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SCLC: Immunotherapy questions


MyWifeSCLC

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Looking toward the future of my wife's SCLC diagnosis, I'm hoping to have discussion around the following questions, either through this post or separate posts. Note that my questions are based on SCLC treatment in the Cancer Therapy Advisor dated 9/20/19.

 

Should biomarker testing be done when LS-SCLC is 1st diagnosed since 1st line treatment usually achieves complete or partial response? (Cost, future mutation, orig treatment for relapse > 6mos)

 

Should biomarker testing be done if SCLC progresses during 1st line treatment?

 

If LS-SCLC progresses during 1st line treatment, should chemo radiation be continued to completion? (Immediate new treatment, new mutations)

 

Should biomarker testing be done when SCLC recurs after 1st line treatment since it becomes resistant?

 

What biomarkers should be tested for due to huge alphabet soup of markers? (PD1, PD-L1, CTLA-4, TMB, EGFR, ALK, MSI-H, dMMR, AR-V7, others)

 

Is liquid biomarker testing reliable? (Cost, vs tissue sample, SCLC vs NSCLC)

 

Is OPDIVO biomarker EGFR, ALK, AR-V7?

 

Is YERVOY biomarker CTLA-4, AR-V7?

 

Is KEYTRUDA biomarker MSI-H, dMMR?

 

Is TECENTRIQ biomarker PD-L1?

 

Why is TECENTRIQ typically only specified for extensive and not limited stage SCLC?

 

Is biomarker for IMFINZI PD-L1?

 

Why is IMFINZI not specified for any stage SCLC?

 

Steve

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Steve,

Wow, that is quite a list!

As I understand the current state of art, small cell lung cancer can be effectively treated with immunotherapy. Therefore, you should have biopsy material submitted for a laboratory test revealing PD-L or PD-L1 markers to give an early up front understanding of the possibility of immunotherapy as a second line treatment.

You are right in characterizing small cell as a frequent mutation form of lung cancer. I wouldn't know if mutation affects immunotherapy markers.

The alphabet soup targeted therapy markers (EGFR, ALK and etc.) are called driver mutations and are only found in a small percentage of adenocarcinoma non small cell lung cancer so I think you can rule out the need to test for driver mutations. This link has information on biomarker testing and liquid biopsies. As for the specific immunotherapy drugs and associated biomarkers, I can only suggest reviewing this as a resource. Note particularly the information under the heading "What new Immune checkpoint inhibitors are currently being tested" to see small cell immunotherapy applications in trial. In the immune checkpoint inhibitors information on the previous link, I note that Keytruda is FDA approved "for patients with  metastatic small cell lung cancer with disease progression on or after platinum-based chemotherapy and at least one other prior line of therapy."

Immunotherapy is a new treatment modality and lots of trials are in progress. I'd ensure your medical oncologist is on top of immunotherapy as a treatment method and following the trial results. I'm sorry I cannot address all of your questions.

Stay the course.

Tom

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Thx Tom ... I really do appreciate all your comments throughout the website. I'm the "research type" and have already done much. I know to use recent data or old data that has been recently reiterated. I tend to be hesitant about putting info on a website because folks may roll eyes. I need to get over that.

 

What are your thoughts on continuing a post or starting new posts for a specific topic or question? Also, should my questions stay in the SCLC group or be placed in a specific group based on content?

 

Steve

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Great questions. Tough call on one long string versus separate topics. I think separate and focused threads maybe best?

Following you now. I have many similar questions that I doubt the board can help me with. For example..large cell is in the non small cell category yet they do not automatically check for markers. Reason is they dont find many. My response? Rare tumor that they rarely test. Chicken and egg question 

Large cell is also treated as if it is small cell yet no mention of using tecentriq. Same logic as for testing for markers.

These two plus more will be asked on my next oncologist visit and at second opinion. Plus might ask some of yours too!

This board is really awesome. Glad for all who participate and unfortunately you as well 

Peace

Tom

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Steve,

Your content organization is up to you. There are benefits to individual topic posts and collective posts. I would keep your content in the small cell thread, particularly your focus on immunotherapy for small cell. Immunotherapy is the first advance in small cell treatment in 20 years. 

Stay the course. 

Tom

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