what's next after first-line afatinib? Tagrisso vs carbo/Alimta vs BI 1482694? - 1272223

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what's next after first-line afatinib? Tagrisso vs carbo/Alimta vs BI 1482694? - 1272223

Hello everyone,

So it appears that after just 3 months of Gilotrif (afatinib), my mother may be having disease progression:
- increased bone pain
- "progression" of multiple diffuse bone mets on bone scan & CT chest/abd/pelvis

Although our oncologist says that he thinks the bone scan findings are due to new bone being laid down (Mom's on Xgeva), he has floated the idea of starting carbo/Alimta, if she can't get to a tolerable dose of Gilotrif. After a 2-week drug holiday due to really bad scalp irritation/seborrhea, we've started back at Gilotrif 40 mg every other day.

My question: if she can't stabilize on Gilotrif, or if there is progression, what's next? Do you favor one option over the other?
1. Tagrisso
2. phase 2 trial of BI 1482694
3. carbo/pemetrexed
4. Is Opdivo an option at all?
5. another oncologist suggested starting Tarceva, if Gilotrif fails...

Thank you all for your help, comments, time and sharing your invaluable experiences. I wish you the best,


Sorry. Here out my mothers

Sorry. Here out my mothers details.

06/2015 my mother (67/never smoker, Chinese) Dx Stage IV NSCLC adenocarcinoma. EGFR exon 19
06/2015 T10 to pelvis posterior fusion, multiple spine mets.
08/2015 Gamma knife. all small lesions treated.
08/2015 start Gilotrif 40 mg daily
09/2015 NO PAIN! off all narcotics.
11/2015 possible progression: 1 new lung lesion. more bone mets? Increased back pain.
11/2015 Gilotrif holiday due to scalp seborrhea.
12/2015 what next? Tagrisso vs carbo/pemetrexed?

Tagrisso is approved for

Tagrisso is approved for those with T790M which often develops in people with the egfr mutation who take a tki like tarceva and afitanib. Your mom would need to test possible for the new mutation T790 before getting tagrisso.

The possible efficacy of tarceva after afitanib isn't known because it hasn't been tested nor has it been given in that order for anyone to say what to expect. The 2 drugs are very similar in action with afatinib being the stronger of the 2.

If your mom has the T790 mutation then tagrisso would be the next standard treatment. However carb/alimta is also a very good choice and standard choice if no T790M is found. BTW, it's now possible to have that test done by blood draw though false negative results are more possilbe on it than tissue testing.

I hope she is feeling better soon,

Thank you Janine for your

Thank you Janine for your reply to my question and to all the other posts on the forum. I really appreciate your input. Best to you and your husband!