I've been on Tagrisso since July 2017. I had great initial response with all visible cancer shrinking to the point of no longer being detected except for one solitary nodule that shrank from 1.8 cm to .6 cm. In August 2018, a scan showed the nodule had doubled in size in 10 weeks and a met appeared on a rib. The nodule was radiatied. Scans Dec 2018 showed the nodule had again reduced to about .5 cm, the rib met remained stable and another rib met appeared to be developing.
My doctors have said they will radiate the rib mets when the pain increases, but nothing else. A growing lung nodule and 2 new rib mets seem indicative of progression to me, but no concerns have been raised. At what point should I be expecting my team to be discussing further testing (like a PET scan or biopsy?) and/or adjusting my treatment?
I am having increased pain but am trying to manage until my next scan which is scheduled March 2019. I am unsure how concerned I should be about the possibility of progression or if I should feel greater urgency about addressing the rib pain.
Tue, 01/22/2019 - 07:31
I'm sorry to hear of the pain you are experiencing, as well as the new scan findings. If you're having a great deal of pain, there's not much reason to delay talking to your doctors about radiating the rib met. Treatment for bone metastases tends to run independently from the systemic treatment, as it is intended to palliate symptoms or prevent fractures.
With a well-tolerated, generally effective targeted therapy in place, oncologists often continue that therapy in the face of slow progression, especially when that progression appears in only one or two (or possibly three) locations. Local treatment such as radiation is used to control the cancer in the area of progression. If the pace of progression becomes faster, then a change in systemic treatment may be warranted. The question of whether to get a PET scan now or wait for further signs of more rapid/significant progression is another topic you could discuss with your doctor.
I hope that you can get relief from your pain soon.
Jim C Forum Moderator