Dear Rene & Edward,
I had my right lower lobe lobectomy and left lower lobe resection performed on November 4 and November 11 2014 respectively. There were diagnosed as Stage 1B & 1A respectively. Due to its early stage, no adjuvant therapy was required. From the molecular tissue analysis, the right lung has no EGFR mutation (EGFR negative) and negative to ALK & ROS1 , while the left lung is positive to p.Leu858Arg (L858R) or Exon21 mutation. In my PET scan on December 5 2016, they detected a lesion (cancer) on my T1 Spinous Process, even though there is no other cancer detected else where in my body. Whilst a “cystic (9 mm)” and a “tiny nodular density (2 mm)” on the right middle lobe lung were mentioned in the PET, these were present since 12 October 2015 (via CAT imaging) [during that time, cyst was 3 mm & nodule was 2 mm] - my Thoracic surgeon told me in my meeting on 9 December 2016, not to worry about it as there were there since 12 October 2015 and no lung cancer was not evident on the PET dated 28 April 2016 & 5 December 2016. I underwent a resection of T1 Spinous Process on December 21 2016. From the T1 biopsy report, it is non mutated (EGFR negative), confirming the oligometastatic from my right lung.
Blood Test for EGFR T790M (Exon21 mutation) Mutation Analysis Report for T1 Spinous Process: Jan 6, 2017, performed at Olivia Newton-John Cancer Research Institute.
INTERPRETATION: Plasma DNA is a surrogate for tumour DNA. The absence of the EGFR T790M mutation in the blood does not rule out the possibility that the tumour may harbour the EGFR T790M mutation, especially since the EGFR driver mutation was not detected. This may be due to a low tumour burden. Thus, EGFR mutation testing of tumour tissue is required to exclude the presence of the mutation. If a tissue biopsy is not possible, a blood sample from this patient could be sent to us again when the tumour burden increases. My Oncologist told me that the Circulating Tumour DNA originally proposed to be done at MSKCC may bear similar results as the above and he believes this is a good result because it showed low circulating tumour burden.
I will be undergoing IMRT 30 Gy in 10 fractions over 10 days to treat the T1 Spinous Process in the next 1-2 weeks and my Oncologist recommended Chemo as well. This first line therapy is Carboplatin/Alimta for 4 cycles over a 12 week duration (1 cycle every 3 weeks) to wipe out the remaining circulating tumour before they multiply. My Oncologist cousin in Yale Comprehensive Cancer Center agreed with my Sydney Oncologist that it is potentially curable, so aggressive treatment with radiation and chemotherapy makes sense. In fact, my Oncologist did mention to do IMRT & Chemo together - I am very weary my body just can not handle these combined toxicities.
Q1: After reading your Chapter 2 & 3, I am beginning to doubt if Chemo will actually provide me with a cure?. In other words, would it just delay the inevitable recurrence of cancer?.
Looking at a back-up plan in the event the recurrence happens after Chemo, would immunotherapy still works as effective as if I have not done Chemo (I suppose this is exactly what Rene has been through)?.
Q2: How is Rene's recent neutrophil count when compared with the time she underwent Chemo?. Is Rene's bone marrow back to normal when compared with the time prior to Chemo?. Does Rene have any further side effects as a result of the Chemo?.
Q3: With my non-mutated mets to T1, do you think immunotherapy still provide a higher chances of cure when compared with Chemo?.
My Oncologist mentioned that if Chemo doesn't work (recurrence of cancer), then immunotherapy can be used as a second line therapy.
Q4: What immunotherapy is Rene currently on?.
My Chemo decision time is coming up in a week time - I am just not sure what to do honestly as I have not found a cancer centre in Sydney/Australia that can offer immunotherapy and I am very weary of the lasting side effects Carboplatin/Alimta can have. Due to the time pressure and the thought of circulating tumour multiplying, I may be forced to bite the bullet and take the Chemo option.
FYI, I have stopped taking all my omega 3 high doses, vitamins & supplements in preparation for the IMRT.
Your feedback would be greatly valued & appreciated.