NSCLC with Plural effusion

Portal Forums Lung/Thoracic Cancer NSCLC Stage IV NSCLC NSCLC with Plural effusion

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January 5, 2018 at 8:20 pm  #1293710    


My father was diagnosis with NSCLC with plural effusion. Over the pass 2 years he has gone through carboplatin (1 cycle) > cisplatin + gemcitabin (4 cycle) > alimta (4 cycle) > pembrolizumab (13 cycle)… the disease is now showing progression, with increase fluid and metastatic to neck through lymph node… please advise if there are further chemo treatment or immune treatment that we can give him a try… Can i also check if there are any new drugs coming up or under trial that we can let him to participate? Thanks for helping..

January 6, 2018 at 6:39 am  #1293711    
JimC Forum Moderator
JimC Forum Moderator

Hi narret,

I am sorry to hear of the possible progression of your father’s cancer. I say “possible” because an increase in pleural fluid doesn’t necessarily indicate cancer progression, so it’s more a question of what is going on with the lymph nodes. Lymph nodes can enlarge for a variety of reasons, including common infections. The point is that if he is currently being treated with pembrolizumab, it may be reasonable to continue with that therapy if the evidence of progression is unclear or if the apparent progression is slow. Generally we like to get as much benefit as possible from each line of therapy, and as Dr. West is fond of saying “bad brakes are better than no brakes”. In other words, if a well-tolerated treatment is keeping the cancer under control for the most part, we may want to continue it in the face of slow progression.

If your father’s doctor determines that the progression is significant and it is time to change therapy, there certainly are other standard chemotherapy agents. Given the chemo agents he’s already received, a leading follow-up choice would be a taxane, such as paclitaxel (Taxol) or docetaxel (Taxotere). There is also another version of paclitaxel, Abraxane, which has similar efficacy but tends to be more tolerable. Docetaxel is the best-studied option as a later line of therapy. Another possible choice is navelbine.

In addition, if your father did not progress on any of the prior treatments, his doctor might consider returning to that agent.

There are other immunotherapies, although it’s not usually expected that a patient will respond to a second agent after progression on the first. On the other hand, there are clinical trials underway to test the efficacy of immunotherapy in combination with either another immunotherapy or a standard chemotherapy agent. You can search for clinical trials in your area at clinicaltrials.gov.

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Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

January 6, 2018 at 9:47 pm  #1293713    


Dear JimC, thanks a lot for your valuable input.. will look for the available clinical trial while discuss with doctor on taxane treatment. Thank you.

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