Some background: Three years ago, my husband was 52 and diagnosed with NSCLC. He was put on Tarceva since he was EGFR positive. It worked for 18 months. Afatinib (Gilotrif) was tried after that, but he had become EGFR resistant. He was on Carbo/Taxol for 6 rounds, then Alimta for maintenance. He progressed on Alimta. They then tried Nivolumab (Opdivo), an immunotherapy. He developed a terrible cough and trouble breathing. They attributed that to the Nivolumab since a cough is a reversible symptom of it.
When they did a scan they discovered Lymphangitic spread. It was as if all of his bronchi had become little highways for the cancer to travel on. They did a biopsy and sent the tissue off for testing. It got to where we were having end of life decision-making discussions with the oncologist.
We decided to give Iressa a try to see if the resistance he had developed to the Tarceva had been reversed. The doctor said she could let him try for 2 weeks. It was getting out of control and he would soon be too far progressed to do anything about it. If it hadn't worked they would have put him on Cisplatin/Gemzar. After 2 weeks, he developed a rash and his X-rays showed improvement. His cough has lessened, but is still present, as is shortness of breath (although, that too has improved).
His tissue pathology came back yesterday and he was found to had the EGFR resistant mutation T790M and the oncologist would like to try Tagrisso. He has had mild improvement on the Iressa. He would like to get as much mileage out of it as possible. Would it be wiser to switch to the Tagrisso or stay on the Iressa until he begins to decline again? He will have another scan in 2 weeks and I think that will help to make the decision. It feels like we are playing roulette and trying to decide what number to put out money on.
My question is more of a clarification of how the EGFR and T790 work. Are some cells one, and other cells the other. Do we have to decide which is more dominant?
Reply # - December 29, 2015, 12:18 PM
I think you're thinking is
I think you're thinking is right on this subject. Lung cancer specialist tend to agree in that they like to stick with what's working until it doesn't. The scans and how your husband is feeling will be the guide.
It's thought that the T790 mutation begins in some of the tumors so you usually see progression begin in just one or 2 places (where the t790m develops while the rest of the cancer remains stable). If this is the case most specialists have began focal treatment such as radiation to the one or 2 spots until it's time to move on. You can read and watch much info on this subject. The phenomenon is call acquired resistance. the latest post on the subject, http://cancergrace.org/lung/2015/12/20/ar_2015_qa_riely_horn_acquired_r…
and
http://cancergrace.org/lung/acquired-resistance-patient-forum-2014-vide…
Hope for the New Year,
Janine
Reply # - December 29, 2015, 02:48 PM
Thank you :)
Thank you :)
Reply # - December 29, 2015, 02:50 PM
Janine, I thought Iressa was
Janine, I thought Iressa was no longer available in the US. I found this out in some previous research that only those who were on Iressa before Tarceva approval could continue on it.
Take care, Judy
Reply # - December 30, 2015, 01:54 PM
That's right Judy. My
That's right Judy. My comments were in response to donesewright's statements about her husband taking iressa already so my assumption is they aren't in the US.
Reply # - December 30, 2015, 05:07 PM
Iressa was recently approved
Iressa was recently approved in the U.S.
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm454678.htm
Reply # - January 1, 2016, 05:05 PM
Well what do I know. It's
Well what do I know. It's good to have iressa back in the US. I understand it's a good choice as it has a lower standard dose of the active ingredient most like tarceva which may be the reason it causes less side effects.