First, thanks so much for being here to help. Histology below. We are hearing that there is a high/unacceptable risk of pneumonitis if you go specifically from tagrisso/azd9291 to a immunotherapy. I read an article from 2013 that said that PDL1's have a lower risk of pneumonitis then PD1's due to method of action. I see that opdivo/pd1 and tecentriq/pdl1 are being advertised for EGFR patients that have progressed on chemo and egfr targeted therapy (that's my wife). Any information on whether or not the aforementioned higher risk of going from tagrisso to immunotherapy is true, and if so is that risk lower or the same if you go to a pdl1/tecentriq. Only option for us at this point appears to be chemo, most applicable trials(egf816, asp8273, hm61713) are not recruiting, and immunotherapy appears to be too toxic for sequential treatment with an egfr inhibitor, and more so for tagrisso to immunotherapy.
06/2013 stage IV nsclc adeno egfr 790 and 858 mutated
tarceva- no help
carbo/avastin/alimta 6 months
avastin maintenance 6 months
afatanib 4 months
clovis/co1686 6 months
tagrisso/azd9291 6 months
11/2016 progression
tagrisso then immuno ? - 1289758
ashes123
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Reply # - January 11, 2017, 09:54 AM
Hi ashes,
Hi ashes,
Welcome to Grace. I'm very sorry to know your wife has progressed on EGFR TKIs. I wonder if she progressed systemically or in just one or 3 spots because if the progression is oligo-progression it may be that tagrisso is/was still working mostly and the progressing spots can be ablated.
Otherwise, chemo seems to be the next treatment most lung onc specialists move to after progressing out of TKI. Alimta being the first choice of chemo. Other than chemo there are clinical trials available for those who've progressed as you wife has. If she is able a trip to see a nsclc spec at a large teaching/research hospital can normally point you in the right direction for possible trials, some of which have already shown varying degrees of promise.
I don't know that there are specific data on significantly higher instances of pneumonitis in those who move from tagrisso to immunotherapies. It does seem that pdl1 therapies have fewer side effects than pd1 therapies. The main issue I've noted from our video library on immunotherapy and EGFR and ALK mutations is that immunotherapies most often are not effective There are trials with immunotherapies combined with other treatments available.
I hope your wife finds a treatment both effective and easy on her system.
All best,
Janine