Treatment after Cetuximab

Kassandra_818

Hi there. I'm looking for advice because it seems my dad is running out of options. In 2016, he had a round of cisplastin paired with radiation. He maxed out his lifetime allowance of radiation, so that is no longer an option. They then put him on Opdivo when his cancer spread to his lungs, but it had very adverse effects- it ended up causing his body to attack his liver so he is now ineligible for all immunotherapies, unfortunately. He then began Cetuximab (Erbitux) in September of last year, which was working okay up until about six months ago. The largest two nodules in his lungs are sitting at 6 mm and 14 mm, respectively. I have estimated 5 mm of growth every three months, so I'm guessing his Cetuximab is no longer working at all anymore. His oncologist has expressed discontinuing treatment within the next few months, but the side effects of his chemo are too great to wait that long. I would like to get him off of it now, and possibly do gene testing for a possible clinical trial or another palliative chemotherapy. Does anyone have any suggestions? I understand the possibility of curing the disease is rare, but possible. That would obviously be my ultimate goal, but giving him a longer life span at this point is something him and I will accept as well. He is only 58, and my sisters and I are still very young, aged 7-20 so my dad is really wanting to give this his all. 

wbcgaruss

Tough Situation

This post is hard for me to respond to but I just want to let you know that it sounds like

you have used all options possible.

Also, it sounds like some of the treatments have created their own problems.

I don't have any advice I can give but just keep exploring options work with his

doctors as it seems you have been and are on top of the situation.

Remember Prayer is Powerful-Trust in God

Love him dearly and cherish each day

corleone

You need to discuss this with

You need to discuss this with an open minded oncologist. Probably there is no effective “standard of care” treatment at this point, but what you have suggested is reasonable, perform a genome testing and if any specific mutations are found, these can be targeted (there are a few targeted treatments, specific tyrosine kinase inhibitors, and/or monoclonals that can act upon a mutation).

Aside finding an oncologist who thinks “out of the box”, the other hurdle is that – in order to perform a genetic testing – your father needs a biopsy. An older archive tissue probably doesn’t work, because the pulmonary metastasis have already changed their tumor “profile”.

Also, immunotherapy is not entirely out of question. I agree, checkpoint inhibitors are not an option, but there are forms of therapy, like adoptive cell transfer and oncolityc viruses. This is highly experimental at this point, but maybe there are open trials that may work for him.

johnsonbl

Agree with Corleone...

Find yourself an NCI designated comprehensive cancer center (if you aren't already at one) that has a broad range of trials and the full portfolio of treatment options.  They'll have a multidisciplinary team who can put all their heads together to come up with more options if there are some...as well as supportive disciplines such as palliative care if there aren't any more.

Hang in there.  You sound like a great teammate in his fight.

Brandon