4 ms·

My mother in law has stage 4 lung cancer. Tagrisso is extending her life. The cancer has been shrinking since going on it with few side effects. Unfortunately

My mother in law has stage 4 lung cancer. Tagrisso is extending her life. The cancer has been shrinking since going on it with few side effects. Unfortunately stage 4 cannot be cured, and at some point tagrisso stops working. My understanding is the cancer mutates and eventually develops resistance. Then she will go on chemo and her quality of life will go down. I am thankful for modern medicine that we get some extra time with her.

dangwhy 3y ago
My father is in this situation with prostate cancer. First line therapies have stopped working and now its on to chemo. I am hoping chemo won't damage him too much. There are also radioligand therapies like lutetium 177 but they haven't been sequenced on chemo naive patients yet. So soc is chemo first.
- haldujai 3y ago
  I wasn’t involved in this study but the cancer center I just left was one of the sites for the upfront Lu177 vs chemotherapy trial. Speaking casually with the physician involved recently he said the results weren’t promising thus far. I don’t think this is published yet and I’m not familiar with prostate ca treatment literature so take this with a grain of salt.
  - dangwhy 3y ago
    my father is in india where they've been giving lu177 ( and others) before chemo for quite a while ( other countries being germany and australia ) . Forums are awash with 'success stories' . There are many clinical trials currently in US and canada. Some have published results showing 'non inferiority' in small sample sizes but most are in progress https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8627907/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8627907/ https://clinicaltrials.gov/ct2/show/NCT04647526 https://clinicaltrials.gov/ct2/show/NCT04647526 this one was supposed to publish some preliminary results in q1 2023 but i don't see any updates :/
    - haldujai 3y ago
      > https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8627907/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8627907/ Non-inferiority studies aren't sufficiently powered to answer the question but up-front Docetaxel is pretty old-school. My urology days are long behind me now but even in my residency abiraterone/enzalutamide had taken over as in: > https://clinicaltrials.gov/ct2/show/NCT04647526 https://clinicaltrials.gov/ct2/show/NCT04647526 this one was supposed to publish some preliminary results in q1 2023 but i don't see any updates :/ This is the trial I was referring to, I don't think they're done with the analysis/writing yet. I have no numbers or data hence my casualness but our nucs physician was really excited 5 years ago and lukewarm when I recently asked him if they were finally taking over mCRPC care over a beer. Again grain of salt, but my impression from that convo was it's going to end up another line of therapy (mCRPC treatment is a game of kicking the can down the road as long as possible).
wahnfrieden 3y ago
advice on how to catch earlier?
- grecy 3y ago
  The really crappy part of lung cancer is that it's very uncommon to detect it because there aren't really any symptoms to speak of. Eventually it will metastasize so some other part of the body and THAT will give symptoms. When my Mum was diagnosed the Dr. said the bad news is you have cancer in the bones in your neck. The really bad news is that it started in your lungs, and it's way, way to far along to do anything about. Cancer sucks.
  - haldujai 3y ago
    The good thing is in most people (particularly smokers) it is very slow growing. We also have great non-invasive curative treatment options like stereotactic radiation.
    - jorvi 3y ago
      Don’t smokers account for ~99% of cases of small-cell lung cancer, which is by far the worst type to have (very prone to metastasis and grows rapidly)?
      - haldujai 3y ago
        Small-cell (SCLC) is definitely very aggressive and more strongly associated with smoking than non-small cell lung cancer (NSCLC), I'm not sure about 99% but that seems too high. It's fairly rare though, the quoted numbers from SEER are 14% but from a clinical perspective most of us that deal with lung cancer feel that's discordant with our practices and likely an overestimate. In either case, smoker or non-smoker you're far more likely to develop NSCLC with adenocarcinoma being more common than squamous cell (typically only in smokers for the latter but still less common than adenocarcinoma). The typical adenocarcinoma most people get has a doubling time of roughly 1-2 years.
anton96 3y ago
This gets me curious, if we would be sure cancer become resistant at some point. Why would we give higher dose of the cure at start ? Wouldn’t the body handle it ?

dangwhy 3y ago

My father is in this situation with prostate cancer. First line therapies have stopped working and now its on to chemo. I am hoping chemo won't damage him too much. There are also radioligand therapies like lutetium 177 but they haven't been sequenced on chemo naive patients yet. So soc is chemo first.

haldujai 3y ago
I wasn’t involved in this study but the cancer center I just left was one of the sites for the upfront Lu177 vs chemotherapy trial. Speaking casually with the physician involved recently he said the results weren’t promising thus far. I don’t think this is published yet and I’m not familiar with prostate ca treatment literature so take this with a grain of salt.
- dangwhy 3y ago
  my father is in india where they've been giving lu177 ( and others) before chemo for quite a while ( other countries being germany and australia ) . Forums are awash with 'success stories' . There are many clinical trials currently in US and canada. Some have published results showing 'non inferiority' in small sample sizes but most are in progress https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8627907/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8627907/ https://clinicaltrials.gov/ct2/show/NCT04647526 https://clinicaltrials.gov/ct2/show/NCT04647526 this one was supposed to publish some preliminary results in q1 2023 but i don't see any updates :/
  - haldujai 3y ago
    > https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8627907/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8627907/ Non-inferiority studies aren't sufficiently powered to answer the question but up-front Docetaxel is pretty old-school. My urology days are long behind me now but even in my residency abiraterone/enzalutamide had taken over as in: > https://clinicaltrials.gov/ct2/show/NCT04647526 https://clinicaltrials.gov/ct2/show/NCT04647526 this one was supposed to publish some preliminary results in q1 2023 but i don't see any updates :/ This is the trial I was referring to, I don't think they're done with the analysis/writing yet. I have no numbers or data hence my casualness but our nucs physician was really excited 5 years ago and lukewarm when I recently asked him if they were finally taking over mCRPC care over a beer. Again grain of salt, but my impression from that convo was it's going to end up another line of therapy (mCRPC treatment is a game of kicking the can down the road as long as possible).

wahnfrieden 3y ago

advice on how to catch earlier?

grecy 3y ago
The really crappy part of lung cancer is that it's very uncommon to detect it because there aren't really any symptoms to speak of. Eventually it will metastasize so some other part of the body and THAT will give symptoms. When my Mum was diagnosed the Dr. said the bad news is you have cancer in the bones in your neck. The really bad news is that it started in your lungs, and it's way, way to far along to do anything about. Cancer sucks.
- haldujai 3y ago
  The good thing is in most people (particularly smokers) it is very slow growing. We also have great non-invasive curative treatment options like stereotactic radiation.
  - jorvi 3y ago
    Don’t smokers account for ~99% of cases of small-cell lung cancer, which is by far the worst type to have (very prone to metastasis and grows rapidly)?
    - haldujai 3y ago
      Small-cell (SCLC) is definitely very aggressive and more strongly associated with smoking than non-small cell lung cancer (NSCLC), I'm not sure about 99% but that seems too high. It's fairly rare though, the quoted numbers from SEER are 14% but from a clinical perspective most of us that deal with lung cancer feel that's discordant with our practices and likely an overestimate. In either case, smoker or non-smoker you're far more likely to develop NSCLC with adenocarcinoma being more common than squamous cell (typically only in smokers for the latter but still less common than adenocarcinoma). The typical adenocarcinoma most people get has a doubling time of roughly 1-2 years.

anton96 3y ago

This gets me curious, if we would be sure cancer become resistant at some point. Why would we give higher dose of the cure at start ? Wouldn’t the body handle it ?