Joan Fong

First post: Nov 14, 2013 Latest post: Oct 19, 2017
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"After I came back from a trip on October 3rd, 2013, I found it extremely painful to walk.  I didn't know it at the time, but the pain was due to a bone tumor that had caused a hairline hip fracture.  The pain was further magnified by an unrelated cough that I had developed.  When I initially went to the doctor, I was given medication for the cough and pain.  The x-rays did not indicate anything broken or arthritis.  In my mind, that was good news.  Later, the cough stopped, but not the hip pain.  Walking continued to be extremely difficult.  I saw the orthopedic doctor.  When the cortisone shot did not alleviate the pain, I went in for the MRI on Monday, 10/21.  The MRI revealed a disturbing picture with the bones.  On Wednesday, 10/23, I had a CT scan to find the primary source of the problem.  The next day, Thursday, 10/24, my doctor confirmed that there was a growth in my lung.  So the journey began.

On Tuesday 10/29, I had a PET scan and Wednesday 10/30, I had a bone biopsy.  Those test confirmed that I had Stage 4 lung cancer, as it had spread to the bone and to the lymph nodes.  I met with the oncologist on Monday, 11/4.  This is when I found out about the hairline fracture to my hip that was caused by the bone tumor.  Radiation therapy would be given to shrink or eradicate that bone tumor so that the regular bone could regenerate, allowing me to walk normally later.  In the meantime, I need to limit usage of my left leg to avoid further fracturing.  So, wheelchair, crutches, and walker for a while.  Ten days of radiation therapy from 11/6 - 11/19 (tel:11/6 - 11/19).  So far, so good.  

We are awaiting the results of the genetic testing.  If I have this genetic mutation that is found in Asian women who never smoked with lung cancer, I can be treated with a drug, Tarceva, instead of chemo, as the first line of defense.  I'm praying that I have this mutation because the drug is less harsh to the body and it can provide a longer life expectancy.  

This has been a very hard diagnosis to swallow.  I am grateful for my family and friends who have been so supportive with love and encouragement.  God has been with me each step of the way to provide me with the strength to carry on.  I am not fearful because I am assured of my eternal destiny.  I am so grateful for Ron, who has cared for me so well.  I am so blessed!  I hope to make the most of my time to enjoy my friends and to celebrate life!   /s/ Joan Fong November 2013

***** UPDATED 8/4/2017 *****
Diagnosed October 2013 with Stage IV lung cancer, inoperable and incurable as a 56 yo Asian Never Smoker 
dx 10/2013 with Stage IV NSCLC EGFR exon 19 with mets in lung, hip, pelvis and spine

In the 45 months since then, life has been good living with cancer, not dying from cancer. The lung cancer invisible war has ebbed and flowed with battles fought in the lungs, hips, pelvis, spine, liver, lymph nodes, shoulders, ribs and brain.  Joan passed onto glory July 29 after doing 15 different lines of treatment, dying of lung cancer causing liver failure. Memorial Service Aug 30. Interment Sept 1st. Rejoice in the Lord Always! Again I say rejoice, is Joan's favorite Bible verse.  May you rejoice too in this life compressed!

- Plan A - RADIATION palliative fix of the hip -10 rounds radiation Nov 2013. Hip naturally mends. Walking Jan 2014
- Plan B - TARGETED THERAPY 1st line of therapy Nov 2013-Sept 2014 - targeted therapy using daily oral pill 1st Gen TKI inhibitor Tarceva (Erlotinib). Joan is EGFR exon 19 del positive. * Responsive to treatment with initial shrinkage of 75% in first 90 days * Progression June 2014 (8 months)   * 
**** MILESTONE ***  8 MONTH SURVIVAL JUNE 2014!!!!   
      MEDIAN SURVIVAL ANTICIPATED 8 MONTHS.  BEAT THE MEDIAN   * BIOPSY TO ANALYZE PROGRESSION June, and then again in July 2014.  No actionable mutation therapies discovered.
- Plan C - CLINICAL TRIAL #1 - 2nd line of therapy Sept 2014- Jan 2015- clinical trial of INC280 &Tarceva * INC 280 is for cMET overexpression. * Responsiveness mixed * Progression Jan 2015     
- Plan D - SYSTEMATIC CHEMOTHERAPY - 3rd line of therapy Jan 2015-August 2015 - targeted chemo * Carboplatin/ Avastin/ Alimta 6 rounds, then maintenance Avastin/Alimta * * Responsive with reduced activity and size after two cycles     *   Progression August 2015   
- Plan E - TARGETED THERAPY #3 - 4th line of therapy August 2015 - June 2016 - 2nd generation TKI inhibitor Afatinib daily oral pill & chemo infusion of Cetuximab every two weeks * Responsive as stable *  Progression Feb 2016 *     * Liquid biopsy finds T790M, which is an actionable mutation

