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Patient Question: What Is the Next Step on My Lung Cancer Treatment Journey?

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Published on January 9, 2018

What options are available for lung cancer patients seeking treatment after a drug study is closed? Expert, Dr. Christine Lovly from Vanderbilt Ingram Cancer Center explains what steps to take for post-trial access to treatment. Watch as she also shares current clinical trials in targeted therapy for EGFR and VEGF. 

The Living Well with Lung Cancer series was a Patient Empowerment Network program produced by Patient Power. We thank Celgene, Helsinn, Novartis and Genentech for their support.

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Transcript | Patient Question: What Is the Next Step on My Lung Cancer Treatment Journey?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That's how you’ll get care that's most appropriate for you.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Andrew Schorr:

Here's a question we just got in I want to pose.  It's about trials from David.  He says my name is David.  I'm 67, and I'm six and one-half year survivor of stage IV metastatic lung cancer.  Despite my illness, I maintain an active lifestyle that revolves around my avocations of photography, gardening and cycling, which is great.  For me cycling is the medicine that allows me to keep my spirits high and the dark side of this disease in the background. 

It is not uncommon for me to cycle more than 200 miles per month.  Wow.  Good for him. 

Dr. Lovly:

Wow.

Dr. Subbiah: 

Wonderful. 

Andrew Schorr:

For three-and-a-half years I was on erlotinib (Tarceva) in a trial and then switched to another clinical trial offered by a company Clovis called rociletinib.

Dr. Lovly:

Rociletinib

Andrew Schorr:

There you go—and will soon start cycle 36 of this treatment despite the fact that when the studies close rociletinib will never come to market, he says—I don't know if that's true—and I have been told I am one of three people worldwide who is still on this drug.  So he's still on the drug. 

My question is twofold.  First, would my next logical step be to take Tagrisso, or second, is there another clinical trial therapy I should consider?  So this is related to trials, and he's doing great, so I know he doesn't want to stop his cycling.  Any other trials you wanted to mention, Christine?  Apparently, this was a drug where now he's still on it, but the drug study is closed. 

Dr. Lovly:

David, first, you're really an inspiration, and I mean it's just amazing you've done so well and been so active, and really just can't say enough about how inspiring your story is.  You're exactly right. Rociletinib is a drug that was developed specifically to target EGFR.  It is not being developed any further, even though there are patients like yourself who continue to benefit from it.  I hope that you can stay on rociletinib for a long time. 

In the case where that rociletinib stops working against your tumor, it will be very dependent on when that happened.  So let's say, God forbid, the rociletinib stops working today.  Well, there are some data that have already been published about the effects of osimertinib or Tagrisso after rociletinib in patients who receive that sequence, rociletinib followed by Tagrisso.  So Tagrisso could potentially be an evidence?based option. 

But I would also say that understanding how tumor cells and how these EGFR-mutant lung tumor cells become resistant to drugs like rociletinib or Tagrisso is a very hot area of study right now, and there are many clinical trials trying to address how do we overcome resistance in this context.  For example, there are clinical trials of osimertinib, which is also called Tagrisso, with another targeted therapy called selumetinib, which is a MEK inhibitor.  There's clinical trials of osimertinib plus bevacizumab, which is an antibody that targets VEGF.  It's a growth factor that makes blood vessels grow in the tumor.  There are lots of clinical trials in this space, lots of opportunity for us to learn together as a team how best to overcome resistance to EGFR?directed therapies.  

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

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