Treatment options in recurrence - 1294413

jess123
Posts:7

Hii everyone

My mum has paratracheal lymph node recurrence 6 month postlobectomy on the same side, mum wants to pursue target therapy but her surgical biopsy initially had EGFR exon 20 insertion and osimertinib recommended in the test report, her onc said she is stage 3 now and ideally the treatment is chemo and radiation, I want to help her by giving more information but I dont know which is best, can anyone please help me with some advise, also her PET only lit up on these paratracheal lymph nodes, I really appreciate your help so far, this site has given me a lot of valuable information, thank you.

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Reply # - May 14, 2018, 09:40 AM

onthemark
Posts: 258

It is good you have a precise staging. There is new information on treating exon 20 in this thread:
http://cancergrace.org/topic/exon-20-insertion-mutation

If it were me I would investigate getting into a clinical trial for poziotinib which is showing early remarkable results for exon 20 (see for instance the April 2018 report: https://www.sciencedaily.com/releases/2018/04/180423125207.htm_

Osimertinib is also in clinical trials for exon 20 and tumour shrinkage has also been observed in early trials: http://ascopubs.org/doi/abs/10.1200/JCO.2017.35.15_suppl.9030

A sensible approach is also chemo and radiation as standard of care for Stage III adenocarcinoma. I would discuss all these possibilities with your oncologist and maybe get a second opinion at this decision point.

Reply # - May 14, 2018, 10:36 AM

catdander
Posts:

Hi Jess, I'm so sorry your mum has recurred. You asked in a previous post about others who may have recurrence similar to hers. Yes, the paratracheal lymph nodes are a place you would expect a recurrence in lung cancer. Unfortunately it's not near uncommon enough. Our current diagnostic techniques only pick up cancer cells that have attached someplace and multiplied enough to create a mass that can be seen with scans like CT.

There are clinical studies underway (I found 3 in clinicaltrials.gov) testing whether or not osimertinib has efficacy in egfr exon 20 mutations. So for now this treatment should only be given in a trial setting because no one knows if tagrisso would be better than chemo or worse or somewhere in between. The teams giving the drugs do an excellent job at watching and caring for patients but it's not recommended outside a trial. Here is a link to the trials and their locations, http://bit.ly/2rGzKPa

An option also may be to watch the lymph node to see what it does. Though it's very likely to be cancer in this situation it could also be from inflammation or infection as a normal function of the lymph system. Otherwise a biopsy will tell for sure what it is.

Radiation is usually given for curative purposes unless to treat an obstruction, protect bone or aid in pain relief. So it may be that if this is a recurrence the onc wants to radiate in hopes to cure. In which case chemo/radiation is standard second only to surgery.

Keep us posted and best of luck to your mum.
Janine

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