MALIGNANT PLEURAL EFFUSION - 1258952

hjoyce
Posts:2

Hi All, My husband dx in march with stage IV adenocarcinoma of lung. EGFR+ exon 20. He only went to the ER because he was having shortness of breath while lying flat. Long story short.. he had 3.5 liters drained from his left side which was malignant and further scan revealed a 2.6 cm tumor in the lower lobe. He has completed and tolerated very well 6 round of carbo/alimta/avastin and will now go on the maintenance of alimta/avastin. no fluid has returned since the start of chemo and the tumor is about half the size. my questions are..
can one ever achieve NED with a previous malignant pleural effusion?
can the fluid reaccumulate even without the presence of a tumor?

thanks in advance for taking the time to read and respond.

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Reply # - September 2, 2013, 08:32 AM

catdander
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Hi hjoyce, I very sorry to know you're coming to Grace due to your husband's diagnosis. You will learn that anything is possible with lung cancer, including both NED and the accumulation of fluid in the lung without a tumor though neither is the norm (there's really no norm either ;)). Just an FYI, NED or no evidence of disease doesn't mean no disease. In stage IV lung cancer there is as assumption that micrometastases (lung cancer cells) are always present in the bloodstream and will settle in somewhere and continue the process of creating a tumor that is large enough to be seen by imaging (evidence) such as a CT.

Though usual it's not rare to have a malignant pleural effusion (PE) as the only evidence of lung cancer without evidence of a tumor. People with and without cancer can also have PE that aren't cancerous.

Just an FYI in case you've not seen this,
http://cancergrace.org/lung/tag/exon-20-2/

I hope this is helpful. Please let us know how else we can help.

Wishes to your husband that he continues to respond well,
Janine
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Reply # - September 2, 2013, 08:56 AM

Dr West
Posts: 4735

Janine has provided such a great summary that I don't think I have anything more to add. Even if NED isn't the same as a cure in patients with stage IV disease, it's certainly possible for people with stage IV NSCLC to do well for many years, perhaps illustrated no better than Janine's husband.

-Dr. West

Reply # - September 3, 2013, 06:40 AM

hjoyce
Posts: 2

Thank you for the information it is very helpful. One last question... His tumor was never biopsied b/c they had the fluid to test, would it be a far stretch for someone to have two different mutations? That would certainly open up some treatment options for him if positive for another mutation. I have full confidence in his oncologist and figure she would suggest that if possible but I'm trying to explore every avenue.
Thanks again.

Reply # - September 3, 2013, 10:24 AM

catdander
Posts:

It's not at all likely that one person would have more than one mutation but it has happened on what I believe to be rare occasions. A discussion with his oncologist about the dangers of a biopsy to gather tissue along with the expense would need to be weighed with the likelihood to benefit. In the meantime I'm glad he's responding well on treatment.

You may also want to search the site for that topic, it's been discussed many times. (note you may need to log out before searching depending on your browser)

All best,

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