Are there any targeted therapies for Multifocal Lung Cancer?

@akfishinmom1, does that mean that you got a diagnosis of multifocal adenocarcinoma? Allow me to tag fellow travellers with the same diagnosis, like @merpreb @linda10 @sakota @meka and @bluelagoon

While we wait for others to join the discussion, I think you will find some information and answers in these related discussions:

- Multifocal Adenocarcinoma of the lung, continual recurrences https://connect.mayoclinic.org/discussion/multifocal-adenocarcinoma-of-the-lung-continual-recurrences/
- Is my Lung Disease Stable or Unstable or NED? https://connect.mayoclinic.org/discussion/is-my-lung-disease-stable-or-unstable-or-nedmerpreb

What treatment is being suggested for you Akfishinmom1?

No it hasn’t been diagnosed but I have a needle biopsy within the week. I went into a pulmonologist to see if he could a biopsy on the sub solid nodule using EBUS but he decided it wasn’t possible. He requested a veran or high resolution CT scan and that scan showed additional groundglass in the other lung too. None but one has a solid portion. At that point he mentioned adenocarcinoma in situ and or multifocal adenocarcinoma so I was just trying to do some research on it.

Hi. I just found your post, and I see it's dated from three years ago, so I'm not sure if you're still following replies.

I've had multi-focal LC since 2018. I was originally diagnosed in 2008 with a large NSCLC tumor, underwent chemo and radiation and was cancer free for ten years. Then in 2018 I began experiencing recurrent malignant lung nodules in both lungs, which we've been treating with radiation. I've had five of them so far and apparently I have "multiple" nodules that we're watching and that continue to grow and become solid. We've just found that one we radiated in 2018 has become malignant again (apparently the radiation wasn't effective enough). Because I've now been told by my radiologist that she's not willing to treat me with more radiation anymore (despite not experiencing any side effects), my options now are limited. I'll probably have to undergo wedge resection surgery.

I've been following a clinical trial at MD Anderson using the immunotherapy drug Keytruda for lung nodules (the IMPRINT trial), and was able to speak with the doctor in charge of the trial who gave me more information. He informed me that although the trial won't be over until 2025, they're seeing that Keytruda is reducing and even eliminating these nodules in many of the participants after only three treatments. This is probably the next route we're going to try, although I'm a little wary after reading how bad the side effects could be with Keytruda.

I'd like to know more about your progress so far. Multi-focal LC seems to be becoming more common.

Hi Doug,
I was diagnosed in February 2020 with multifocal lung cancer. I had an upper left lobectomy at that time followed by four rounds of chemotherapy as a preventative measure. At the time I was living in North Carolina. Since then I have moved to Canada and seven months ago had upper right and lower right wedge resections (at the same time) removing four nodules. These nodules have been there since the beginning and were very very slowly changing so we decided to get ahead of it and do the surgery. I have one other nodule in lower left with mild metabolic activity that we are watching but so far it’s stable. I have several other nodules that show no activity in a PET scan. I have no lymph node involvement nor distant metastasis. I am in a wait and watch mode with my medical oncology team while doing therapies with a naturopathic oncologist to try to keep things stable. (High dose vitamin C and Mistletoe infusions every other week and daily supplementation)

I imagine your Radiolgist is concerned with your lung capacity. My understanding is that treatment options are based on location of nodules and lung capacity
I was diagnosed in Dec 2021 with multifocal adenocarcinoma. I have had two VAT wedge resections RUL, LUL each for one nodule. I followed with SBRT for two other nodules. Unfortunately, I had pneumonitis from radiation.
I can't do anymore surgeries due to lung capacity. They have mentioned ablation and immunotherapy. However, I also have pulmonary fibrosis and there is a risk of new pneumonitis with any option.

I got word from my oncologist yesterday that my radiologist did agree to radiating the current nodule. But we found another nodule on Tuesday's PET scan that had some slight metabolic activity as well, so it looks like that's going to be another one to deal with in the future. I don't know if Canada is incorporating immunotherapies or targeted therapies in their treatments, but has your oncologist considered that?

Hi. Like trudyhs above, has your oncologist talked to you about possible immunotherapies or targeted therapies? It sounds like you would be a perfect candidate for trying those.

Yesterday my oncologist informed me the radiologist agreed to radiating this nodule again, despite her telling me in the past it was a no-go. I wasn't looking forward to the idea of a wedge resection surgery, so it's kind of a relief.

Because I have pulmonary fibrosis as well as multifocal cancer, future treatments must be weighed against the risk of new pneumonitis and the significant impact it could have on my quality of life. Any treatment is now a risk for me. I am already on oxygen for sleep and exertion.
I had two wedge resections and would not mind doing another one, but not possible. I prefer cutting them out because then they are gone, and can be identified

I see. I'm pretty sure that wedge resection will also be on the horizon for me in the future as well. I guess the idea of lung surgery after the amount of radiation I've had scares me as they've told me the radiation has left portions of my lung fibrotic. I had a large tumor in 2008 radiated as well as these current nodules.

You mentioned the possibility of ablation. I've done some reading about it, but it seems like it's rarely used for lung nodules, despite some fairly decent success rates. Both oncologists as well as my radiologist don't seem to show much interest in it for some reason, or know much about it. I'm wondering why it isn't a more widely used treatment.

After the last surgery in March 2024 and based on the genetic markers of my pathology my oncologist offered chemotherapy followed by a year of immunotherapy. I declined. In Canada the clinical trials of immunotherapy include chemo first so in order to have immunotherapy covered by our national health plan I would have to have chemo first. I've done chemo 5 years ago as a preventative and none of it made sense to me. It felt like taking a bazooka to a fist fight. I opted to wait and concentrate on my naturopathic therapies to see if we could keep things stable. If things start to heat up then I'll certainly consider having systemic drug therapy. My 6 month follow up CT scan indicated stability so I'm comfortable with my decision so far.