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[CheRub]

Hello!

I am new to my diagnosis and forum! 
I recently had a right lower lobe lobectomy for a 2.3 cm malignant tumor. 13 lymph nodes were removed for pathology and one of them showed the EGFR mutation. The first oncologist I went to recommended 4 doses of chemotherapy over a 12 week period followed by 3 years of Tagrassi as an “insurance” plan against further mutations or microscopic cancer cells traveling in my body. I have an appointment for a second opinion on a few days at NYU Perlmutter Cancer Center. I am wondering why I need to kill all the good cells in my body with standard chemotherapy and weaken it “just in case” some microscopic cells escaped before taking Tagrassi. Has anyone had a similar experience? I am in my late 60’s and otherwise in excellent health. 
Thank you for any advice you can share!

[Tom Galli]

Welcome CheRub!

As I understand your situation, your doctor wants you to have 4 cycles of conventional chemotherapy, and on completion, start Tagresso, a Targeted Therapy drug that is effective against certain forms of Adenocarcinoma with EFGR expression. I think the reasoning is conventional chemotherapy kills cancer cells while Tagresso stops existing cancer from progressing. Since the lymph node pathology showed metastatic disease, your physician wants to kill circulating cells before they form into a nodule.

That might be the reason but be sure to ask the Perlmutter Center physician to explain the reason for adjuvant conventional chemotherapy.

Stay the course.

Tom

 

[Karen_L]

Hi CheRub,

Your doctor's treatment plan(s) depend(s) on the specific EGFR mutation(s) you have. You can read about biomarker testing here.

Yes, the chemo will kill cancer cells. But it probably won't get all the un-seeable "seed" cells that are floating around. Unfortunately, this notion of seed cells currently seems to be a real puzzle for researchers.

Tagrisso is a TKI (tyrosine kinase inhibitor), a targeted therapy, not a form of chemo. By that I mean, it is targeted to interrupt the cellular action of the particular mutation that has been found in your lung tissue.

Sounds like the oncologist is suggesting a one-two punch to get you the best odds going forward. It will be interesting to hear what others docs say.

Please keep us posted.

 

[LilyMir]

Welcome and sorry you had to join us!

I have the same mutation (EGFR) and following surgery was given adjuvant chemo and now adjuvant Tagrisso for 3 years. Reasoning given to me was that clinical trials had this sequence (they estimated chemo reduces recurrence risk by about 15%). During my chemo, which was hard, my oncologist mentioned that some top doctors even moved directly to adjuvant Tagrisso after surgery but that she prefers to adhere to evidence. Most recently Astra Zeneca released results of (ongoing) clinical trial and Tag seemed effective with and without chemo but I believe the numbers vary with chemo still holding some advantage (probably more so for higher stages but it has been a while since I read their papers).

The answer is thus a bit complex if not even evolving  (what's the risk of skipping chemo?). If you have complications (e.g. kidney or liver issues), it may be best to discuss risk vs reward of doing chemo before Tagrisso. If you are otherwise healthy, and/or your stage is not early, maybe discuss the chemo regimen they suggest and ask lots of questions.  Also should you decide to take chemo, always seek help if things get too hard,  they can always change medications or doses (they did in my case and it made such a difference). Chemo is harsh and caused me some long term damage but it was something I am now glad I had done so I do not keep thinking what if (kind of throwing everything at the cancer while I could, I was 49 at diagnosis and my little boy needs me!).

Here is something to start your reading on this issue but there are more recent findings that will probably be published soon by Astra Zeneca including OS (overall survival), not only DFS (disease free survival):

https://www.astrazeneca.com/media-centre/press-releases/2021/tagrisso-extended-disease-free-survival-regardless-of-prior-adjuvant-chemotherapy-in-early-stage-egfr-mutated-lung-cancer.html#

"In this exploratory analysis of the overall trial population, adjuvant Tagrisso reduced the risk of disease recurrence or death by 84% in patients who had been treated with prior adjuvant chemotherapy (based on a hazard ratio [HR] of 0.16, 95% confidence interval [CI] 0.10-0.26) and by 77% in patients who had not (HR 0.23; 95% CI 0.13-0.40). DFS benefits were similar across each stage of disease."

Good luck!