Transition from Tarceva to Tagrisso Chemotherapy

Hi szhang, I'm so sorry to know that your father is in this position.

It's not known if your father would have progressed in the same way whether he stayed on tarceva or moved to tagrisso (it's one of the difficult parts of cancer, sometimes you will just never know and for that I'm sorry). Anytime you're at a transition point like he is in now and before starting a new treatment is the best time to see a 2nd opinion onc(keep in mind a 2nd doesn't mean you change oncologist but just getting the opinion from a specialist who sees nothing but people like your dad every day and has access to the most up to date thoughts, practices, and trials). On the other hand, if someone is declining quickly it may be necessary to move right into treatment that will get the best results asap with the least side effects. Today the standard practice is carbo/alimta (carbo is prob as good as cisplatin without as many side effects same for alimta compared to a taxane). Adding tarceva would likely add side effects without much expectation of adding benefit. People sometimes find benefit from going back to tarceva after a break so after alimta is no longer appropriate is a good time to try tarceva again.  Unfortunately there isn't a 4 gen in place.  But there may be promising trials available that are appropriate for your dad. 

Please keep us posted on what and how your father does.  Let us know if you have more questions. I hope this helps and I hope he is feeling better soon.

All the best,

Janine

We're glad to help. The link in my previous post (at "2nd opinion". sorry I didn't even point it out) is a most excellent article to answer your questions so I won't even try to paraphrase any of it, it's probably my favorite post on Grace and the post I most often share. Absolutely respond here with follow-up questions after you have a chance to take it in. I would ask why and what data suggests continuing tagrisso while taking chemo doublet. There may be a good reason but as I said before it typically adds toxicity without much benefit.

Thanks for keeping us posted. I know how stressful this time of limbo is. I hope your father is lucky to have very few side effects, it's not uncommon and it's pretty common for people with egfr mutations to do very well on this doublet and with alimta alone.
Let us know whether he gets an appointment with Mayo.
Telemed 2nds are becoming more of an option since covid. Dr. West our founder and board president is a real fan of them.

Hi szhang,

Good to hear that the first infusion went well. As far as nausea, that often kicks in a couple days after infusion. Based on information provided by her chemo nurse, my wife found that it was better to prevent nausea than to try to knock it down after it sets in. With that in mind, she began to take her prescription anti-nausea medication on day two, before becoming significantly nauseous, and that seemed to be effective. She also ate more frequent, smaller meals rather than consuming larger amounts at a single sitting, avoiding foods that were more likely to cause nausea because they were tough to digest or too spicy. Though it's recommended to try to eat a well-balanced healthy diet, at times patients receiving chemo can have reduced appetite and it can become more important to find a way to take in sufficient calories even if that means consuming foods which may be considered less-than-ideal from a nutritional point of view. It also helped to get outside in the fresh air for at least a short walk, as tolerated. Your father's treatment center may have a cancer nutritionist on staff who may be able to provide helpful suggestions.

These techniques minimized greatly the side effects of the chemo, although in the middle days of the three week chemo cycle, as blood counts dropped somewhat, fatigue did set in. As blood counts rebounded in the second half of the cycle, fatigue lessened. So it's good to keep that in mind and adjust activity levels accordingly.

As far as supplements, claims are made for a variety of them, but evidence is often quite slim. In any event, any supplement under consideration should be discussed with his oncologist, in order to prevent possible negative interactions with treatment.

I hope he continues to feel well and gets good results from carbo/alimta.

Jim C Forum Moderator

Hi szhang,

Thank you for updating. I'm sorry your dad has had to put off his 2nd infusion. It's not all that uncommon to have to postpone treatments because of low blood counts and waiting or skipping a treatment doesn't seem to have too much of an effect on a person's outcome. If carboplatin continues to be a problem it can be dropped and alimta given alone which is what would happen after 4 or 6 cycles because of its toxicity.

How was the appointment today and has he heard back from Mayo?  BTW, if a second is still on his agenda there are many other specialists on par with those at Mayo plus virtual 2nds are a growing option since covid.   

Hi, I'm so glad your dad was able to get his 2nd infusion. I meant to say earlier that Jim's suggestions are really very good. If neuropathy becomes painful which often wouldn't happen until 3rd or 4th cycle gabapentin is helpful. I put ginger in everything for nausea. Mashed potatoes are easy to eat and with butter, cream chz, etc adds a lot of calories if he has trouble eating. And if he is having trouble eating and eats pork, adding bacon or bacon grease to almost anything made food more palatable for my husband.
Like Jim said nausea pills before nausea starts. Ensure Plus if food isn't an option. I'll add as I think about or find other tips.
I know your dad just retired and isn't used to lounging about but laying on the couch and watching tv reduces a lot of problems of fatigue.
I hope you and yours do well.

Hi szhang, I'm glad your dad has done well but I know it's stressful. 

Your dad should always speak with his oncologist when there are new or worsening symptoms. 

In its simplist terms sugar feeds cancer cells just like it feeds normal cells.  So you can starve cancer but it will also starve the rest of the person.  This article explains how the body uses carbohydrates and how that relates to cancer growth. 

If you or your dad are more comfortable with Spanish we have this Spanish language video about the sugar myth. 

This article, What is an Optimal Diet for Cancer Patients? Nutritional Goals with Cancer may be helpful.  Note that this diet is rich in carbohydrates. 

Eating a healthy diet is always important but sometimes just eating what you can becomes the most important part of the diet whether it's high carb low protein or vis versa or if it's an ensure plus, mashed potatoes and ice cream.

I hope your dad feels better.  Let us know how your dad gets along and of course ask questions as they come up. 

And take care of yourself,

Janine