**** MILESTONE  **** 24 MONTH SURVIVAL NOV 2015!!!!

- Plan F - RADIATION Cyberknife new growth in the T8 spine March 2016 
- Plan G - RADIATION Cyberknife new lesions in the liver (3) and the T8 spine March-April 2016 * Gold seed fiduciaries implanted into liver. ** PREPARING FOR CLINICAL TRIAL DISCOVERED 13 BRAIN METS APRIL 2016. Asymptomatic.
- Plan H - RADIATION Whole brain radiation therapy May 2016 * ten rounds treatment

- Plan I - CLINICAL TRIAL #2 - 5th line therapy * June 2016 to Sept. 2016 *  Phase 1 clinical trial AZD9291 osimertinib (Tagrisso) and necitumumab (Portrazza)  Stable to slightly smaller at the end of cycle 2 (six weeks of treatment)  end of cycle 4 (12 weeks), lung still stable, but growth detected in liver.  PET confirms cancer activity in the liver and also in the sacrum as well as in the lung
Plan J - CLINICAL TRIAL #3 - 6th line of therapy * October 13, 2016 started new clinical trial testing Onalespib (AT13387 a Heat Shock Protein 90 inhibitor) with Erlotinib (Tarceva).  CT shows Right Upper Lung primary is almost as large as when first diagnosed having grown 50% in six weeks. CT Scan at the end of eight weeks shows RUL primary stable, but progression in the liver. PET shows heightened activity in the bones. Progression December 2016 * Back MRI 12/8/16 shows Cancer growth in T5-T11 with fears of spinal cord compression T7-T9
             MILESTONE **** 36 MONTH SURVIVAL NOV 2016!!!!
             OVER 90% DON'T SURVIVE 36 MONTHS.  BEAT THE AVERAGE.  5-year SURVIVAL less than 5%

Plan K * RADIATION - Ten rounds of external beam radiation to the T4-T12 (30Gy) December 2016
Plan L * SYSTEMATIC CHEMOTHERAPY - Paclitaxel (Taxol ®) and carboplatin (also known as Taxol/Carbo) 12/30/16 – 03/17 * PROGRESSION March 2017   Remote Second Opinion April 2017 concur trial or experiment.
Plan M * May 2017 - Restart Tagrisso while try to get into clinical trial ABBV-399 Phase 1 clinical trial * delay entry due to discovery brain mets and low platelets.

Plan N * Nuke 13 brain mets May 2017 with SBRT * platelets too low to get into trial

Plan O * Opdivo (Nivolumab) Immunotherapy June * Liver failing end June. 

Plan P * Palliative Care * entered hospice Saturday July 22. Passed onto glory July 29, 2017

Plan Q * Live the Quintessential Life  
***** UPDATED 09/17/17 *****
11/13 - 9/14 Tarceva * Progression found in June
9/14-1/15 Clinical trial NCT01911507 INC280 and Tarceva * Progression found in January
1/15-8/15 Carboplatin with Alimta/Avastin (6 cycles and then 4 cycles maintenance)  * Progression found in August
8/15-4/16 Afatinib* Progression found in Feb 16 * Liquid biopsy finds T790M
3/16- SBRT Cyberknife metastasizes in T8 spine
4/16 - SBRT Cyberknife 3 met spots in liver 
5/16 - Whole Brain Radiation 13 mets in brain * discovered by trial baseline tests * asymptomatic 
6/16 - 9/16 * Clinical trial NCT02496663 Osimertinib and  Necitumumab * progression in liver/bones 9/16. Liquid biopsy T790M suppressed by Osimertinib, but new PIK3CA mutation discovered.
10/16 * 12/16 Clinical trial NCT02535338 Onalespib (AT13387 a Heat Shock Protein 90 inhibitor) with Erlotinib (Tarceva) * progression found in liver and heightened activity in the bones.  Stable in RUL. * Spinal MRI reveals T5-T11 active with T7-T9 spinal cord compression concerns
12/16 * External Beam Radiation of T5-T11 * 30Gy
12/16 - 3/17 * Paclitaxel (Taxol ®) & carboplatin started 12/30/16 * Progression March 2017
3/17 * in search of next steps. ABBY 399 or SOC?
4/17 * discovered brain met due to clinical trial MRI. 
5/17 * expanded to 13 brain mets.  Cyberknife * Interim Tagrisso restart
6/17-07/17 * Opdivo * liver failure * Hospice * Passed onto glory

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