What happens when your cancer becomes resistant to your course of treatment and progresses? That’s the question we explored in the September episode of our Lung Cancer Living Room series.
Dr. David Gandara, professor emeritus and co-director of UC Davis Comprehensive Cancer Center’s Center for Experimental Therapeutics, discussed a number of options. The good news is that it turns out there’s a lot that can be done if your cancer becomes resistant to its current targeted therapy (TKI) or immunotherapy. He explained that the options include understanding why your lung cancer became resistant through a re-biopsy of tissue or a blood biopsy, choosing a second or third generation TKI to better treat the progression, and adding a MET inhibitor drug if the cancer shows a MET amplification. Participating in a clinical trial may also be an option.
Highlights from the September 2022 episode of the Living Room
Among the highlights from his remarks:
- A re-biopsy of tissue or a liquid (blood) biopsy may be recommended to understand what is causing the resistance.
- Many EGFR patients who develop resistance to their TKI will show a MET amplification—something Dr. Gandara described as a “dancing partner” to the EGFR mutation—and will show improvement by adding a MET inhibitor to their treatment plan.
- There are many promising clinical trials happening right now aimed at better treating progression with immunotherapy or in cancers with EGFR, KRAS, HER2, and other biomarkers. (GO2’s LungMatch service provides personalized help navigating the clinical trial process to understand whether one of these trials might help to treat your lung cancer.)
- Those living with EGFR lung cancer, including the hard-to-treat EXON 20 insertion type, are optimistic about the results of the CHRYSALIS-2 trial, which showed that the combination of Amivantamab and Lazertinib produced promising results even after progression on multiple other lines of therapy.
- After having biomarker testing done to look for biological changes associated with your cancer, your doctor may recommend a targeted therapy or immunotherapy to treat your specific type of lung cancer.
- Tagrisso (Osimertinib) has been the standard of care first line treatment for EGFR positive NSCLC, but many patients will develop resistance.
Finally, Dr. Gandara recommended that all patients consider a second opinion to confirm that you are comfortable with your course of treatment. Contact GO2 for Lung Cancer’s HelpLine at 1-800-298-2436 or email support@go2.org for support in finding a doctor and through your diagnosis and treatment.
More information about targeted therapy, immunotherapy and progression:
Please join us on YouTube for next month’s Lung Cancer Living Room, October 18 at 5:30 pm PT, for a conversation with the University of Pennsylvania’s Dr. Anthony Lanfranco and lung cancer survivor Terri Ann DiJulio on understanding lung nodules and their causes, diagnosis, monitoring and treatment.
Thank you for this valuable information. I am particularly interested in what is in clinical trials for the ALK mutation and where those trials are being conducted.
Hi Amy,
There are trials for patients with ALK mutations to find new targeted therapies that may work for those that have tried other ALK driven therapies already. The trials are hosted at hospitals and cancer centers all around the country. If you would like more information on clinical trials, our LungMATCH treatment and trial navigators can provide you with personalized, one-on-one support. To connect with our LungMATCH team today, call us at 800-298-2436, email support@go2.org or use the “Lung Cancer Questions?” tab on the right-hand side of our website.
I am currently on Tagrisso and responding very well but I am concerned about resistance development. Is there anything I need to be thinking about now or wait until the point that resistance develops and manifests itself?
Hi Paul,
Glad to hear that you are responding well to Tagrisso. In general, there is not much that can be done while Tagrisso is working well, and your doctor likely won’t change anything while the cancer is under control. If the cancer does progress, you should get a new biomarker test to see if there are any genetic causes for the progression. If you would like an overview of the options that may be available to you if the cancer does progress, or have other treatment related questions, please contact our LungMATCH Team. Our LungMATCH program is a free treatment and trial navigation resource that can help you understand treatment options, refer you for biomarker testing and more. To connect with our team, call us at 800-298-2436, email support@go2.org or use the “Lung Cancer Questions?” tab on the right.
[…] Dr. David Gandara, professor emeritus and co-director of UC Davis Comprehensive Cancer Center’s Center for Experimental Therapeutics, discussed a number of options. The good news is that it turns out there’s a lot that can be done if your cancer becomes resistant to its current targeted therapy (TKI) or immunotherapy. He explained that the options include understanding why your lung cancer became resistant through a re-biopsy of tissue or a blood biopsy, choosing a second or third generation TKI to better treat the progression, and adding a MET inhibitor drug if the cancer shows a MET amplification. Participating in a clinical trial may also be an option. Watch here. […]