Is having a mutation vital for cure?

[catlady91]

My mum was diagnosed with stage 3B squamous cell non-small cell lung cancer in Feb. She's doing well; she finished her chemo and radiotherapy a while ago and recently started immunotherapy. My mum's biomarkers showed that she has PDL1, which is why they approved her for immunotherapy. A lot of people talk about mutations, but apparently squamous cell doesn't tend to have any mutations. My mum is EDGF wildtype which means that she doesn't have that mutation. Is this a bad thing when it comes to trying to cure or to treat lung cancer? Does having mutations mean that there's more of a chance for cure?

[Tom Galli]

Cat lady,

Very small percentages of NSCLC Adenocarcinoma have tumors with mutations that are attack portals for targeted therapy. These mutations you speak of are more commonly referred to as tumor markers and there are lots of them. Unfortunately, as you said they do not occur in squamous cell NSCLC. But, PDL-1 is a arrack portal that is found in Small Cell and both forms of NSCLC. It points to the suitability of immunotherapy as an effective treatment. Immunotherapy is the new treatment mode just coming into prominence for a year or so. Targeted therapy has been around longer but as I said, only for a small percentage of those with lung cancer. 

i would think immunotherapy is the much better and lasting path to no evidence of disease (NED). When it works it really works. Unfortunately those who have targeted therapy sometimes find their cancer has mutated to resist the targeted drug. 

So I think immunotherapy is the best treatment method for your mom given her circumstances. 

Stay the course. 

Tom

[catlady91]

Hi Tom,

Thanks for replying. I thought mutations were really common in adenocarcinoma but you say the mutations occur in a small percentage of people.

I thought that targeted therapy was common and I always wondered why they didn't give my mum targeted therapy. 

I really hope that the immunotherapy works.

[Tom Galli]

Catlady91,

Here is the link that shows the percentages of adenocarcinoma that can benefit from targeted therapy. Note the pie chart and paragraph titled Driver Mutations in Adenocarcinoma.

Only about 25% of adenocarcinoma patients can benefit from targeted therapy. None with squamous cell or small cell benefit from this treatment. That is why your mom is not getting it.

I also hope immunotherapy works.

Stay the course.

Tom

 

[MarieE]

My husband has squamous cell NSCLC and MET exon 14 skipping alteration, and has just started a newly approved targeted therapy. The original plan had been for chemo and immunotherapy since he has high PDL-1 but this seemed the better route for him. Of course, we just hope it works! The first two oncologists we went to for consults didn't even mention it as an option. There are so many new advances happening so quickly that I'd imagine it is tough to keep up with everything.

[Deb W]

I also have MET exon 14 skipping but this was not found until after my first chemo and immunotherapy treatment (my My PDL is only 12%).  I switched  my oncologist because the MET  information was right in front of him for 12 days and he still didn't know it until the second opinion doc demanded to see the pathology report.   I am now at a comprehensive cancer .  The board decided to keep me on this treatment to see if it works.  I had my first CT scan after 2 chemo treatments yesterday and the lymph node tumor shrunk by 25%. I was told It is a small amount of cancer, but since this was micro metastasis and couldn't be seen  after the surgery in March of 2019 - obviously the cancer really wasn't gone even though the margins were clear and several lymph nodes were negative because I had symptoms in October - after scanning they said it was inflammation caused by the surgery and I believed them.  I was still having shortness of breath when I climbed stairs but thought that maybe this is how it will be from now on since 1/3 of my lung was removed.  Fast forward to April 16 and now I had Stage IV. The plan is to continue  the same treatment for 2 more cycles.  If it has improved again in 6 weeks they will drop the carboplatin, check again.  If this does not work, I will have the option to take the targeted drug Trabecta.

[MarieE]

Wow, so much of this sounds familiar, Deb. My husband had clear margins after the surgery in October and his scan in January was clear. He kept complaining of pain near the large incision site from the surgery and they kept telling him it was from the nerves regenerating and from scar tissue. It was only after the lump in that location got to be the size of a golf ball that they finally did another biopsy and PET scan and found that the cancer had spread. He also has shortness of breath and uses a steroid inhaler daily.