The first 3-week cycle of chemotherapy (cisplatin 150mg in 1000ml saline + pemetrexed 1000mg) ended 11 October, 2024. After radiation we attended a chemotherapy treatment review with Dr Melvin Chin (Medical Oncologist) and Dr Nick Yeo (Medical Oncology Registrar) in preparation for commencement of Cycle 2 (14 October, 2024). The consult started with me going through the side effects that I had experienced with Dr Yeo. Seems that I have had a good run of it by only experiencing mild symptoms and the symptoms that I had were controlled well enough so that they did not severely affect my wellbeing. Effects of the second cycle of chemo are expected to be similar to Cylce 1 but radiation therapy will have stronger impacts. Dr Chin emphasized that Week 5 (commencing 21 October) is likely to be the toughest, mainly from the side effects of radiation – fatigue and probably inflammation of the oesophagus (oesophagitis). The oesophagitis will make swallowing uncomfortable. Looks like a couple of weeks of soups, mince, pasta, and mushy casseroles. My main job is to monitor and report symptoms if they affect me adversely, especially if the side effects limit me eating.
How long after the chemo infusion is my immune system severely compromised? The first few days after infusion are when immunity is severely depressed. After that, immunity slowly renews so that by day 10 – 12 immunity is well on the way to recovery and I can socialise (as long as I steer clear of souls suffering colds, flus, or other lung infection viruses!).
What plans for “consolidation” treatment after chemoradiation? The first stage of treatment is combination chemoradiation (“definitive chemoradiation” with curative intent) which is designed to try and kill all traces of the adenocarcinoma (primary tumour and activity in lymph nodes). I will have another scan 2-3 weeks after the end of Cycle 2 to see how effective the chemoradiation has been. (Cyle 2 ends 1 November but I need 2 extra radiation treatment for make up for the maintenance day and public holiday, so we anticipate last radiation to be 5 November, 2024. That being the case, the “how did it go?” scan will be late November/early December. The possible results of the definitive chemoradiation treatments are: Complete Response (CR – no sign of cancer after the treatment); Partial Response (PR – tumours/activity reduced; primary tumour or lymph node activity disappeared); Stable Disease (SD – no change in tumour size or locations) ; Disease Progression (DP – tumours increased in size and in more locations). The outcome of chemoradiation in my case is not as yet known. We must wait and see.
Whatever the outcome of the definitive chemoradiation, it is usual for treatment to continue with another form of chemotherapy (consolidation treatment) in an attempt to attack any loose cancer cells that might still be floating around in my bloodstream or sitting in tissues. The standard drug used for adenocarcinoma consolidation after definitive chemoradiation drug used is Durvalumab. However, research has found that Durvalumab is not very effective against cancer cells, like mine, that have mutations of Epithelial Growth Factor Receptor (EGFR) – the enzyme that triggers that cell growth. Similarly, current immunotherapy drugs do not work so well if the cancer cells have the EGFR mutation. That’s the bad news. The good news is that there is another drug (Osimertinib) which targets cells with EFGR mutated cancer cells and inhibits progression for 2-3 years or more (the trial is still going and is too recent to know about 5 year survival rates. (5 years without progression or return is a common measure that the cancer treatment has worked. Doctors rarely say that cancer is cured because it often returns after a time).
After a robust discussion between myself and the doctors about the implications of recent research on deciding which treatment was right for me, we agreed that “targeted therapy” using Osimertinib against the mutated EGFR cancer cells would be the pathway to follow. I will start taking Osimertinib after the chemo radiation treatment finishes and the results of the scan are known.
For the detail curious, I have added articles to the Resources section about EGFR, targeted EGFR treatment, and Osimertinib consolidation.
