Stage 1B EGFR+ no adjuvant therapy offered

[Julie_k]

I just had my first oncology appt today, post lobectomy, and I was a little surprised that even though I am EGFR positive, I wasn’t offered adjuvant targeted therapy or adjuvant therapy of any kind. I suppose I should be thrilled that they think they got it all, but instead I know that others have lowered chance of recurrence with targeted therapy and feel like I’m missing out on lowering my recurrence chances too. 
 

My cancer is 1B, pT2N0M0. They seem to feel like the B and the T2 are just technicalities, but I feel much more nervous about it. 
 

I have p.E746.A750del, exon 19 deletion, and she made it sound like because my tumor was 3cm instead of 4, and because it is A750del instead of L858R, that is why I wasn’t a candidate. But, I think from reading that I might still be a candidate…

Are the side effects really terrible, and I should just go on my way and wait for my 6 month scan? They seem really sure that it won’t recur and if it does, it will in my lungs or lymph nodes. I just have a hard time believing it.

[Marilyn Raven]

I had a lobectomy in June 2021 also 1B and also no further treatment as no lymph involvement I have just had my second clear scan BTW I am in Australia, I wasn't given any extra information though the tumor was smaller than yours I hope this helps, good luck on your journey and stay well  ❤️ 

[LilyMir]

Hi,

Someone here was staged 1B as I recall and was given an "option" to take Tagrisso (but not chemo) if they wanted, maybe they can comment. I think they were told risk of recurrence is 30%.

The ADAURA trial showed advantage for Tagrisso as adjuvant in stages 1B to 3A (stage definitions changed during trial mind you). Earlier stages obviously receive less benefit since most of them are cured by surgery alone but recurrence risk remains. Adaura2 is ongoing I think and is looking at value of Tagrisso for stage 1A.

I guess this is one of those risk vs benefit situations. Tagrisso has risk. Not giving adjuvant therapy has risk. Doctors seem to have different preferences for risk. Maybe a second opinion is warranted?

Good luck!

[Judy M2]

Hi Julie, I think I read your cross post on Facebook and I was one of the commenters.

Tagrisso as adjuvant therapy after surgery for early stages is relatively recent. In my comment I suggested you seek a second opinion with an EGFR specialist. 

I was inoperable Stage 3b, so I had chemo and radiation first. For me, the side effects of Tagrisso are minor and manageable. 

Keep getting those regular scans! 

[Tom Galli]

Julie,

For those diagnosed with Stage I lung cancer (IA or IB regardless of type) and treated by a successful resection of the nodule, post surgical adjuvant therapy in the form of conventional chemotherapy or targeted therapy is usually not offered. Why? As LilyMir points out, recurrence for Stage I disease is about 30-precent. Here is a study that outlines the risk of recurrence based upon diagnostic stage. A good thing is your biopsy has been tested by a laboratory given that you report you are EGFR positive. Many surgically treated folks at this stage do not get a follow on laboratory test so you are well ahead of the curve.

Note the studies stated risk differential. While Stage I has a 30% recurrence probability, Stage II has a 61% and Stage III a 63%! Adjuvant chemo with conventional drugs, targeted treatment and immunotherapy is common with Stage II and Stage III disease because of this very high probability of recurrence.

You are right to feel nervous. But the fact you already know you are EGFR positive and that you have very effective targeted therapies identified if you have a recurrence ought to calm your nerves, somewhat. I hope your medical oncologist has you enrolled in a program of CT scan screening. If so, this will catch a recurrence early and your targeted therapy will deal with it effectively.

Stay the course.

Tom

[Marilyn Raven]

Thanks my surgeon referred to my tumor as unremarkable common in smokers and non smokers, so probably no markers of note, I am however on 6 monthly scans for the next few years so an recurrence should be found early, fingers crossed 2 down so far so good, at this stage I feel very lucky that it was picked up early and wasn't a  connected to my previous uterine cancer also 1b from 5 years ago I have just been cleared with that so now they are focused on the lung cancer, yep I feel very lucky indeed and I am grateful for every beautiful day. 

Blessings all