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Advanced tumor testing in SCLC


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I had a much better interaction with my Mom's doctor today regarding clinical trials and recent advancements in SCLC care, and she advised me that even though we're still in first-line treatment, it wouldn't be a bad idea to get an understanding of the second-line because of how fast this disease can recur and/or spread.

There have been a lot of new developments available in clinical trials or even with existing drugs for off-label use, but picking which route to go depends a lot on the specific characteristics of the tumor. For example, some attractive routes vs. standard chemo (which isn't very effective after the first line):

-Opdivo+Yervoy: Off-label or Clinical trial - Particularly effective if your cancer has a high tumor mutation burden (TMB) 
-Keytruda: Off-label or Clinical trial - Particularly effective with high PDL1 expression 
-Rova-T: Clinical trial - Particularly effective with high DLL3 expression

So, my question is: Testing for these specific characteristics is not usually done for SCLC, and indeed the pathology report we got didn't do these tests. Rather than randomly picking a second-line treatment, I'd like to opt for one that's more likely to work. So...

Literally, how do we test for these? Order a biopsy and send away to a lab? Is this advisable to do proactively? Would a biopsy be more painful/damaging than it's worth?

Just not sure how to go about this.

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After a first biopsy diagnosing type, should one have a second to check for biomarkers?  This is a very good question and when I asked it in the dark ages of treatment, I was told my biopsy material was retained by the pathology lab and if enough of it remained, that sample could be sent for biomarker analysis.  So, I'd get with the doctor that ordered the initial biopsy, identify the pathologist, and have him or her contact the pathologist, or you contact the pathologist reporting patient name, date of procedure and report number (from ordering doctor) to order a biomarker test.

These tests generally are done by a special laboratory and take about 3 weeks to return results.  I'd try this route before a second biopsy.  But if a second biopsy proves necessary, my view is it is worth the effort.

Medical oncologists are getting very aggressive using new drugs in new ways to treat late stage cancer, as well they should.

Stay the course.



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My Medical Oncologist ordered this testing both with my initial lung biopsies and another done later on an adrenal met. I ask him about it on my first or second visit and he said sending for these was automatic. Don't know if he meant for his patients or generally. Of course, I have NSCLC rather than SCLC. Procedure may be different. I'm not sure he would have mentioned it to me if I hadn't ask. Have you ask your mom's Oncologist if this has been done? I ask for and received a hard copy of the report done most recently. It's very detailed (about 5 pages) and gives a list of what would be most likely to work on my particular cancer. Very worthwhile to have in my opinion. Also, extremely expensive. So far, my insurance is refusing to pay for it to the tune of $40,000.00. Don't know how that's going to turn out yet. Hope something here was helpful. You and Tom are great minds thinking alike. Lol. Your mom is lucky to have you in her corner. 

Judy M

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Thanks both for this!

Tom...so helpful as always. I'll ask who the initial pathologist was because that all occurred when my Mom had her seizure and emergency brain resection down at the main campus of the hospital. We've moved to the local campus, so the doctors are different, though they are all in contact.

Judy: thanks for the heads up about the cost. It's certainly worth it if it gives my Mom a shot...she's certainly got the money. However, you're right that I think this is pretty standard for NSCLC, but not at all for SCLC unfortunately. There are no immunotherapies that are proven to work, but a couple of them have shown definite signs of working in clinical, which is why doctors can prescribe them "off-label." However, now that there's evidence indicating which are more likely to work, we should try to find out more about this cancer even though that's generally not done in SCLC.

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Yeah, I asked my surgeon and my oncologist about it.  They said the testing would not be done due to the early stage, but that the samples would be stored and if it ever became necessary to do that testing, it could be done.

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