MyWifeSCLC Posted February 23, 2020 Share Posted February 23, 2020 I came across an interesting article indicating DLL3 seems to be highly expressed (a bunch of it) in SCLC and LCNEC and not so in normal cells. The article discusses some studies and trials for targeting DLL3. Early trials appear to validate this method. Clinical trial NCT03319940 is the 1 I will be following. AMG757 and AMG757 + KEYTRUDA are the drugs being tested. https://jhoonline.biomedcentral.com/track/pdf/10.1186/s13045-019-0745-2 My wife appears to be eligible for the clinical trial mentioned above. 1 location is in Nashville, TN which is drivable for me (Dandridge, TN). However, I would be nervous about a phase 1 trial. Anyone have thoughts on phase 1 trials? Several statements stood out in the article. I have paraphrased as follows: 1. Anti-PD-L1 TECENTRIQ + standard chemo (1st line) is limited (avg. 2 months). 2. Anti-PD-1 IMFINZI and IMFINZI + YERVOY have similar results to Topotecan (2nd line). 3. Topotecan has limited benefits (2nd line). 4. PD-L1 expression in SCLC is small. Adding months to someone's life is certainly something you want to attain but the word "limited" is sobering. I have read information about testing for DLL3 both in tissue and liquid biopsies. I could not glean enough information about how hard this is to do or if local hospitals/cancer centers are set up to do this. Great question for an oncologist! Steve Link to comment Share on other sites More sharing options...
Tom Galli Posted February 23, 2020 Share Posted February 23, 2020 Steve, I'm not much of a Wikipedia guy when it comes to research but occasionally a Wiki summary is very useful. I think this one on clinical trails and phases meets that mark. Ensure you understand what standard of care treatment alternatives would be off the table if you choose to participate in a clinical trail. In an unrelated question, have you consulted with a radiation oncologist to determine if precision radiation (Stereotactic Body Radiation Therapy (SBRT) could be administered. Some radiation oncologist are getting aggressive in using this technique against extensive stage small cell. Two outcomes are possible: reducing the tumor burden and therefore slowing progression and amping up the immune system through the Abscopal Effect. Stay the course. Tom Link to comment Share on other sites More sharing options...
MyWifeSCLC Posted February 23, 2020 Author Share Posted February 23, 2020 I don't use Wikipedia as much as I should. The phase 1 explanation was excellent and did add more to what I already understood. You hit the target if what I was thinking on care during a trial. Who takes responsibility for care if things go sideways in the trial, especially if the trial clinic is seeing you once every 2 weeks. I have not talked about SBRT to our radiation doctor. My wife starts her 1st radiation next week with the "typical" 1st line IMRT. I will ask about the SBRT at our next meeting. I need to do some research ... I thought SBRT was for small nodes. I know staging doesn't change once diagnosed but when cancer recurs, it seems that treatments become as if stage 4. Steve Link to comment Share on other sites More sharing options...
Tom Galli Posted February 23, 2020 Share Posted February 23, 2020 Steve, You'll need to find the right radiation oncologist. Some are getting very aggressive treating even large tumors in multiple locations. I'd put SBRT and immunotherapy clinical trial in the decision analysis if first line treatment doesn't work. Moreover, I can't see how SBRT would adversely affect participation in a chemo-based immunotherapy trial. Read this. I'd fire off an email to the National Cancer Institute Intramural cancer treatment program at the POC shown in the blog. They design clinical trials for individuals, pay for all costs including travel, food and lodging while in treatment. Stay the course. Tom Link to comment Share on other sites More sharing options...
MyWifeSCLC Posted March 13, 2020 Author Share Posted March 13, 2020 Hey Tom ... I have not heard back from Jan Pappas ... perhaps they get inundated with emails and can only answer a few that might be interesting. Steve Link to comment Share on other sites More sharing options...
Tom Galli Posted March 13, 2020 Share Posted March 13, 2020 Steve, Email her again. I bet the NIH is overwhelmed by coronavirus concern because they are treating a large number of lung cancer patients. Stay the course. Tom Link to comment Share on other sites More sharing options...
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