I had my 4 year cancerversary in late May and since that date all medical news is negative. Just to summarize rapidly I am treated for an adenocarcinoma of the lung (I also have an SCLC but it seems quiet for the time being) and was EFGR mutated for the last four years. I was on Erlotinib, Osimertinib and then Afatinib. I tried bevacizumab, cetuximab and panitumumab unsuccessfuly when my cancer progressed. In March, I started a chemo (carboplatin+alimta for four cycles and Alimta as maintenance afterwards), which shrunk my lesions after two cycles but the control Petscan made last Tuesday showed a new very active lesion in the lung, several new nodules in the lung and four of my 15 bone metastases with increased hypermetabolic activity.
intedanib targets vascular endothelial growth factor receptor (VEGFR), fibroblast growth factor receptor (FGFR) and also platelet derived growth factor receptor (PDGFR), so the spectrum of inhibition is wider.
do brain MRI regularly because if you catch a brain lesion early, you can zap it easily with GammaKnife
EGFR19 T790M EGFR19的情况，开始用Gefitinib had good response，后发现brain & leptomeningeal metastasis（脑脊柱），用RT治疗两个 intra-axial brain metastasis 但不是全脑放疗，PET扫描发现multiple bone metastasis。停止Osimertinib 开始脉冲tarceva 600mg twice weekly，加上Bevasizumab (Avastin) 900mg (15mg/kg).。had good response。
MET amplification. This seems to be a common resistance mechanism in the brain for many patients with EGFR.
PTEN mutations found on the Guardant report give us a clue: maybe these are the reason for resistance and the AKT-mTOR pathway is activated as a result.
有加倍Tagrisso 之后没有new brian met出现的情况（之后还对已有的进展的brian met进行了Gamma Knife treatment t），有brian met不意味着progression。
软脑膜转yi leptomeningeal metastases that the standard treatment for lepto is radiation, or -in the case of EGFR patients- pulsed erlotinib or double dose osimertinib.
some oncologists recommend intrathecal chemo and whole brain radiation. Some other oncologists recommend WBR plus either gemcitabine or paclitaxel, which can cross the blood-brain barrier, once it is disrupted by radiation. Apparently the co-administration of radiation and gemcitabine (or paclitaxel) allows the chemo drug to reach tumours within the CNS.
（XL）Cabozantinib in Patients With RET Fusion-Positive Advanced Non-Small Cell Lung Cancer and Those With Other Genotypes: ROS1 or NTRK Fusions or Increased MET or AXL Activity
显身卡
