exon 19 duplication . what treatment - 1294431

Sat, 05/19/2018 - 08:11

Good dat. Wife diagnose with stage 4 lung cancer last october. done targeted treatment with tagrisso from 07 nov 2017, due to egfr exon 19 duplication. during 1st month tumour shrink but not significant and stop taking tagrisso since 20 march this year as doctor advice tumour is immune to the treatment. suggest go for chemo but wife afraid and went for a natural healing process. last pet scan on 14 may 2018 and tumour grows with met to bones, liver and kidney. What shud be the next course of action. Thank you

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Hi simonz,

Welcome to GRACE. I'm sorry to hear of the progression of your wife's cancer. Although we can't directly advise you which particular treatment to choose, we can provide some thoughts about the factors that you and your wife might consider in making that decision.

First, it's important to note that although every patient hopes that their initial treatment will produce major shrinkage, with stage IV lung cancer that is often not possible. But a treatment may keep the cancer from growing further, an outcome we call "stable disease", which is a good (even if not the best) result for metastatic lung cancer.What is not clear from your post is whether your wife's cancer, after the initial shrinkage on Tagrisso, continued to grow significantly. If so, there was certainly no reason to continue Tagrisso. But if the disease was stable, then continuing Tagrisso until meaningful progression was seen would have been a reasonable option. A well-tolerated targeted therapy such as Tagrisso is often continued even in the face of slow progression.

One of the options for treatment of metastatic lung cancer is immunotherapy, but clinical trials have shown that the response rate for patients with activating EGFR mutations is quite low. As a result, most oncologists in this situation would favor standard chemotherapy. While chemo can produce troublesome side effects, in recent years less toxic chemo agents have been developed, and the ability to keep treatment side effects under control has greatly improved. One of those recent drugs for non-squamous lung cancer is Alimta (pemetrexed), which many doctors feel is the best-tolerated therapy for most patients.

I hope that your wife can have a good discussion with her oncologist and select a treatment plan with which she is comfortable. In addition, when a patient reaches a decision point such as this, a second opinion with another oncologist is often a good choice.

Best to you and your wife.

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