Targeted therapy no longer working

[u/GoldAd799]

A family member was diagnosed with T2bN3M0 lung cancer a year ago. They were started on targeted therapy Osimertinib (otherwise called Tagrisso I believe). Initially this showed some really positive results, with the main mass reducing in size. However on the last scan, it showed the tumours have now increased in size. Now waiting to hear whether chemo/radiation will be the next steps. Has anyone else/family members also experienced targeted therapy no longer working? What treatment came next and how did this affect prognosis?

[u/Impossible-State6621]

My wife has been on Osimertinib, and although she hasn't progressed just yet, it's inevitable.

There are a number of second-line treatments, which depend on how much progression occurs and how the cancer mutates. In some cases patients are prescribed radiotherapy and are able to continue on Osimertinib. In other cases, a biopsy shows that another form of targeted therapy can help. In yet other cases, chemo can be prescribed, or amivantamab, or datopotamab in combination with deruxtecan. And clinical trials may also be available.

It's a terrible waiting game, but the next steps should be clearer soon.

[u/ReniValentine]

I was on Tagrisso from 5/2021 until earlier this year. The change was due to the inevitable drug resistance. I'm currently on a chemotherapy course which includes Rybrevant (I need to confirm the spelling). So far, the cancer is responding well to treatment.

[u/GoldAd799]

Thanks both. Have just found out that radiotherapy is not an option due to the cancers location, so they are going to try chemotherapy (4 sessions over a 12 week period). Any tips on how we as a family can support them going through this? As I know the side effects can be tough. Wishing you all the best on your journeys

[u/ThisSelection7585 → u/GoldAd799]

What regimen, do you know? Mine was carboplatin/pemetrexed/Keytruda every 21 days. Thankfully no nausea! That was the effect I dreaded most. I got profound fatigue and constipation that is now managed with pericolace twice a day. I’d say hydration is  key—I swear by this sugar free electrolyte drink called Suerox. Noticeably rehydrates when water isn’t cutting it. My labs have been good (except the expected blood count drop) even broths are a great soothing source of hydration. Find pleasant scents to keep rooms fresh. Keep a sense of normalcy within reason, it helped me feel I wasn’t losing all control of little things. Limit crowds and other infection risks of course during the week blood counts drop. My side effects usually hit and hit hard  by day 4-6, usually normalizing by day 10 so I’d have a week to do errands out of the house. 

[u/Mysterious-Two2103 → u/GoldAd799]

If your family memeber is able to get fat adapted by not eating sugars, carbs, starches they can fast for 36-72 hours before chemo to put their normal cells into a protective state so the chemo will not make them sick.

You can research it and hear peoples testimonies on youtube to see what and how they did it.

[u/ThisSelection7585]

I’ve heard sometimes masses grow before shrinking, maybe it was in that phase when the scan was taken. Target therapy was the second option if my chemo didn’t shrink the mass enough to an acceptable working size. I have a HER2 mutation so they’d use Enhertu but it has its own risks and side effect profile. But they say we can go the surgical route🙏thankfully. They told me radiation would be the 3rd option so I would say you at least have radiation as an option.  

[u/ConstantWar4437]

I have stage 4 NSCLC with Ross1 mutation.  When my targeted therapy Augtyro stopped working because of resistance my doctor had me do a new lung biopsy to confirm if the mutation is still Ross1.   The results  came back Ross1.  My doctor said every time  I have resistance to treatment I will be doing a new biopsy because mutations can change from one to another   I am currently doing chemo with my targeted therapy Augtyro I am hoping to switch to a new targeted therapy in the new year