How long does it take Tarceva to start working?

[daughteradvocate]

My dad was diagnosed w/ stage IV NSCLC, EGFR+ in January 2016. He was in a clinical trial for a 3rd gen TKI drug up until last month when a progression was found in his liver, and he developed much more pain in his chest, back and leg, probably due to bone metastases. Not finding a T790 mutation, his doctor switched him to Tarceva. How long can we reasonably expect before there will be any effect? How long does it usually take before the drug starts to shrink the tumors?

[Esthersm]

I had been taken Tarceva for almost 5 yrs , the 2nd scan , after 3 months,showed shrinkage of the lung tumor, buts a lot of manageable side effects. Hope your Dad feel much better! I'm 76 yr old.

[scifiknitter Blogger]

Daughteradvocate,

What drug was your father taking before his doctor switched him to Tarceva? Has he had standard platinum based chemo yet? Does he have strong opinions about what he is willing to take for treatment that would affect the options that his doctor offered him?

It's unusual to go from a third gen TKI back to a first gen TKI like Tarceva, and there isn't a lot of information other than individual patient stories about how successful that approach is likely to be for your father.

I'm on my third EGFR TKI now. It's been my experience that I have had a pretty good idea that the drugs worked for me within days or a few weeks through easing of symptoms. These drugs start working right away if they are going to work. If his symptoms don't improve soon, he probably should get back to his doctor for an examination and evaluation so that a new treatment plan can be figured out before too much time elapses.

Kudos to your father for being part of a clinical trial! I hope the experimental drug did well him for a substantial period of time.

Anita

[daughteradvocate in reply to scifiknitter]

Thanks for the responses!

It was EGF816, which is supposed to target the T790 mutation (which he didn't and still doesn't have), but generally be effective for EGFR+ and avoid major side effects. It kept the cancer from progressing for a whole 13 months, with very few side effects indeed, but never showed much of a reduction in the primary tumors. Now that there is a progression, I guess the hope is that the tarceva will be more effective, though they can't be sure. There is also the concern that he can't tolerate the regular platinum based chemotherapies in his current condition.

He has an exit interview for the trial next Monday, and I guess they will evaluate how the tarceva is working then.

[scifiknitter Blogger in reply to daughteradvocate]

Did he take the EGF816 as a first line treatment? If so, his doctor may think that it is worth trying. Which EGFR mutation does he have?

Thanks to your dad for participating in the EGF816 trial, it sounds like a promising drug. 13 months stable with few side effects when you don't have the main mutation targeted by the drug is quite a decent result!

All best hopes for your dad's next consultation.

Anita

[daughteradvocate in reply to scifiknitter]

Yes, the trial was his first line, which I guess was good because he didn't go through the rigors of chemo, but I can't help wondering if he had had a more aggressive treatment when he was stronger, would he have maybe have a more tolerable tumor load now. Of course there is no way to know, and I don't think he regrets having joined the trial. He really has been getting top of the line treatment and monitoring, and of course the savings on the drug, not to mention the benefits to future patients, are important as well.

I think the mutation is EGFR exon 19 deletion. Not sure if that was what you meant. I didn't realize the subtypes had a significance.

Thanks again!

[scifiknitter Blogger in reply to daughteradvocate]

The subtypes do have significance. Exon 19 deletion (which I also have) and exon 21 L858R generally respond well to EGFR TKIs while people with exon 20 mutation have a lower response rate.

I think it might be a possibility that your father's doctors think that the resistance mechanism for EGF816 might be different than the resistance mechanism for Tarceva (which is a new T790M mutation in about 60% of cases), in which case there would be a decent chance that he will respond to Tarceva. At first I was puzzled by the treatment recommendation, but it makes more sense to me as a drug that might help your dad, given his mutation and the fact that he has had only one line of treatment. If it works, his quality of life could improve quite a bit.

I also was in a phase II trial. You can't beat the care you get.

I've got my fingers crossed for him!

Anita