Exon 18 deletetion (G719X) or Exon 20 treatment

[PhilMul]

By now the popular treatment for NSCLC patients with EGFR Exon 19 deletion seems to be Tarceva (Erlotinib). If you are lucky enough to have Exon 20 with a T790M mutation you might be able to get on the AZ9291 trial ... but is there a specific treatment for Exon 18 deletions? Is anyone with Exon 18 deletion on a targeted treatment and if so what is your success?

Although my wife is Exon 18 and 20 positive, our onc has her on Peme/Carbo and 150mg Tarceva. She is on her first cycle with Tarceva while this is the fourth cycle with Peme/Carbo. The Peme/Carbo alone only showed 12% reduction in the lung tumor while 50% reduction in the lymph nodes were realized. She will take Peme/Carbo and Tarceva for 2 cycles and then a PET/CT scan to check the results. Unfortunately, she is having trouble tolerating the 150mg Tarceva as she breaks out in a dangerous rash all over her body. I am talking about a very painful rash with pimples having whiteheads. Ughhh. Her onc prescribed Prednisone and asked her to stop the 150mg Tarceva for 10 days and then he wants to reduce the dose to 100mg. If she can tolerate the 100mg Tarceva along with the Peme/Carbo then it might be a good plan. Is anybody in a similar situation? If so, please post your results.

Thank you,

Phil

P.S. Our onc at MD Anderson tells me that Tarceva has worked for NSCLC patients even though they do not have Exon 19 or 21. This may be good news!

[johnp]

The rash is positive and correlates to a good response. Best wishes.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3834717/

[adfender3]

Phil.... I was diagnosed with Stage 4 NSCLC, EGFR+ with exxon 19 deletion. Before Tarceva I had one treatment with Alimta and carboplatin. Then markers came in as above. I was then started on Tarceva 150 and within a week or so I was a giant pimple. My Onc did as your wife's did. Once I dropped to 100mg the rash decreased a great deal but, remains present now 13+ months later. I'm sure your Onc told you the rash is often an indicator of good activity against the cancer. Also for nearly one yr I've been on a topical ointment made by a specialty compounding pharmacy named DermaTran. They are in Rome, GA. This ointment is made for TKI induced rashes. See if your wife's oncologist would check into it for her. I do know of some folks who have responded to Tarceva who are not exxon 19 or 21. I wish your wife and you good luck...you'll be in my prayers:)

Andy