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Chemo before Tagrisso or not? Need info but where do I start?
I am having a hard time deciding if I want to do chemo before starting Tagrisso or just starting Tagrisso without doing Chemo. My oncologist shared that he would support either way. He did feel that strong Tagrisso now is slightly where he leans but also that chemo could help too.
My situation is unique. I had my ULL removed 10/5 and was Stage 1 going in to that. There was 1 lymph node they removed that was positive but cancer. It was right on the line of being considered “tier 1 or 2” in terms of its location. I was told it could be Stage 2 or 3 depending but they staged up to 3a. Also going in, there was an 8mm nodule on the right lung that was going to be watched as it was too small to biopsy.
After surgery, the tumor board agreed that the right lung was more than likely cancer, and I received 5 rounds of SBRT radiation to address it. They cannot know if it was a second primary cancer (stage 1) or related to my left lung cancer (metastic; stage 4). Good news is, it is believed cancer on the left was all removed and the right will be addressed with the radiation.
I have the right mutation to start Tagrisso. From what I was told, Standard of care for Stage 3 would be chemo then Tag. But, if I’m stage 4, it’s no chemo, just Tag.
I’m conflicted. And very overwhelmed. I just want the best shot at living a long life. And I’m tired of living this nightmare. I appreciate my oncologist leaving it up to me but I feel ill equipped to make the decision.
Any thoughts on where I should start to gather info? I’m going ahead with chemo education which is required in order to do chemo, hoping that might help steer me.
Advice/resources are welcome.
Thanks
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Good to hear your update. I would be inclined to tell him exactly what you said - you don’t feel equipped to choose and would be grateful if he could lean in and give you input he might give his sister.
That said, I’m a statistician among other worthless skills. In my world, the likelihood a mass in one lung is unrelated to that found in the other seems improbable. There’s an old saying in the diagnostic world that docs are taught:
'when you hear hoofbeats, think horses not zebras,' meaning don’t overlook the probable result.
I hope that didn’t just add to your confusion. As ever, I’m sending good Juju your way. ❤️
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3 ReactionsI did ask him what he would tell me if I was his wife. I don’t feel he answered me. He did say he leans towards starting Tag
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2 ReactionsThen that’s likely as good a lean as you’ll get. You know he has to avoid “but you told me to”… so you aren’t overly influenced and he isn’t over-reaching. But if your Dad was a doc and he said that? Only you can answer.
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2 ReactionsResults from the FLAURA2 trial have come out this year and the results provide "compelling evidence that the addition of chemotherapy to osimertinib can provide a new option for patients and clinicians that further improves outcomes compared to osimertinib alone and, as such, can further delay treatment resistance and disease progression." There are several articles about this on the internet; here is one of them:
https://www.cancernetwork.com/view/osimertinib-chemo-improves-survival-vs-osimertinib-in-egfr-nsclc
The combination has been granted priority review by the FDA:
https://www.astrazeneca-us.com/media/press-releases/2023/tagrisso-plus-chemotherapy-granted-priority-review-in-the-us-for-patients-with-egfr-mutated-advanced-lung-cancer-10162023.html
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4 ReactionsHello @dragonspark
I don’t know if this is going to help in your decision making however in my situation (stage 2a tumor, lower right lobectomy) my oncologist suggested 4 rounds of chemo (cisplatin and permextred) followed by Tagrisso as giving slightly better chances of overall success. The chemo isn’t fun and did have some significant side effects (some kidney damage which resulted in only 3 rounds being completed and some hearing loss). However if the chemo truly helps my ultimate outcome then I’m OK with that decision.
Your situation is certainly different and I wish you luck in which ever decision you go with.
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6 ReactionsThank you! I think those are indicating taking Tagrisso at the same time as chemo. That want the option presented but perhaps I should ask about that.
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2 ReactionsThank you for sharing. Interesting that my oncologist thinks the other way for me. It might be because of the unique situation and unknown of the right lung.
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1 Reaction@dragonspark, these decisions can be so difficult. We're not doctors, and often there isn't one clear path, because both are good options. I try to remind myself to be thankful that there are still options. Ten years ago, there may not have been choices.
Take into account the side effects of the Tagrisso. Generally, the TKIs (tyrosine kinase inhibitors) are well tolerated, but each medication has its own list of side effects, and prior liver or kidney issues may impact how well you will tolerate the medication too. Many people take Tagrisso with minimal side effects.
If you take the Tagrisso, does your doctor intend on keeping you on that medication until it is no longer effective? That would generally be the path of a stage IV patient. Also, you may want to make sure your insurance will cover the drug long term if you are not classified as stage IV.
If you do the chemo and Tagrisso combination, would your oncologist plan to discontinue the Tagrisso after a certain number of years? As @lijda pointed out, there are recently published studies to support the combination, so that's encouraging news.
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4 ReactionsWas your hearing loss and kidney damage resolved after stopping chemo?
The hearing loss is permanent (I now wear hearing aids). The kidney impact has stabilized and has not caused any noticeable effects…..just something that they wanted to closely monitor. My elevated creatinine levels may be the result of the Tagrisso as well. Chemo also can cause anemia (frequently) but in my case it did bounce back after a few months. Hope this helps.