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.