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Dec 22, 2018 · PD-L1 inhibitor + EGFR target therapy : increased serious side effects in Lung Cancer


My name is Lek. I am writing to the Connect from Thailand. I have been reading excellent supporting messages in this group for a few weeks and very impressed by members here. Here are my story:
My father was diagnosed with NSCLC adenocarcinoma 5 years ago. We had undergone cryosurgery followed by EGFR target drugs, i.e., Tarceva and Iressa, for 5 years. His EGFR mutation test was positive. Now, at the age of 82 yrs old, the cancer has relapsed with new solid tumor at the same location (2.5 cm x 1.5 cm). Hoping to use Tagrisso to treat the mutated cancer, he had done biopsy again but unfortunately, the test for T790M was negative. (We have positive for EGFR T854A (21.98%) and L858R (21.73%))

The test for PD-L1 shows only 2% for both tumor and immune cell but the Mismatch Repair (MMR) test indicates proficient MMR and MSS (I was told that this makes the PD-L1 drug less effective).
Our doctor in Thailand suggested using PD-L1 drug such as Keytruda and Opdivo in combination with Iressa but we are still in the decision making stage.
(From my research, it seems like the response rate of PD-L1 is not high and there are also unpredictive autoimmune side effects which could also persist even if we stop the drug. )

In searching for more information, I also run into an article "Trial Results Highlight Changing Lung Cancer Treatment Landscape". It was mentioned in the last part of the article that "use of EGFR targeted drug in combination of PD-L1 GREATLY increased the risk of serious side effects in the lung." Here is the link : https://www.cancer.gov/news-events/cancer-currents-blog/2018/durvalumab-brigatinib-lung-cancer-trials

At the moment, he shows no sign of sickness and still on Iressa until now. In the meantime, my father also controls his diet (anti-angiogenesis foods) and tries using Cannabis oil, as well. (Just started over a week ago.)

I just want to have views or experiences from members in the group or perhaps doctor on the side effect/ efficacy of PD-L1 drug in combination with EGFR target drug. Perhaps, they can help us make decision easier.

Thank you very much in advance.
Appreciate your comments.