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by e40 854 days ago
My wife was diagnosed in Nov '23. Stage 4. She had a mutation that allowed Tagrisso/osimertinib. There are many mutations, but this one is prevalent in Asian women who have never smoked.

There was a trial published just after her diagnosis that showed progression free survival at 2 years of 57% (chemo+osimertinib) vs 41% (osimertinib).

https://www.nejm.org/doi/full/10.1056/NEJMoa2306434

She's 6 days into the chemo. There are 4 rounds of pemetrexed+carboplatin and then maintenance carboplatin (forever). Every 21 days.

So far, it's been rough, but hopefully her body will adjust and once she's just on carboplatin hopefully her quality of life will be better.

She had few side effects from the osimertinib, but the main one was mouth sores. They're gone now, thankfully.

Another thing people need to know about this: this diagnosis often comes with regular thoracentesis (removal of fluid from the chest). In this case, it's in the lining of her lung, not lung itself.

Advice to anyone in this situation: make all future appointments for thoracentesis, because you don't want to go into the ER/ED to get it done. And, we've stopped allowing residents to practice on her (once it was quite painful).

EDIT:

Forgot to add: carboplatin crosses the blood-brain barrier, as do the cancer cells. The end state for this cancer, even with the above treatments, is usually tumors in the brain.

4 comments

Hey, best of luck to you both. I've been there with close family members and cancer. It's no fun at all. Easily the hardest thing I've ever had to do in my life was just to care and watch.

Make sure to grab family and friends to help out. The want to help out, most of the time, at least. I know it's hard to ask, but make sure to do it anyways.

And yeah, standard generic advice to take care of yourself too. I hated that advice, as there just was never any time to do so. One thing that helped was to schedule that 'me' time in and make others aware of it. If you put it on the schedule, you'll have a better chance of taking it.

Two tips with MDs:

1) Carry and use a notebook in all MD interactions. Just a simple journal is all. Time, medications given, dosages, MD administering, etc. It's a good back up to have, sure, but you'll likely never use it. The real power is when MDs see you writing things down. They take you more seriously and they take themselves more seriously. I think they think that you'll sue now and have some proof. But who knows.

2) If you're in for a long term treatment (1+ nights) put a big bowl of candy outside the door. Nurses etc. will stop by more often to check up on things and generally seem to like you more. Consider putting cigarettes in there too, depending on if your nurses smoke. Then they will really like you and go above and beyond.

Again, best of luck to you both.

FUCK cancer.

Thanks. Appreciate the tips.
Can you refuse allowing residents to practice on you or your loved ones for better quality of care?
Sure, you can generally refuse any medical care in the US. With respect to residents, It can be as simple as asking and picking the right doctor for your procedure. Their credentials are generally public.
Yes, you can, and the doctors we talked to said it would not negatively impact them.
> this one is prevalent in Asian women who have never smoked.

Does that mean the rate is lower for Asian women who do smoke?

My understanding, though not by any means an expert, is that lung cancer that non smokers tend to get is different to that which smokers tend to get.
This is my understanding.
I think they just mean that the incidence is much higher in that group than would otherwise be expected.

Not all lung cancers are related to smoking, but I'm not aware of any where smoking decreases incidence or is protective.

I wish her and you all the strength in the world.
Thank you.