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HER2 non small cell adenocarcinoma stage 4 lines of treatment
Hello this is all very new to us. Husband age 63 and excellent health diagnosed June 2025.
He has minimal symptoms but he is stage 4, Lung non small cell Adenocarcinoma , positive ERBB2 ( HER 2) , PDL 1%, Mets to liver and bone. After 4 cycles of carboplantin, pemetrex plus pembro to be followed by maintenance pemetrex and pembro.
He will have PetScan next week ( 4 cycles have been completed) .
A preliminary CT ( after 2 cycles) showed 20% tumor shrinkage and no new tumors. It seems like rather than continue more cycles of maintenance why not right away start with the meds that are being found very effective for HER 2 ?
Is there documentation showing that the first line is more effective for specifically HER 2 in lung adenocarcinoma?
Thank you.
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ps
The second line is
Fam- Trastuzumab deruxtecan-nxki for HER 2 over expression in non small cell lung adenocarcinoma.
hi @mil63 - I would ask your husband's oncologist about Zongertinib. It received FDA approval in August as a second line treatment for HER2 mutated non squamous, non small cell lung cancer. And in the clinical trial, it was more effective in patients that had NOT previously received a second line HER2 antibody drug conjugate. If you aren't getting the answers you need from your team, it's always worth getting a second opinion, especially from a NIH Cancer Center.
https://www.fda.gov/drugs/resources-information-approved-drugs/fda-grants-accelerated-approval-zongertinib-non-squamous-nsclc-her2-tkd-activating-mutations
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1 Reaction@mil63, A new diagnosis like your husband's is often overwhelming. There is so much to learn, and many decisions to make. That's great that his tumors are responding to treatment!
There may be research that supports the oncologist's plan, but maybe the choice is squishier than that. It's certainly worth a conversation. Some stage IV cancer patients can go directly to a targeted therapy as fist line. I was one of those cases. I'm still on my first line inhibitor (for ALK positive NSCLC). Have you asked his oncologist what reason they have for continuing with the current treatment vs an inhibitor?
@sboes , I believe you are HER2, and were on enhertu at one point. What treatments are you doing now, if any?
Thank you very much for this information.
@lls8000 thank you . We had a second opinion at Mayo when we started and they concurred 💯 with the first line treatment I mentioned in our local hospital .
It’s chemo carboplantin, alimta and additionally immunotherapy- keytruda.
The second line explained to us is :
Fam- Trastuzumab deruxtecan-nxki for HER 2 over expression in non small cell lung adenocarcinoma. (if we find first line not working)
It seems to be working at mid cycles but it feels like , are we wasting time? Can it be more successful do other ?
Obviously we are still getting educated and it is overwhelming. It’s a scary feeling to think we have to negotiate .
@lls8000 . Hello, what types of treatments did u receive that YOU are alive 5 years later?? chemo? radiation?
I'm waiting for final diagnosis for stage 4 lung cancer. NO word from my doctor yet, if I need biopsies of lung and lymph nodes. Also final results of thyroid scan. It metastized to my skin of right temple. That is why we found I had cancer w/out any signs and symptoms at all.
Thanks so much. I am scared about what I have read about immunotherapy meds!! very scary!
My husband has only had his 4 cycles every 3 weeks . He was just diagnosed This June. I think my sentence is a little confusing.
He has done really well with chemo including the immunosuppressant. We were told the possible side effects and ways to reduce them and be more comfortable. For example- anti nausea medication. I wish you all the best! With a little preparation you can do this!