A brief lesson and update

Some people have asked that I explain the basic types of treatment for stage four lung cancer.
I was diagnosed with stage four non-small cell adencarcinoma that has spread throughout my body.
There are three basic types of chemotherapeutic treatment for cancers that have spread widely throughout the body, before any treatments start.
1- targeted therapy
2- immunotherapy
3- standard chemo.

I started off with standard treatment and that worked for a short while. There are dozens of combos of standard chemo and that will always be available to me.

Targeted therapy is used when the tumor is tested for common gene mutations (such as in the EGFR, ALK, or ROS1 genes). If one of these genes is mutated in your cancer cells, treatment will likely be a targeted therapy drug:

* For tumors that have the ALK gene change, crizotinib (Xalkori) is often the first treatment.
* For people whose cancers have certain changes in the EGFR gene, the anti-EGFR drugs erlotinib (Tarceva), gefitinib (Iressa), or afatinib (Gilotrif) may be used as the first treatment.
* For people whose cancers have changes in the ROS1 gene, an ALK inhibitor such as crizotinib might be used.

My tumor was positive for the EGFR gene and I was on a clinical trial of super high doses Tarceva starting April 2016 for 13 months until it stopped working. While it worked Tarceva shrunk and eliminated most of my tumors.
By stopping to work, I mean that they found a bunch of new tumors, primarily along my spine.

They redid the tests again to try find any new mutation that will respond to a different targeted therapy drug and the initial results showed no new gene change. So unless further tests show a gene mutation, targeted therapy is off the table for now.


My tumor cells might were  also be tested for the PD-L1 protein. Tumors with higher levels of PD-L1 are more likely to respond to certain immunotherapy drugs, so treatment with pembrolizumab (Keytruda) might have be an option. People with the EGFR mutation that I have usually do not respond to immunotherapy. Ironically, immunotherapy works best on heavy smokers. I will be a candidate for immunotherapy if all other treatment options fail.

At this point I will return to standard chemo, as long as it keeps working or my tests indicate a better treatment plan.

The chemo along with all of your prayers and good wishes will let me continue enjoying life to it's fullest.

Thanks to all of you for everything.

update

I have not posted for a while because things were going well.
I feel great and except for the annoying side effects of the Tarceva (chemo) I was able to function.
When I started the clinical trial of Tarceva, (thirteen months ago) they explained to me that it often works for about one year at which point the cancer may get 'smart' and mutate and a new drug will be needed to fight the cancer.
On Tuesday I had my regular brain MRI and torso CT scan.
Yesterday I got the results and it seems that the Tarceva is no longer working.  Thank God there is no new growth on the brain. However, they found small tumors along my spine and other bone areas.
I will go for a spine MRI tomorrow for further examination and will be scheduled for a new biopsy. They will look to see if there are new genetic markers that will respond to a targeted therapy.
They will then change my regiment accordingly.
This may seem like bad news, but the fact is that there are great advancements in lung cancer and there are many medical paths to have a life full of quality.
I feel blessed to have so many family and friends praying for my good health.
I will keep you posted on new test results and treatment.