How is lung cancer treated after Nintedanib failure?

Question

Hello doctor,

I am attaching two reports for my wife, who has lung cancer. She has had Raynaud's syndrome for years, and it causes really bad esophageal pain, sometimes unbearable. For six years, she has only been on Nintedanib, but the latest scan shows the disease is active again.

Can you give us your opinion on what to do next for treatment and how to better manage her pain?

We have Morphine, Diclofenac, and cannabis oil at home.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

The CT or computed tomography (attachments are removed to protect the patient's identity), shows progression, so she needs to stop the Nintedanib. Keep going with the Denosumab and her current pain medications. You can add a Fentanyl patch or bump up the Morphine dose after consulting your physician. If her overall condition is still decent, Gemcitabine is an option as next-line chemo.

Please seek urgent medical attention if she experiences:

Increased breathlessness.
Inability to drink liquids.
Pain in the chest.
Confusion.
Weakness suddenly.
Uncontrollable pain.

You should take her to see a doctor immediately. You have also listed general symptoms, including circulation-related symptoms. If she experiences an episode where fingers become white and blue, then red, due to cold temperature or stress, with numbness and tingling sensations or pain in fingers, this could be a sign of Raynaud's phenomenon, which is due to narrowing of small blood vessels.

Prognosis is poor at this stage, so her comfort is the goal. The esophagus finding is serious; the scan shows the mid-esophagus is being compressed by the tumor. If she is having any trouble swallowing, she needs to see a GI (gastrointestinal) surgeon, and a feeding tube may be needed. Hospice care is also something to discuss.

General measures that help with Raynaud-type symptoms include:

Keeping hands and feet warm.
Avoiding cold exposure.
Avoiding smoking or nicotine.
Reducing emotional stress.

I hope this information helps you.

Revert in case of queries.

Thank you.