Can my mother switch to Erlotinib during chemotherapy?

Question

Hello doctor,

My mother has been diagnosed with stage 4 adenocarcinoma. She was having trouble breathing due to pleural fluid buildup. As per our oncologist's suggestion, we started Gemcitabine-Carboplatin chemotherapy 10 days ago. The suggested course of treatment is six cycles of chemotherapy.

As the test for EGFR mutations was not successful, the doctors did not suggest Erlotinib-based treatment such as Tarceva. Can we switch to Erlotinib after two cycles of chemotherapy without knowing whether EGFR is positive or not?

Please advise.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your anxiety.

By the EGFR (epidermal growth factor receptor) not being successful, do you mean that the test was not positive for mutations, or that it could not be performed due to inadequacy of the sample? Please clarify.

Starting EGFR inhibitors in the absence of mutation is not recommended, as there will be no benefit, and the patient will lose valuable time in which she could have received chemotherapy. If the sample is inadequate and it is strongly recommended to get a rebiopsy, then continue chemotherapy till then.

Revert back with the answer to the above question.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

I have read your queries and can understand your concerns.

GemCarbo is a decent option since Pemetrexed cannot be given due to pleural effusion. If it is stage IV, then there are usually ample sites from which an adequate sample can be taken, like the liver. If she has a gross pleural effusion, it can even be tapped and sent for tissue block formation.

That tissue block can be used to study genetic analysis. This is much less invasive than a deep tissue biopsy and is commonly practiced. Patients are more compliant with this. If it is possible on your part, then send the PET CT or CT report. We will discuss with our interventional radiologist about the adequacy of the sample site.

I hope this helps you.

Please let me know if I can assist you further.

Thank you.