My 60-year old non-smoker East Asian mother in law was diagnosed with Stage 4 Lung Cancer about 3 three week ago. The cancer was identified as poorly differentiated adenocarcinoma that has spread to the pleural fluid. Biopsy of a pleural lesion revealed,
"Sections show multiple pieces of core fibromuscular tissue. No lung parenchymal tissue identified (or remained detectable). There are areas of desmoplastic stroma with invasive solid sheet proliferation of neoplastic cells with moderately pleomorphic nuclei and occasional tumor cells with pale mucinous cytoplasm. No gland formation is seen. "
A cobas EGFR test revealed she is EGFR negative. (I understand this can happen more frequently with mucinious cytoplasm.) A CT scan showed enlarged lymph nodes (right hilar and subcranial) although the cancer appears to be merely in in the right lobe (heart/aorta/pulmonary artery appear normal). Her symptoms consist of an occasional cough. She seems to be in good health, weighing about 100lbs.
After the negative EGFR test we heard about NCT01639001: "A Study Of Crizotinib Versus Chemotherapy In Previously Untreated ALK Positive East Asian Non-Small Cell Lung Cancer Patients".
The problem we have is that to participate in the study a portion of the biopsy cells will have to be mailed to the USA and we will know the results "in two weeks" during which we cannot begin chemotherapy.
What are the risks of delaying treatment 2 weeks? If it comes back ALK+ -- treatment cannot start until about 1 week after the results are received.
I am looking for any information to help me evaluate the obvious question: "Are the potential benefits of a targeted treatment worth the delay?" Based on CAP guidelines I suspect so. But I am not a medical doctor and the probability of being ALK+ is lower. She is eager to start treatment -- which may decide the question despite any medical advice.
Thank you for your help,
edit2: Onco suspects small-cell LC / meso.