Tarceva, afatinib questions about options - 1270721

Thu, 08/06/2015 - 13:23

My mom was diagnosed with Stage 4 NSCLC adenocarcinoma, EGFR+ in September 2014. She began Tarceva in October and tolerated it well. In June, a PET/CT showed some very small growth. Unfortunately, she switched to Afatinib on July 4 (there were a handful of reasons why I didn't think she should switch right away, but unfortunately she got scared and did). She took it for about 10 days. At first, she had manageable side effects, but then terrible diarrhea that landed her in the hospital. It turned out the diarrhea was from food poisoning! So, she stopped taking it for about 10 days and then restarted it. After taking it for about 10 days this time, she developed a rash all over her body and her dr said it was an allergic reaction to afatinib and to stop immediately or she could die from shock. Here are my questions:

1. If she wasn't allergic the first time she took it, could she really be allergic this time after taking it already for 10 days?
2. Can she go back to Tarceva if the growth is very slow?
3. What other options are there at this point?


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Welcome to GRACE. I'm sorry to hear of the problems your mom has been facing. It would be difficult to second-guess her doctor's assessment of an allergic reaction from our vantage point on a web site, as compared to her doctor, who has access to all of her information and has an opportunity to examine her. Whether it's an allergic reaction or not, it is not uncommon to hold back or change a treatment when it is causing such significant side effects.

Often when has been responding well to a targeted therapy such as Tarceva, it is not unusual to continue it in the face of very slow growth, in an effort to get as much benefit as possible from each line of treatment used. There's really no reason she can't try a return to Tarceva, with close monitoring to see if it is still effective.

If she needs to move on to another treatment, there are third generation EGFR inhibitors currently being tested in clinical trials. They may target a resistance mutation known as T790m, which might require that a new biopsy be obtained. One such drug is discussed here and the links at the end of that post contain more information.

Aside from those drugs, there are trials of immunotherapy drugs, as well as standard chemo agents such as Taxotere (Docetaxel) or Alimta (Pemetrexed) which could be used. Both drugs are FDA-approved as second-line treatments for NSCLC.

Good luck with whatever path she chooses.

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