thoughts on options after progression? - 1274476

Fri, 06/24/2016 - 11:18
lungpp
Posts:

Hello all...I frequently peruse this site but don't post often. It has been an incredible source of information.
I'm an EGFR exon 19 deletion stage 4, on afatanib with last scan showing some slight progression at the primary site. I've only been on afatanib for 8 months. Would this indicate a more aggressive cancer? I'm a little surprised at how fast I progressed. My options now are to either do local radiation to the site or do biospsy to see if I have the T790M mutation for Tagrisso. Anyone have thoughts or experience with this situation? The spot that would need to be radiated is the spot now and would likely take away any potential for tissue biopsy from the site once radiation is done. I know there is blood biopsies but from what I understand they can have a high false negative rate and often need to be confirmed with tissue biopsy anyway. I've also had SRS and had a complete response in the head with afatanib so far keeping things under control. I appreciate any feedback. Thank you.

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JimC
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Hi lungpp,

One opinion often expressed by the GRACE faculty is that slight progression may not warrant any change in treatment, since progression can be at such a slow rate that it is better to continue a well-tolerated treatment that is for the most part keeping the cancer at bay. Without knowing the extent of the progression, I don't think you can say that progression after 8 months indicates a more aggressive cancer, since that time frame is close to the median for an EGFR inhibitor. If you continue afatinib, the next scan should give you a good idea of the rate of progression.

As Dr. West has said:

"It’s not rare to have a situation in which our interval scans show a relatively minor change that you need to squint to see, but it may well lead us to overreact and make a change, because we’re predisposed to action, even when it’s just like changing lanes in a traffic jam and doesn’t get you anywhere any faster." - http://cancergrace.org/cancer-101/2012/08/29/treat-the-patient-not-the-…

JimC
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