[xivzgrev]

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]

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]

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]

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://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]

> 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 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).

[anton96]

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 ?

[wahnfrieden]

advice on how to catch earlier?

[grecy]

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]

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]

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]

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.

[jorvi]

> I'm not sure about 99% but that seems too high.

I double checked, only 2.5% of SCLC incidences is from non-smokers.

[fendy3002]

same here, my mother had cancer in spine when diagnosed, and it came from lung. Already late stage and metastasize. No symptom until it reached the spine and causing occasional pain and lately inability to move her legs.

Died on less than 2 months after that. It sucks.

[grecy]

I'm really sorry to hear that.

My Mum was told that people with her diagnosis survive on average one year. She fought hard through radiation and years of chemo, and made it just less than three years after the diagnosis. Through most of it she was waking me up at 6am to go for a sunrise walk on the beach. I hope I can be that strong one day.

[toomuchtodo]

Low dose CT scan for those susceptible.

https://www.cdc.gov/cancer/lung/basic_info/screening.htm

https://www.uspreventiveservicestaskforce.org/uspstf/recomme...

[TrackerFF]

Lifestyle changes for one.

Do you smoke? quit smoking. Do you live in areas with lots of air polution? High levels of radon where you live? Move.

Do you work with a bunch of carcinogenic chemicals? Find something else to do.

You can also get a gene test do see if you're suspectable to certain cancers.

But most importantly: listen to your body. If you feel that something is wrong, take it up with your doctor.

[haldujai]

The newest thing is to avoid ground level apartments in a city with traffic if you can.

I’ve been told brake (or tire) dust is the newest suspect for why young never-smokers are developing lung cancer (combined with certain relatively prevalent mutations).

[wahnfrieden]

my city apartments are always coated in black dust... several floors up

[uncletammy]

Any recommendations on a genetic test to check for susceptibility?

[wahnfrieden]

weed?

[ChoGGi]

Switch to edibles?

[wahnfrieden]

;_;

[xivzgrev]

Not really. Lung cancer is mostly due to smoking or radon. So don’t smoke and get your house tested.

Outside of that, it’s a crap shoot. My mom in law didn’t have either risk factor. PET scans can pick up but each one exposes you to radiation which can also cause cancer. So they generally don’t screen for low risk patients.