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Emma's GOTG

Open Questions

Sharing my journey and asking for the world's expertise to help navigate complex decisions in treatment.

Current Line of Treatment

  1. Given the current response situation, how to balance treatment efficacy and side effects? Specifically when / how can we think about adjusting the treatment frequency (now 21 days / cycle with Trodelvy injected on Day 1 and 8 and Ivonescimab on Day 1)? What do we need to achieve first and also continue to observe if we want to lower the treatment frequency or dose?
  2. We want to combine systematic treatment with local treatment in order to achieve maximum efficacy and potentially prevent recurrence. We have considered radiation (including SBRT, proton therapy) and ablation. We would like to seek advice on how to best add local treatment on top of our current systematic treatment? And if it's possible to stop systematic treatment if remaining tumor sites can be eliminated with local treatment?
  3. We are preparing the design and production of neoantigen mRNA vaccines. We would like to seek clinical advice on how to combine mRNA vaccine with our current treatment. And whether we need to stop Trodelvy for a period in order to enhance T-cell immune status for the vaccine to be more effective?

Future Line of Treatment

  1. We have lined up future treatment options in the following pecking order. We would like to seek advice on any additional therapy to add to the list and advice related to questions we have below:

    1. Next line ADC
      1. DS-8201 for HER2-low
      2. EGFR/HER3
    2. Chemotherapy
      1. Platinum-based chemo (given she already used taxane in 2023)
    3. Targeted therapy
      1. PI3K inhibitor: there are some drug candidates but none designed to target p.V101L mutation. Any evidence that current inhibitors can also be effective against this mutation?
    4. CGT
      1. TIL: current issue is how to collect specimen samples
      2. TCR-T: current challenge is finding matching HLA typing
      3. CAR-T: which target?
    5. Radio-ligand therapeutics
  2. In addition to the neoantigen mRNA vaccine, is there any other technology we can leverage in order to design customized treatments based on specific protein and gene mutation profile of her cancer?