Treatment of lung adenocarcinoma

At age 85 I've just been diagnosed with Stage 4 metastisized NSCLC lung cancer (PET scan showed it also in adrenal glands and lymph nodes). The lymph node biopsy showed MET exon 14 and I'm about to start the targeted Rx Tepotinib (TEPMETKO). However, I was offered a clinical trial that combines Tepotinib with Ramucirumab. IF I start Tepotinib alone, I won't be allowed in the trial. So confused. Some people say "if there's a trial that's specifically for you, you are crazy not to do it." I've declined so far (but haven't started any Rx yet) as I think at my age, dealing with the probable complications of 1 drug is enough. My objective is to stop the cancer from spreading, if possible, but to have a somewhat decent life too. Thoughts? Experience?

At age 85 I've just been diagnosed with Stage 4 metastisized NSCLC lung cancer (PET scan showed it also in adrenal glands and lymph nodes). The lymph node biopsy showed MET exon 14 and I'm about to start the targeted Rx Tepotinib (TEPMETKO). However, I was offered a clinical trial that combines Tepotinib with Ramucirumab. IF I start Tepotinib alone, I won't be allowed in the trial. So confused. Some people say "if there's a trial that's specifically for you, you are crazy not to do it." I've declined so far (but haven't started any Rx yet) as I think at my age, dealing with the probable complications of 1 drug is enough. My objective is to stop the cancer from spreading, if possible, but to have a somewhat decent life too. Thoughts? Experience?

@mangolinda8191, These decisions are difficult at any age. Knowing how strong you are and what other heath conditions you have will all come into play. Your oncologist is likely best to know what you may be able to handle. We have had other members mention tempmetko, and as with most of these cancer medications, there have been observed side effects.
Here's a link to a post from @hatterasj10202,
https://connect.mayoclinic.org/discussion/therapy-for-metx14skipping-altetation/
Do you have someone that has been going to appointments with you? Are they able to help in the decision making process? Sometimes I find it helpful to talk through the options.

@tongxiaozhi there is research showing that patients like your mom that do both chemotherapy and osimertinib have a better/longer response. that said, chemotherapy has more difficult side effects. it's a case where you have to balance quality/quantity of life and consider your mom's overall health and priorities.
https://www.nejm.org/doi/full/10.1056/NEJMoa2306434

@tongxiaozhi, I started taking Tagrisso after my lung cancer metastasized to my brain. My doctors surgically removed the cyst, and then I had four rounds of targeted radiation. A month after the radiation, I started taking Tagrisso alone in December 2020.

I did not have chemotherapy because chemotherapy does not cross the blood-brain barrier. However, since then, the Flaura 2 Phase III study has shown that the combination of Tagrisso and chemotherapy improves both progression-free survival (PFS) and overall survival (OS) compared to Tagrisso alone, https://www.ilcn.org/final-flaura2-os-data-show-osimertinib-plus-chemo-offers-benefit-compared-with-monotherapy/. But your oncologist will take into account your mother's age and overall health before prescribing chemotherapy. These decisions are never as simple as they look.

Your mother is lucky to have a child that is doing all this research on her behalf. I wish both of you all the best.

Matthew

@lls8000 Thank you. My husband has gone to appointments with me and I have a doctor-friend who's happy to talk it through. I keep thinking I SHOULD do the clinical trial and tomorrow is probably the very last day that I could, theoretically, be eligible.