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    • A pulmonologist (lung specialist) could help address the underlying cause and then management of the effusion. Good luck. -Dr. West (More)
    • Dr. West, I went in for kidney stone issues and came out with pleural effusion. The ER doctor didn't seemed to be worried nor did my pcp. I am in the end process trying to donate my kidney to someone in need but I'm being held up because 2 years later the new xrays ordered came back with pleural (More)
    • Thank you very much, Dr. West. I've studied a lot from you. (More)
    • Good questions. I think the best answer is that we don't know. As helpful as the IMPRESS trial was, I think it is more informative in telling us that we are mistaken to presume that most patients should have treatment continued with concurrent addition of chemotherapy. However, there are some patie (More)
    • Thank Dr. West for a very clear explain about LUX-Lung 5. I would like to show you two ways of conclusion of IMPRESS trial, which one is better ? 1. We should switch to chemo without continuing EGFR TKI 2. We shoudn't combine chemo/EGFR TKI I think that after the result of ASPIRATION trial, if y (More)
    • I consider them apples and oranges. The LUX-Lung-5 trial was in a molecularly unselected patient population who had been on Tarceva (erlotinib) or Iressa (gefitinib) for at least 12 weeks without significant progression, then received Gilotrif (afatinib) given in a setting where it is not clearly in (More)
    • How about LUX-Lung 5 trial ? the combination of afatinib and paclitaxel is better than chemotherapy alone after progression. How can I explane the difference between LUX-Lung 5 and IMPRESS ? (More)
    • Yes, I think the IMPRESS trial is sufficient to change practice and lead us to favor switching to chemo without continuing EGFR TKI therapy. In terms of your proposed schema for a later trial, are you speaking of a later generation EGFR TKI such as rociletinib (CO-1686) or AZD9291 vs. chemo? If so, (More)
    • Dr. West, Do you think IMPRESS trial is "strong" enough to make us stop EGFR TKI when progression and change to chemotherapy as Dr. Mok concluded ? I think we can conclude that after progression only chemotherapy is enough we shouldn't combine chemo and TKI. I also think that we need a trial with (More)
    • thank you so much for all your information it means more that you know to have the time to really step back heal from surgery and know that it is not a time bomb ticking away inside me I just told my husband I am going to take a deep breath heal from surgery and approach this later. Of course my can (More)
    • It's also important to underscore that neither I nor your surgeon nor anyone can guarantee that the cancer won't recur, especially if the ambiguous findings on the scans now actually represent cancer. However, if those areas are cancer, doing chemotherapy now won't cure it. So if you do chemo for am (More)
    • The harm I referred to is that there is a trend in several trials of patients with earlier stage, lower risk disease to have a greater risk of dying if they received chemotherapy after surgery than if they didn't. There is always some risk with chemotherapy, which is offset if the risk is high enoug (More)
    • Thank you for your response I wish you had the magic drug for me I am so very confused my surgeon was of course able to remove the speculated mass but the other comment on my pet scan was subtly hypermetabolic consolidation involving the medial right upper and posterior right lower lobes which I (More)
    • I'm sorry to hear about all you've been through. There is no anticipated value for chemo in someone with a node-negative resected non-small cell lung cancer that is less than 4 cm. There is some suggestive evidence that it is associated with harm. Good luck. -Dr. West (More)
    • I was diagnosed with lung cancer in 2005 adenocarcinoma had my upper left lung lobe removed went on a adjunctive chemo taxol and carboplatin in 2010 ct showed a small speculated nodular in upper right lobe Doc said we would watch it in 2011 it had grown lit up on a pet scan went back to my first sur (More)
    • Thanks, doctor. Your posts have really helped me from the start; it's an honor to get your reply. (More)
    • The risk goes down, but the risk is less "front-loaded" with lower risk cancer. If you have stage III NSCLC, the cancer usually recurs in the first 12-18 months or not at all. Most patients with stage I NSCLC are cured, but the risk is distributed more over time...still, it goes down with each scan. (More)
    • Wow, Polapony, your comments mirror my thoughts almost exactly! I've recently had a clear two-year scan after lobectomy for a 3 cm Stage 1b adenocarcinoma with partial BAC features, and no nodes, am still on a six-month scan schedule for another year. Definitely noticed that line by Dr. West about (More)
    • Dr West. Thanks so much for the info. We have decided to go ahead with the clinical trial. Even if my husband receives the placebo he will for sure get good follow up. (More)
    • I would advise you to review this summary: http://cancergrace.org/cancer-treatments/2014/12/30/which-cancers-and-which-patients-an-immunotherapy-primer-for-patients-pt-3/ The association of PD-L1 expression with response is quite variable and not extremely strong. There are responders who are (More)

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