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NSCLC Diagnosis

My wonderful mother-in-law was very recently diagnosed with stage 4 NSCLC. We are facing several treatment options and I thought reaching out to a handful of messge boards and forums might help us decide which path to follow. The basics are she has never smoked or drank – even on rare ocassions – a day in her life. At age 79, and prior to this diagnosis, she had never experienced any major illnesses, hospitalizations (aside from child birth) or surgeries. Hopefully that will bode well for her as we move forward with treatment. And just to clarify, we are located in the United States, and she is currently in Asia. The initial thought was she had a mass in her lungs only, and that it was likely adenocarcinoma. Had that been the case the survival rate would have been 95% +, but as additonal scans were done it was determined she had a single spot on her lumbar, and also cancer present in her lymph nodes. And the biopsy ultimately showed a combination of two NSCLC sub-types – both adenocarcinoma and squamous cell carcinoma. Having both is rare but not unknown. Working in her favor is no cancer was detected in other major organs such as the brain, liver or stomach. On the other hand, genetic testing revealed she is not a candidate for any of the available targeted therapies. The doctor did say she was a good candidate, based on certain metrics, for immuntherapy. And obviously they are going to begin radiation treatments on the lung and lumbar areas within the next couple of days. The big question facing us at the moment is whether to pursue just immunotherapy at the outset, or to start with a combination of both chemo and immunotherapy. Her doctor is recommending the former, and after a two-month period they will assess whether or not the immunotherapy is working. He did say that it doesn't work for everyone. Our immediate question was what if it doesn't work? Is there a risk the cancer will have continued to spread during that two-month period? This is a particular concern since it has only been detected in two areas and the lymph nodes thus far. The doctor did not answer this question. His recommendation that we start with immunology only is based on the potential side-effects of chemo, and he also referenced my MIL's age. But of course it is hard on most people, and I've known many cancer patients older than my MIL who have undergone chemotherapy. But perspectives are sometimes different from one country to another. As the family have done their own research, we have seen numerous sources that say studies have shown using a mix of chemotherapy and immunotherapy as a first strike against NSCLC is a good approach, and helps the immune system find and destroy cancer cells. To be clear, our goal is to pursue whatever protocol gives us the best chance of extending mama's life. We we told a median survival for a stage 4 mutation negative lung cancer patient is approx 1 to 1.5 years…. with 10-20% possibly surviving 5 years or more. With so many new therapies on the horizon, and things moving so fast in terms of new treatments, the difference between surviving 1 1/2 or 2 years vs. 4 or 5 years might be the differnce between long-term survival or not. For instance, if starting with a combination of chemo and immunotherapy provided even marginal odds of extending mama's life beyond what beginning with just immunotherapy might do, she would likely choose that path. We certainly undertand that median surival charts aren't the best predictor of what will happen in specific cases, and that every individual is different. But this has been a traumatic and unexpected diagnosis for the family (as it is for all families), so any insight or information from others who have faced – or are facing – a similar path, would be appreciated. And perhaps there are therapies that might work we haven't even heard of? Or diffrent types of chemotherapy? Honestly we have no idea. But we are going to do whatever we can to fight and win this battle, including bringing mama to the U.S. for her treatment if necessary. I do have all of her scans and reports and biopsy results, so if anyone has a specific question, or needs additional info before answering, please ask. Thank you in advance for any assistance anyone can provide!

  1. Hi, I am so sorry to hear your mother-in-law was diagnosed with lung cancer. While we cannot offer anything that can be construed as medical advice, I can say that it is protocol in many cancer centers here in the US to give a combination of immunotherapy and chemo. A lot depends on the health of the patient and other factors that the doctors may be more aware of. If you do bring her to the US, do you know where you will be staying and have you chosen a comprehensive cancer center in that state? I don't know your financial situation, but treatment is ridiculously costly without insurance, I'm not sure how international health insurance would work, but hopefully you can work all that out if you decide to come to the US. Please keep us posted, we are here for you and your mother-in-law. Warmly, Alisa, Lung Cancer Patient Leader

    1. Hi . First, let me echo in saying so sorry to hear about your mother-in-law's diagnosis. Second, as Alisa an you also said, it is true that immunotherapy is often combined with chemotherapy in first-strike treatment (see: https://www.nejm.org/doi/full/10.1056/NEJMoa1801005). Of course, specifics of the individual circumstances, such as the duel type cancer diagnosis, may make a difference. Hopefully, a second opinion can provide additional insight or peace of mind that you are headed in the right direction and doing what is possible. Wishing your mother-in-law, you, and your family the best. Richard (LungCncer.net Team)

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