Viability of biopsy
after a year and a half first on THP and then just HP I have partial progression- one of the lesions increased a lot in uptake, a few lymph nodes increased in uptake and a couple of new avid nodes popped up. The lesion is 1 cm in the upper lobe of the left lung. Lymph nodes are in the right supraclavicular fossa (4mm), right superior mediastinum (6 mm) , subcarinal node (7 mm). One of the hilar nodes has increase uptake as well but not to the level of those listen above (about 4 while those listed above are about 7) so although it may be most accessible for biopsy it may not be that representative and I do not know it's size.
While the next line of treatment would be Kadzyla I wondered whether a new biopsy may be beneficial - may be my hormone status changed u other mutations present..
Do those lesions sound like accessible for it?
Shall talk to oncologist on Tuesday.
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Not sure about your accessibility question, anotherone, but I do hope you get answers and get a good plan in place. I think I’d want a biopsy especially on the new nodes.
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anotherone, just want to point you to this study about loss of biomarkers. It appears from this study that loss of HER2 is not terribly common ( looks like <10% in Table 3) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC67693...
If you have options for Foundation One or Caris though that might be good to do it as it might identify other mutations. But not every area/insurance will pay for the tests. I'm sorry not sure about locations being amenable for a biopsy. Mine is in the middle lobe of the left lung and was biopsied twice - easy peasy under CT.
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Thank you , moth and olma
I do not think my insurance would pay for test - the standard of care is Kadcyla next so I guess they would say if the test will not influence treatment then it should not be done.
I was trying to figure out for myself whether it would be worthwhile paying for it myself.
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Anotherone,
You should look up Foundation One and Tempus and any others that do genomic testing. If your insurance in the UK will pay for a biopsy, then you could possibly get some assistance from the companies themselves for the actual genomic testing. In the US, Foundation and Tempus at least cap the cost of their testing if you meet their financial requirements.
Here, at least, the tests not only show possible actionable mutations but possible clinical trials that you could qualify for.
Good luck.
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Anotherone, if they can do a biopsy easily then it’s definitely worthwhile to do the biopsy. The problem about lung nodules is that most of time they cannot be easily biopsied. I have progressions in my lung nodules on three separate occasions and none can be biopsied unfortunately. I had to have a VATS thoracic surgery to get a biopsy when I was first diagnosed.
Moth, how big was your lung nodule when it’s biopsied? All mine are under 1 cm and my IR said no way.
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figtree, oh my lung gunk was big. My first tumor in Feb 2020 extended essentially the entire width of the lung and was over 5 cm tall. It was huge - but grew so fast that it outgrew its blood supply & the whole thing was necrotic. I grow weird fast & stupid tumors.
Then in Nov 2020, in the scar tissue of that mess, something fast again grew in it (I was scanning q 8 weeks then) - went from nothing to I think it was over 2cm by the biopsy/radiation treatment. I wasn't ever told what my IR's cutoff for grabbing a sample was though.
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thank you all for posting.
My oncologist suggested biopsy herself ; she said with a surgeon we will try to arrange transcutaneous of a clavicle lymph node under ultrasound and on another hand will contact thoracic people to check with them what is the easiest way to get it from my chest if we do not manage that lymph node.
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