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Mild side effects = lack of effectiveness?


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Hi everyone, I have Stage 4 NSCLC, with mets to my bones. My first treatment was carboplatin and alimta, 4 cycles, three weeks apart. The worse side effects were extreme fatigue and a general achniness, and some queasiness, but no bad nausea and some thinning of my hair. Next up was Tarceva beginning at the end of Feb. of this year. I was fully prepared for the rash because it seemed like it would be inevitable, but it never happened. Again, fatigue (very mild) has been my chief complaint. I have to say, overall, I feel good. Almost normal. 

My scans from a couple of weeks ago, after about 4 months on Tarceva, showed two new bone mets to my right hip and sternum, but no other progression. My oncologist said we could do another bone scan in a few weeks to see if those 2 areas still looked active, but since these were new areas, he said it was pretty likely they're cancer. So -- as of tomorrow I'll be starting Tagrisso.

My question is this -- might a lack of or very mild side effects correlate to the effectiveness of the treatment? I'm finding myself hoping that I'll "feel something" when I begin the Tagrisso in the hopes that it will mean it's working better for me than Tarceva. I know that's a little irrational, but it seems plausible. My oncologist says the treatments don't have to "taste bad" in order to be effective. 


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I had Tarceva back in the dark ages when doctors didn't realize it didn't work on Squamous cell Lung Cancer.  But I sure did have horrible side effects: the worlds worse case of head and neck acne, and lower GI disturbance that kept me "running" to the bathroom.  The rumor in 2006 was if you had side effects, the treatment was working.  Obviously, that was not the case.

Since then I've done lots of reading about targeted therapy and I conclude from that experience that there is no correlation to side effects and effectiveness of Tarceva.  Apparently, your cancer has resistance to tyrosine kinase inhibitors (TKIs), and Tagrisso overcomes this resistance.  So hopefully, a couple of months hence, you'll be reporting vastly better scan results.

Stay the course.


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