|Non Small Cell Lung Cancer||61||Bulgaria||2014||currently in treatment|
Dancho, Non Small Cell Lung Cancer
|61||Bulgaria||2014||currently in treatment|
In October 2014 the patient (a 61-year-old male, never smoker) was diagnosed for a NSCLC stage IV.
The patient was diagnosed for a NSCLC stage IV.
Biomarkers already tested:
– EGFR negative
– 3 cycles of cisplatin 150mg /gemcitabine 2000mg
– 3 cycles of docetaxel 75mg
We received the sample more than one year after the first diagnosis and we performed an OncoDEEP on the original biopsy. On the contrary of what was found, we identified two activating mutations in EGFR.
Approved for lung cancer : afatinib (from July 2015)
3 OncoTRACE analyses showing the disappearance of the mutations. Confirmation by CT Scan.
After 12 months since the reception of the report, the patient is in complete remission and no variants have been so far detected in the blood which confirms the complete remission.
After 16 months of treatment with afatinib, the OncoTRACE#6 has revealed the presence of the EGFR acquired resistance mutation T790M (1%). Although this variant is known to appear after 1st (erlotinib) and 2nd generation (afatinib) Tyrosine Kinase Inhibitors (TKI) treatment, it has not been associated with resistance to second-generation TKI.
Nevertheless, presence of this variant in the blood might indicate a relapse of the patient. A CT scan has been performed and no mass has been observed. Relapse could not been confirmed yet and the oncologist decided to continue with the current treatment.
However a particular attention should be paid, involving a closer monitoring
The 7th OncoTRACE analysis showed no ct-DNA in the blood confirming the last PET Scan. The transitory increase of variant T790M might be the result of a micro metastasis.
However, the 8th OncoTRACE showed this time 3 EGFR mutations. This time, disease progression was confirmed by CT scan.
The patient is currently on Pembrolizumab since Osimertinib is not available now in Bulgaria. The patient seems to be answering well to the treatment since all the variants have disappeared in the blood as proven by the latest OncoTRACE.
Because of the presence of a new EGFR variant, T790M, the treatment was modified to Pembrolizumab (osimertinib not being available in the patient’s country).
Dr Boris PETROV
OncoDEEP & OncoTRACE become a useful tools to understand the patient evolution and response to treatment.