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 (computed tomography) 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 develops:

Worsening breathlessness.
Inability to swallow liquids.
Severe chest pain.
Confusion.
Sudden weakness.
Uncontrolled pain.

You also mentioned general symptom concerns, such as circulation-related symptoms. If she has episodes where fingers turn white, blue, then red in cold weather or stress, with numbness, tingling, or pain, that can suggest Raynaud phenomenon. This happens because small blood vessels temporarily narrow. Severe attacks can sometimes cause fingertip pain or sores, especially in people with connective tissue disease or poor circulation.

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.