Ask the Expert About Lung Cancer

TraceyS

The Personalized Medicine Foundation and Cancer Connect are pleased to provide patients and caregivers the opportunity to ask questions about the management of lung cancer and about the COVID-19 pandemic with Dr. Charu Aggarwal, MD FACP Assistant Professor for Lung Cancer Excellence Perelman School of Medicine at the University of Pennsylvania. Dr. Aggarwal is an expert on the use of precision cancer medicines and immunotherapy for the treatment of lung cancers.

Please submit your questions using the form below and you will be notified when the responses are posted.

Click here to submit your question to Dr. Aggarwal.

Answers to Submitted Questions About Advanced Lung Cancer (pending)

I am in remission for NSCLC and tested positive for COVID-19. Once you’ve had COVID-19 can you get it again?

We are actively learning about covid19. At this time, data are very limited, it would depend on the level of immunity generated by the initial infection.

I have Stage IV NSCLC, Adenocarcinoma, PDL 1 of 75%. Currently on DPX Survivac clinical Trial receiving Keytruda since Feb 14. My scans show progression of my lung tumors and lymph nodes though bone mets are shrinking. My doctor wants to start chemo. Today is my one year “cancerversary”.

  • Is it possible that there is another gene mutation?
  • Should I get tested for any other biomarkers? I am -negative for EGFR, ALK, ROS1.
  • Is there another immunotherapy drug that could be used instead of resorting to chemotherapy?

The question for NGS testing for other markers would be better answered in the context of what kind of testing was performed at the time of initial diagnosis. What kind of panel was tested? Were other clinical mutations tested- including KRAS G12C? If a limited panel was performed for only the three listed genes, then it would be good to test for the other treatable mutations, namely KRAS, NTRK, MET, and BRAF.

There are other immunotherapy drugs that are in clinical trials that are being evaluated, which can be considered before proceeding with chemotherapy. There are many different clinical trials, so it would be best to speak with your physician about them.

I am 71 years old and have stage 4 EGFR positive NSCLC diagnosed 1/18. I took Iressa for 17 months before progression and switched to Tagrisso 80 mg 11/2019. It made me very sick, I could not eat and my doctor stopped if for 15 days, then restarted on 40 mg. I am not sure how effective the 40 will be but if I have progression but can I gradually increase the dose back toward 80? Do you have other dosing or treatment recommendations if I fail Tagrisso?

It is important to understand the reasons for a dose reduction. The most common side effects of diarrhea and acneiform rash can and do respond well to treatment holds. In most cases, we are able to restart Tagrisso at 80 mg with supportive measures such as anti-diarrheals, and measures for rash/dermatitis. If patients can tolerate 40 mg, consideration should be made to increase dosing to 80 mg. In cases, where full dose is infeasible to administer due to side effects, it is reasonable to consider a dose reduction to 40 mg.  While a large body of literature on efficacy of reduced dosing does not exist, retrospective reports demonstrate equivalent efficacy to the full dose.

Ongoing clinical trials are evaluating next generation tyrosine kinase inhibitors, either alone, or in combination with Tagrisso. Radiation may be another reasonable alternative, in case of isolated area of progression.

Chemotherapy remains a viable option in case Tagrisso stops working

I have received treatment for stage IV NSCLC with Keytruda + chemo because I had high PD1 and have now progressed on lung and liver. What treatment options exist now?

The Ask The Expert Series is made possible by support from The Personalized Medicine Foundation, Lilly Oncology and CancerConnect.

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