
" Hi Alex, the MRI results are amazing! My oncologist even phoned me – unusual. He’s so pleased. All thanks to you. If it wasn’t for you, I would not be here. I’m over the moon." – Lilian
This case study was prepared by our lead cancer expert and Chief Research Director, Alex Rolland. Alex has helped prepare treatment plans for oncologists at the Mayo Clinic, MD Anderson, and Johns Hopkins, as well as cancer centres and hospitals worldwide. He is one of the world’s leading minds in Precision Cancer Medicine and oncogenomics.
Lilian is a patient with EGFR mutated NSCLC who had stopped responding to Taggriso.
Previously, her oncologist had prescribed Tagrisso based on tumor DNA sequencing, which detected two EGFR mutations (EGFR G719S and L861Q). However, she had stopped responding and developed a brain metastasis.
We reviewed her DNA report and did an advanced new RNA expression test that looked at the expression of 22,000 genes. While DNA testing is important to identify DNA alterations that drive the cancer, only RNA expression testing can tell us if these alterations are actually driving the cancer.
This is because cancers use both DNA mutations and epigenetics (differential activation/silencing of genes in order to create the myriad of cell types that make up our bodies). Our expression analysis showed that EGFR was over-expressed by 17.9-fold and concluded that Osimertinib was not doing its job!
From our experience, we have found that each drug has a very unique mutation profile and that often gets missed. Lilian’s tumor DNA sequencing report identified the presence of both an Osimertinib sensitive EGFR L861Q mutation and an Osimertinib resistant EGFR G719S mutation.
Lung cancers that harbour the EGFR G719S mutation have a lower sensitivity to third-generation TKIs than to second-generation TKIs – and clinical trial data shows Afatinib is more effective for cases with uncommon mutations, especially EGFR G719S and L861Q (Yang et al., 2015). So Lilian’s oncologist prescribed Afatinib.
We then conducted blood based circulating tumour DNA testing(ctDNA)which showed that her EGFR L861Q was only slightly elevated (by 1.5%) so by deduction we assumed the EGFR G719S was driving the growth and that is why we urged the switch to Afatinib.
Additionally, since Lilian had radiation for her brain tumour, we suggested adding Avastin.
The addition of Avastin was two-fold. First, it is synergistic with Afatinib in NSCLC and increases overall responses, progression free survival, and overall survival rates when combined with Afatinib. Secondly, it reduces nonvascular permeability in RT brain necrosis and alleviates edema.
Lilian recently shared her latest scan showing significant reduction of her cancer and a resolution of her brain metastasis and edema.
In other words, she is now free of brain tumors and is in remission in under less than 3 months!
These results are the rule, not the exception, when you apply Precision Cancer Medicine properly to your cancer care.
And our team is here to help you do just that.
We can help almost anyone with cancer – even if it’s stage 4, and even if you’ve already been told there are no more options left for you. As long as a patient is well enough to tolerate targeted therapies (which are often far better tolerated than standard treatment), we can help.
Our interdisciplinary team of experts helps cancer patients by applying Precision Cancer Medicine to their cancer care. This means we use the most advanced medical science, newest targeted treatments, and leading-edge technologies to help patients maintain the highest quality of life possible and enter remission asap.
If you’d like to be getting results like Lilian’s, register for a Precision Second Opinion consultation with
Alex today:
Register for your Precision Second Opinion with cancer
expert, Alex Rolland
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