Opdivo OR chemo for Resectable Stage 3A NSCLC

[Greekgirl3]

Hi everyone.

Unfortunately, my 65 year old mother was just diagnosed with stage 3A Nonsmall cell lung cancer with evidence of mostly Adenocarcinoma and less than ten percent of squamous cells. Her tumor is 6cm in diameter and beginning to invade the main pulmonary artery. She tested negative for mutations.

The surgeon claims the tumor is potentially respectable if we can shrink it. So we were given two neoadjuvant therapy choices:

Option one: The oncologist offered us the standard of care which is a chemo cocktail of cisplatin and alimata for three months and then reevaluation for surgery.

OR

Option Two: to participate in a clinical trial using Opdivo for two infusions over a 28 day period for the first time in patients that are not yet stage IV. Then reevaluation for surgery.

We don't know what to do? Can fellow members weigh in on knowledge and personal experiences on side effects and effectiveness for both the cisplatin and alimata vs Opdivo.

Is Opdivo too much of a gamble for a potentially respectable tumor? Likelihood of cancer progression in four weeks (add another two for routine tests).

Which is "safer" route to go?

We were not given as much feedback and reassurance as we would have liked on either option and feeling very afraid and frustrated in what already was a high stress situation with the new diagnosis.

Where can we go to seek additional sound oncologist advice in a speedy manner? The trial for Opdivo is coming to a close, so time is of the essence for decision making.

Thank you to all!!!!!!!

[Tom Galli]

Greekgirl,

Stage IIIA, potentially surgically treated and negative for tumor markers right? Then, I'd try standard of care hoping to shrink tumor enough to allow surgery. My reason is surgery is curative while chemo alone is normally not. My confusion with the Opdivo choice is it is normally only effective against Adenocarcinoma that displays certain tumor markers. Does your negative for mutations mean an absence for tumor markers? Ensure you know if your mom's cancer can be successfully treated by Opdivo. Mutations and tumor markers are sometimes interpreted to mean the same thing.

Stay the course.

Tom

[Greekgirl3]

Hi Tom!!!!

I'm not sure how to find out about tumor markers. Not much was explained to me at my visit. Ugh!

The pathology note says: histology ally the tumor shows small areas of squamous and glandular differentiation. The tumor us positive for TTF-1 with rare cells, less than ten percent positive for P40 which raises the question of possible squamous differentiation.

Can you explain this, eeeeeeek!!!!!!

[Greekgirl3]

Forgive my typos.

[Tom Galli]

I'm not a doc so consider that limitation. The "raises the possibility of squamous differentiation" means to me the pathologist is not sure about the type of cancer. This introduces risk that Opdivo will be effective. Get a second opinion. Send the report to your mom's general practice physician.

Wish I could give you a better answer but on vacation with limited connection to the web to research.

Other LUNGevity folks have a view?

Stay the course.

Tom

[Greekgirl3]

Tom!!! Thanks so much and I'm sorry for bothering you on your vacation, which I'm sure you sooooo deserve. Have fun!

The pathology also says favors Adenocarcinoma but questions the possibility of squamous cell as well because less than ten percent of rare cells tested positive for P40. Hmmmmm.

I'm also so curious why they are pushing two infusions with Opdivo on the trial?

If anyone else can weigh in, that would be great!

Thanks so so much!!!!!!!!