When are mutation testing done and targeted therapies initiated? - 1261908

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When are mutation testing done and targeted therapies initiated? - 1261908

Much has happened since my last inquiry in December. My sweetie's right lung was removed by robot (RATS!). After discharge he spent a week at home then announced he wanted to return to work, etc. So he did. In the next two weeks he will start adjuvant chemo - 4 one day treatments with pemetrexate (500mg/m) and carbo (AUC=6) at 21 day intervals. There has been a slight delay in getting chemo started because the oncologist really thought it was a good idea or decided to yield to my dogged insistence that the upper GI hot spot on pre-surgical PET CT scan be scoped/biopsied. If someone wants to comment on reasons why the pre-surgical providers (pulmon., thoracic surgeons) chose to proceed without addressing GI hot spot, I am all ears.

So the good news from surgery is that mediastinum nodes sampled (7, 4R and 2R) were negative. My opinion based on cancer crash course, prognostic findings not so sanguine: level 11 lymph node, positive; 3.6-4.6 cm poorly differentiated (grade 3) adenocarcinoma; vascular invasion present.

Now I am trying to wrap my head around mutation testing and targeted therapies. At what point in this journey should I expect or insist on mutation testing? If done, can previously removed lung tissue be used?

The results of the GI biopsy are due this week. Doc saw irritated area but did not think it looked like cancer.

Please do not hesitate to tell me where to go if my questions have been addressed. I love searching and I have probably found and/or read about the subjects but I find myself in a state of bewilderment.

I am indebted to cancergrace and hope that I haven't wasted any of your valuable time.

With utmost respect,

Reply To: When are mutation testing done and targeted therapies

Hi Lisa, It definitely has been an active time for you two. Your sweetie must be a fiercely determined guy to go back to work so quickly after having an entire lung removed. I hope he's feeling close to as well as he wants. ;)

I feel comfortable in saying that he should have plenty of tissue to do just about any or all testing of value assuming the tumor was at least a cm. Following are a couple of posts the first is a very new blog post by Dr. West that may be of value. http://cancergrace.org/lung/2014/02/02/adjuvant-targ-rx/
and this with description of staging and treatment, http://cancergrace.org/lung/2010/04/05/an-introduction-to-lung-cancer/
And one more describing modifying factors such as vascular invasion, http://cancergrace.org/lung/2012/05/15/modifying-factors-adjuvant-chemo/


Dr West
Reply To: When are mutation testing done and targeted therapies

Yes, I wrote an answer several hours ago that didn't get through, but it highlighted the same post that Janine just noted. The key thing to know is that there isn't any evidence that molecular marker testing or targeted therapy improves survival after surgery, so it doesn't have a standard role. There is even reason to think that it could be harmful.

As for the PET scan finding, we routinely see ambiguous findings all the time, and it depends on the particular location, uptake, and other features...very often they are just physiologic (normal metabolic activity), inflammation, or a small area of infection. The docs always need to judge the probability that a questionable finding is real and should be done as part of the workup, later as a lower priority item, or not at all.

-Dr. West

Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education