Dear Friends,
I wondered if you'd have a few minutes to share your thoughts with me. Hopefully, I have a few weeks to make a decision on my next course of action/medicine. Here's a little background info:
- I'm 42 years old
- Married with 6 children ages 14 down to 5
- Diagnosed with Stage IV Adenocarcinoma LC in March 2015
- EGFR Positive, T790M Positive, Exon 19
- Extensive Metasteses to the brain, bones (ribs, spine, femur, etc), lymphatic system.
- "Inumerable nodules" in the lungs, scattered throughout all 5 lobes
- First-Line Treatment: Tarceva worked brilliantly for 7 months, producing a near-total response. All noticable signs of cancer were gone within 6 weeks. After 7 months, progression began in the lungs, bones and brain again.
- Second-Line Treatment: Tagrisso. Worked well for 7 months. Response wasn't as dramatic as with Tarceva. But it was still extremely effective. My brain mets cleared (and are still gone), bones show extensive healing, and lungs were dramatically improved. No new mets anywhere
- Last week--at the 7-month mark on Tagrisso--my scans showed progression in my lungs only. Brain and bones are still clear.
- I'm mostly asymptomatic. Energy level is decent. My breathing isn't perfect but it is good enough. No noticable symptoms except for a little shortness of breath (especially in the mornings) which i've had for most of the time I've been on Tagrisso
My questions are these. My oncologist recommends Chemo for my 3rd round of treatment. He recommends Pemetrexid (Alimta) and Carboplatin. Do you agree with this? I would like to preserve my ability to work full-time as I am doing now. And I'd like to keep my ability to remain an active husband and father as long as possible. In your experience, how severe are the side effects of Pemetrexid (Alimta) and Carboplatin?
If you believe I should look into something different, please share.
Also, I'm hesitant to abandon Tagrisso yet. Do you think I'm foolish to wait for my next scans?
Reply # - July 7, 2016, 02:55 PM
Hi,
Hi,
Welcome to GRACE. I'm sorry to hear that you have progressed on Tagrisso. However, one of the first questions to ask is: How much progression is there? Especially with targeted therapies which are well-tolerated, there is a reluctance to abandon a particular agent in the face of slow, limited progression. You haven't really stated how much progression there is in the lung, but if the progression there is small and that is the only location that has grown, it may be reasonable to continue Tagrisso and get the maximum benefit from the drug. Dr. West is fond of saying that "bad brakes are better than no brakes" - if Tagrisso is keeping progression slow, that may be better than switching to another regimen which may or may not be as effective.
Carboplatin/Alimta tends to be one of the best-tolerated platinum combination therapies for lung cancer, and Alimta as a single agent is often well-tolerated by many patients for an extended period of time when used as "maintenance" therapy after 4-6 rounds of the platinum doublet. Side effects such as nausea tend to be well-managed with medication.
There's no wrong choice here, but since the pace of development of lung cancer treatments has increased in recent years, there's good reason to get everything you can from each drug so that you can benefit as new agents become available.
Good luck with treatment either way.
JimC
Forum moderator
Reply # - July 12, 2016, 08:26 AM
Jim,
Jim,
Thank you very much for your reply. It confirms the feelings I've had regarding my current situation. In answer to your question. My progression in the lungs is minimal. There are approximately 5 new opacities, but it's possible those opacities might be remnants of some Pulmonary Embolisms I had 3 months ago. In other words, they might not be cancer progression.
Could I ask you (and any others who'd care to chime in) one additional question? I've heard of patients taking higher doses of Tagrisso. As far as I can tell, this isn't exclusively for those with Leptomeningeal Disease. What is your opinion on higher doses of Tagrisso (120 and 160mg). Since Tagrisso is working so well in my brain and the rest of my body, I wonder if a higher dose might be what is needed to reverse the potential progression in the lungs?
Best regards,
Aaron
Reply # - July 12, 2016, 11:54 AM
Hi Aaron,
Hi Aaron,
There's really no way to know. Standard dosages are determined in early clinical trials at the maximum amount that is tolerated by most patients while still showing efficacy. So it's possible that a higher dose could be more effective, but raising the dose could just add side effects without additional benefit. In addition, it would be unlikely that insurance would pay for it.
JimC
Forum moderator