tue, 08/22/2017 - 00:04
Thanks for the reply, if she is not T790 would she be eligible for immunotherapy ? I have read that immunotherapy is not effective in patients with EGFR but I also seen that it is approved for use in squamous so it's a little confusing , thanks
Tue, 08/22/2017 - 12:18
Usually those with an EGFR mutation have little to no smoking history, the egfr "driver" mutation is also the only mutation these people have. It seems this is what makes them also less likely to have a high enough concentration of PD-L1. We don't understand enough about pdl1 to say why this connection exists. It seems likely the more mutations one has the higher the PD-L1 level (the more one smokes the more mutations one has from the bombardment of carcinogens). Most people with squamous nsclc have a significant smoking history but the few with squamous and EGFR usually don't have a smoking history.
Your wife doesn't fit neatly into the above scenario but it's probable she wouldn't benefit from immunotherapy and likely to benefit more from standard chemo or a trial.
With that said she probably wouldn't have a problem with insurance if she and the onc want to try it since she has squamous histology.