T790M finally detected

Hi and welcome to Grace. There's not always enough mutation to be caught in a sample of blood or a tissue biopsy.
Today, tagrisso is given as first line treatment and (at least often) given 2nd line no matter t790m detection especially since it is not always caught in testing.
Let me ask one of our faculty to comment further and/or correct me.
Thanks for your question and best of luck,
Janine

JojoS,

It is important to note that no test is perfectly sensitive at detecting a target all the time, and this is definitely true for a "liquid biopsy", doing next generation sequencing from plasma. The technology for these tests has been improving over time, but it's less reliable in patients with a relatively low volume of disease, because it requires the ability to detect shed DNA from tumor cells. Because of this, in patients with only limited disease in the chest, it's notoriously less sensitive than it is for patients with more disease visible on scans, which correlates with more circulating tumor DNA to detect.

With regard to your question of other mutations detected, this is not yet extremely well established, but there are studies that have indicated that the duration of benefit from drugs like Tagrisso tend to be shorter in patients who also have other mutations like TP53 and/or other mutations present. However, we still treat and hope for the best result...it doesn't change our management plans.

Good luck.

-Dr. West

That is very exciting to hear that you can give tagrisso a chance. I don't know for sure but I feel that Grace can be at least partially credited for my husband's cancer outcome. Without a doubt, Grace helped me keep my sanity by allowing me enough insight to know he was getting the treatments best for him.

If I may point out a mistake and common misconception...Palliative care is comfort care given to anyone in need of comfort. Your docs were probably suggesting "hospice care" which is a type of palliative care but without life-prolonging, anti-cancer treatment. The terms are relatively new to medicine and have undergone some definition changes throughout the years. Always welcome palliative care, whether it's a slice of cake or acupuncture. :)

I hope you do well with tagrisso. If you need help finding anything let me know.
Best of luck,
Janine

Oh JoJo I am so sorry. Deciding to stop treatment has got to be one of the bitterest options yet it's important to understand what that conversation would be like with the oncology team. So I'm glad you've shared this part of the cancer journey with us. We, at least in the US don't talk about death and dying and are taught to fear it unfortunately we are not shown how to approach it or talk about it. Hence we are slow to invite hospice care into the norm. Palliative and hospice care teams have end-of-life care experiences that go far beyond what most of us possess.

I wish your person and you peace,
Janine

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