I was on Tarceva for 2 years until I had progression. Then I went on Carboplatin and Alimta for a little over a year. I have now progressed on Alimta maintenance. So what is the thought of going back on Tarceva now?
Sun, 11/16/2014 - 09:38
That's something that is attempted at times, and Dr. West has written a post about some of the trial evidence and considerations involved here. There is also plenty of ongoing research into therapies after EGFR TKI acquired resistance, as you can see here. That is an option you may want to discuss with your oncologist.
Sun, 11/16/2014 - 09:43
When given again after prior progression on prior Tarceva (erlotinib), Tarceva has a very low response rate of <10% and typically very brief responses when they do occur. The most promising approach today for patients with an EGFR mutation who have developed acquired resistance is an agent such as AZD9291 or Clovis's CO-1686, now named rociletinib. Those agents seem to be active primarily in patients with a T790M mutation, who develops during treatment with Tarceva in about 60% of patients as they develop acquired resistance. To find it, it's necessary to do a repeat biopsy of progressing disease to look for this mutation, but if it's present, a trial with AZD9291 or CO-1686 is what most experts would favor.
For people who don't have a T790M mutation, there may be some other trials of patients with acquired resistance, and the combination of afatinib (Gilotrif) with cetuximab (Erbitux) has also shown some promising activity in early work.