Connect
Effect of Tagrisso on GGOs in multifocal lung cancer
Question: Has anyone had experience with GGOs (ground glass opacities) turning solid after treatment with Tagrisso? Or any experience in general with GGOs and Tagrisso, especially in multifocal lung cancer, however the GGOs responded to Tagrisso: shrinking/disappearing; unchanged; growing? How long it took to see a response to Tagrisso?
Background: In June of 2024, I started Tagrisso to treat multiple GGOs across three remaining lobes of my lungs, some with a solid component, that had shown growth over time. The upper right and upper left lobes were removed via VAT lobectomies in 2019 and 2021, respectively. I delayed starting Tagrisso because I was asymptomatic and I wanted to delay starting a treatment to which the cancer would eventually become resistant (at the time, a median PFS (progression-free survival) of 18.9 months).
The first scan after starting Tagrisso, in September 2024, showed (1) no new lesions (which had been noted in prior scans); (2) the size of all lesions more or less stable with minor changes; (3) a notable change in appearance from a ground glass/mixed opacity to a more solid appearance. The December 2024 scan showed stability: no apparent growth or shrinkage in the now mostly solid lesions.
Because the lesions changed after starting Tagrisso, but did not change in an expected way, it is not clear that the change is necessarily a reaction to Tagrisso –or perhaps not necessarily a desirable reaction. This raises the question of how long to continue Tagrisso. My next scan is in March; we will assess after each scan.
Note: It is possible that not all lesions have the EGFR exon 21 L858R mutation. Tissue biopsies from the two lobectomies in 2019 and 2021 were positive for EGFR exon 21 L858R mutation. Five lesions sampled via a bronchoscopy in 2022 were positive for EGFR exon 21 L858R mutation or for KRAS mutations (EGFR and KRAS are mutually exclusive). A liquid biopsy was negative for circulating tumor DNA; I have read that multifocal lung cancer rarely yields a positive liquid biopsy. There is no practical way to biopsy all lesions.
Like
Helpful
HugInterested in more discussions like this? Go to the Lung Cancer Support Group.
Connect
@lijda. You've been at this for a while now, congrats on being 5+years. I'm sure you have learned a lot. The Tagrisso may be working in other areas, so it makes sense to me (a non-clinical observer) to continue with the treatment. Are you feeling ok? GGO may not be related to the cancer. Our lungs can take a long time to recover from illness and trauma.
-
Like -
Helpful -
Hug
1 ReactionI thought I had responded to this comment two days ago but can't find it. I will try again:
Thank you for your worthwhile suggestions. I certainly like your thought that GGOs might not be related to the cancer; I requested a strong course of antibiotics early in the process to see if it would have any effect on the lesions (it didn’t). All of the doctors so far (one surgeon, three oncologists, two pulmonologists, and a tumor board), based on reports and their experience, have assessed the GGOs as cancerous –certainly enough of the GGOs to work with that as an assumption.
I know that Tagrisso can protect the brain from metastases. Multifocal lung cancer, however, has a reduced risk for metastases, especially for GGO lesions. Multifocal lung cancer, again especially with GGOs, can also indicate a better prognosis than more traditional types of cancer, for example, an average 5-year survival of 85% in multifocal GG/L tumors (which were mostly part-solid) in one study. I used to receive brain MRIs with my every-three month CT scans, none of which showed brain metastases.
For me, I see the change to solidity as a wild card, especially with all of the lesions becoming solid. I don’t believe there is a standard-of-care answer for me but I had hoped to find others who had a similar experience with GGOs becoming solid after starting Tagrisso and to learn of their treatment plans.
I do feel OK, aside from the effects of losing 40% of lung capacity and side effects from Tagrisso (I am taking the lower 40 mg. dose to help manage side effects).
-
Like -
Helpful -
Hug
2 ReactionsHi Lijda, I was diagnosed with multifocal adenocarcinoma in 2023 and had a VATS RUL lobectomy. I've just been diagnosed with cancer (testing still pending) on an 8 MM nodule in the LUL. I didn't even know they would consider taking both upper lobes. How has your breathing /life changed since the 2nd lobectomy?
-
Like -
Helpful -
Hug
1 Reactionhi @balevine - is a wedge resection possible? I also have multifocal adenocarcinoma with nodules in every lobe and that is my treatment plan. I read in one your previous comments that you had 3 separate primaries at diagnosis. I did, too! I have the genetic EGFR T790M mutation, which makes it easy to develop lung cancer. Have you been tested for that?
-
Like -
Helpful -
Hug
2 Reactions@mamajite
Hi, testing is still in progress so I don't know yet about the EFGR mutation yet.
-
Like -
Helpful -
Hug
1 Reaction@balevine if you have what I do, it would have shown up on your previous biomarker testing - or if you have a liquid biopsy done.
@mamajite they didn't do any testing after my first nodule (lobe)was removed (a point of contention with me) but i believe they have the specimen and can go back and test it along with the new one. Did you have both your upper lobes removed?
@balevine I hope you can find out your biomarkers - it's so important! with multifocal lung cancer I think the chance is higher that there is a genetic risk/predisposition to developing lung cancer component.
I haven't had any surgery yet. I have so many nodules they initially thought I wasn't a candidate. I took Tagrisso for 2.5 years and had a good response, but I still have other nodules. I have an oncologist at Dana Farber now that specializes in genetic lung cancer and her team is open to removing just the problematic nodules. right now they're monitoring them until they reach the size/state that surgery is needed.
-
Like -
Helpful -
Hug
1 Reaction@balevine I actually don't remember a signifiant difference in shortness of breath after the first RUL and the second LUL. The second LUL was in March of 2021. My walking did become slower over time, and I did end up feeling some lack of confidence walking in my village; how far should I walk before I turn around so that I know I can make it home without any trouble? And, as others have noticed, humidity makes everything difficult. Recently I bought a small walking treadmill, which I love (except for the one time it threw me off when the power went off and on and off and on again). Humidity is no longer a problem. as well as hills, heat, and cold.
-
Like -
Helpful -
Hug
2 Reactions