Tarceva? EGFR negative?

My Husband is squamous cell lung carcinoma stage IV, he has both lungs involved, with multiple nodes, mediastinum and supraclavicular. He was diagnosed in July of 2011. He has had multiple chemo treatments, including, Paclitaxol/carbo with trial of erbitux.. progressed, then had one dose of gemzar/carbo.. couldn't tolerate it.. switched to just gemzar, progressed, then doxitaxol.. progressed.. had radiation to main tumors, along with taxotere. improvement.. 6 months off due to being sent to roswell for consult.. Uggh!.. back on taxotere. progressed, then just finished 13 weeks of erbitux again.. progressed.. tomorrow he will be starting tarceva.....
Has anyone here had tarceva being egfr negative? I don't even know what to ask anymore..
Any experience as to what supplements he can take wtih this drug?

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I am egfr negative as well as alk negative - and I do not understand what is going on with your friend.

I was offered Vinorelbine and Cisplatin (which I refused).

You need to "ask" more questions/

Let this website guide you by providing significant details.

God Bless, Karen

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He did have a round of navelbine.. he cant tolerate the cisplatin due to the toxicity effect it would have on his WBC's.. the carbo blew him out of the water and he drops easily now..

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We talk about downward drift here in Arizona from the Uranium mines - What about downward drift in your part of the country? Cover-up does not last/ Ask the important questions - like "what will you do to cure my friend"! Tell them you are on to them and to do their best to give your loved one the best!

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When was his last biopsy? Since he's already had Tarceva before, why are they doing it again? Sounds like his only response has been with radiation really. Where is his cancer? Take care, Judy

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I appreciate your advice.. however the onc, definately knows I am on them.. I have fought for my husband from day one.. and frequently tell THEM what is going on.. I am also a nurse, however I do not have the personal experience with this disease so I am asking here to see if I can get any advice from someone who knows better about it..

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He has never had tarceva before.... ??? I am going to have to re read my post maybe I really screwed up my question.. His last biopsy was in march at the roswell cancer institute.. they also did foundation one testing, however it says he has an ALK positive, but it is not the "right mutation" for xclori? spelling..

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Your kid is failing is failing Spanish so you get a math tutor because others with math problems reported success. I really don't get the argument for prescribing a drug (Tarceva) directed to the epidermal growth factor receptor (EGFR) when the EGFR is negative and there is little or no evidence that it is playing a substantial role in the cancer. I'll stand correction if someone wants to provide data showing excellent results among the EGFR negative group.

From my perspective (not a doctor just a commenter), try to find if there is a particular gene or mutation playing a role in his cancer such as KRAS or Cox-2 and consider a drug directed to that.
Cox-2 and KRAS have some association with smoking and in analyzing the particular type of mutation someone is likely to have, smoking history is relevant. The Cox-2 studies were largely disappointing but that was at least partly because most of the studies did not analyze results and examine whether the patient had the mutation.

Your task is difficult but I'd try to find out what is driving the cancer and use a drug directed to that.

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Genetic variations alone do not determine response to targeted therapy. Those patients who test negative for EGFR are left to the same guesswork as conventional therapy. There are lots of things which determine if a particular drug works, beyond the existence of a given target. Does the drug even get into the cancer cell? Does it get pumped out of the cell? Does the cell have ways of escaping drug effects? Can cells repair damage caused by the drug?

Tarceva could be given selectively to patients with EGFR negative NSCLC. It is a challenge to identify which patients targeted treatments like Tarceva will be effective. Patients across a broad range of clinical characteristics could benefit. Being EGFR negative is no reason not to be given this drug. All an EGFR mutation study can tell you is whether or not the cancer cells are "potentially" susceptible to this mechanism of attack.

It cannot tell you if Tarceva will actually work for your individual cancer cells or not. Tumor cells have such an uniqueness that not much is known of their respective reaction to targeted therapies. There are those who are finding out (the hard way by physician's choice therapy) they are EGFR negative and Tarceva has been working.

Greg

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Hello -

I agree with Greg's post above and can give you insight from our current situation. My husband has KRAS mutation and is currently on a clinical trial with Tarceva & AMG 102. His last scan showed a decrease in one of his nodules and the others remained stable. He has 5 nodules and nothing outside of the chest. We are not sure how long this will last but it is a very mild trial and hoping we can ride it out for awhile. We are not sure if it is the Tarceva that is doing most of the work or the fact that it is combined with a clinical drug. I have read many posts about those EGFR negative that respond to Tarceva.

Hoping for the best for your husband...
Beth

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Sorry, thought I read Tarceva (erlotinib). I agree with Greg, as there's no way to know. Some with squamous do respond, while others don't. We just never know.
Any clinical trials he could get into?
Take care, Judy

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It is my understanding that Tarceva works on the blood supply more than the tumour (Iressa is the other way round) and this is why patients who are EGFR negative can have success with Tarceva.
I have also been speaking to someone at Astra Zeneca who make Iressa and the latest research is showing that 5% of patients with Squamous cell carcinoma are testing EGFR positive (this was previously thought to be only 1% which is why no one with squamous was every tested) In the UK it is likely that mutation testing (previously only given to Adenocarcinoma) will now be extended to include squamous also. This is being debated at the BTOG conference in January.

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What lynba says about Tarceva working on the blood supply is very true.

Anti-angiogenic activity and VEGF pathway inhibition of Tarceva.

http://cancerfocus.org/forum/showthread.php?t=3738

With regard to Iressa vs Tarceva, they are about 65% cross-resistant (tolerance of cancer cells to the drug) and about 35% non-cross resistant (non-tolerant), at the tumor cell death level. But both also have antivascular effects, with Tarceva having greater antivascular effects than Iressa and Iressa having greater direct antitumor effects than Tarceva.

However, the drugs have to get inside the cells in order to target anything. In different tumors, either drug might get in better or worse than another. For "targeted" agents, such as Iressa and Tarceva, cell culture tests provide far more relevant information than the molecular tests.

You can take advantage of profiling the entire cell to measure the interaction of the entire genome (not just one pathway or a couple of pathways). There are many pathways to altered cellular (forest) function, hence all the different 'trees' which correlate in different situations.

Is there success with both Iressa and Tarceva?

http://cancerfocus.org/forum/showthread.php?t=3377

Greg

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I am so grateful for all the fantastic replys!!!
Davstar: Bob's onc has mentioned the PD1 drug.. Bob was up for the trial at Roswell Park Cancer institute however he got disqualified as they found Hep C??? We never knew about this and he has never come up with it before.. At any rate the Onc keeps telling us that he wants to "keep you here" until this drug is approved for use, because he feels this is the answer we are looking for.. This is very frustrating to say the least!! And yes so far the cancer has stayed in the lungs and nodes of the chest..
Pawleski: Thank you for so much information! I can't tell you how much the links help me to try to figure out what is happening.. Hopefully Bob will be one of those the tarceva works on until the PD1 becomes available.
Howian1: I guess we will try all that is offered.. It always does seem like the roll of the dice.. I am going to ask about the KRAS and Cox2 testing.. I will have to dig out the foundation one test results to see if they tested for those there..
Costello: thank you for the positive news..
Thank you everyone.. and as always fight the good fight!!

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I've been asked to speak at the British Thoracic Oncology Group conference in Dublin in January about a patients perspective in mutation testing so anything opinions and reasoning anyone has I will incorporate into my presentation.
I will keep my fingers crossed for Dave x

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