Patients want improved efficacy, but not necessarily at the expense of their quality of life. Combination treatment comes with increased toxicities, which make maintaining a normal life more difficult. Even grade 1 side effects such as diarrhea or nausea can make it difficult to hold a job or enjoy activities. Increased side effects also come with more doctor’s appointments and additional medications to treat these issues. Many of these medications are not covered by insurance.
Because of my ability to take an EGFR targeted therapy, I was able to actively raise my children, get involved in advocacy work for lung cancer research, and travel for both advocacy and personal reasons. I was able to limit my scans and visits to my oncologist to every 3 months as long as I was doing well on a treatment. And I was able to live my life fairly normally the rest of the time. I wasn’t tied to an every-three-week chemotherapy cycle. I could “forget” (even though I never really forgot) that I had advanced lung cancer for more extended periods of time.
A possible additional 9 months of PFS would not have been enough for me to choose to start treatment with a combination of chemotherapy and osimertinib.
However, patients are all different, just as all people are different. My assessment of the risk-benefit ratio will not be the same as another patient’s assessment. And even my choice might be different if the PFS benefit was 2 years instead of 9 months. Read more.