Weeks 121 and 122: Radiation, liquid biopsies and more

Written by Lars Haakon Soraas

Weeks 121 and 122 in the war on lung cancer have passed. It has been two busy weeks, with focus on planning radiation of the growing lesion in the lung and considering various treatment options. On 12th December I also got my first ever scientific article published. Here is an update on the current situation and the last two weeks’ treatment and more:

  • As mentioned in the blog post from two weeks ago, the plan has been to use stereotactic radiation on the one growing lesion in Dyanne’s lower left lung. A CT scan was done to prepare for this. However, it turned out Dyanne’s stomach was in the way on the CT images. Another CT scan was needed and Dyanne was this time ordered to fast prior to the scan. This helped a bit, but it still turned out that stereotactic radiation of the lesion was not possible without also hitting part of the stomach – with potentially not so nice side effects. Furthermore, the lesion is in an area of the lung where there is lots of movement due to breathing. To reduce the risk of side effects, the radiation dose was reduced and the dose was split into four fractions instead of three. As each fraction need to happen with one day rest in between, the need for 4 fractions made it difficult to get the radiation done before Christmas (which we, needless to say, wanted). To make a long story short, the end plan (call it the least bad option of the options available) is now to do two radiation treatments before Christmas and two in the week between Christmas and New Year. Dyanne got the two first treatments on Wednesday and Friday this week. The next two will be on Wednesday and Friday next week.
  • The radiation doses she will get on each of the four days is 4.3 Gy. The relatively low dose is due to the stomach being in the way. A part of the lesion (the part which is the furthest away from the stomach) will get a somewhat higher dose (6.45 Gy x 4).
  • The trip Dyanne was supposed to have to Frankfurt last week was cancelled due to the need for doing extra the extra CT scan here in Norway.
  • As we believe, and hope, that immunotherapy and radiation can have a synergistic effect, Dyanne also did  low dose nivolumab (40 mg in total, around 0.7 mg/kg) on Monday last week. The dose is much lower than the standard dose of nivolumab (which is 3 mg/kg) and the reason for this is the risk of side effects when combining some of the drugs Dyanne is on.
  • Dyanne has been quite fatigued the last week. She has also been a bit nauseous on some evenings. We have also found she has somewhat low blood pressure, a bit low hemoglobin and eosinophilia (high eosinophil count). The eosinophilia is somewhat mysterious, but we believe it may be a side effect of the ipilimumab infusion Dyanne got in the end of September.
  • We have also done a “liquid biopsy” (a blood test that looks for DNA from cancer cells) with the lab of Dr Rosell in Barcelona (thanks Dad for driving to Sweden to send it off from inside the EU to get around stupid custom rules in Spain). They only found a very very low level of one EGFR mutation (the T790M mutation). We hope this is a sign that there is not progression in many places. We are also doing a liquid biopsy with Foundation Medicine and should get the results from this next week. This test can help understand what is going on and maybe also what trick (new genomic alteration) cancer cells have employed to become resistant to the current treatment.
  • So far we don’t have any plans to make any major changes in the other treatment Dyanne is receiving. However, we will see how the radiation goes and the results from the liquid biopsy done with Foundation Medicine.

That was a long update. Before we wish everyone a Merry Christmas, I am happy to mention that I have just gotten my first ever scientific article published. The title is Geographic variation in EGFR mutation frequency in lung adenocarcinoma may be explained by interethnic genetic variation and the article was published in the Journal of Thoracic Oncology. The article is trying to explain why EGFR mutant lung cancer is more frequent in some parts of the world than others. The main result is that this quite likely is due to genetic variation that exists between different ethnicities. Figure 1 in the article kind of sums up the main point. For those who would like to read the whole article, it can be found here. Any comments would be much appreciated.

We would like to wish everyone a Merry Christmas and a nice and peaceful holiday break. We would also like to thank everyone who has  supported us one way or the other in the year that has passed. Without the tremendous help we are continuously getting from family and friends, as well as leading doctors and researchers around the world, we would have been able to do half of what we are doing. So thank you all!

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