Dear Cancer Grace,
My father has a malignant pleural effusion on the right side, as a result of his adeno lung cancer. He has undergone a chemotheraoy treatment with alimta and cisplatin which descreased the tumor considerably, but the effusion was still there and after two months his shape got a bit worse and they found that the effusion had again reached two liters. They tried a pleurodesis, which failed because his lung has been trapped in the effusion for too long, was covered with scar tissue and couldn‘t reexpand. His lung is again filled with two liters. We now have to meet the oncologist on monday to discuss further options. My father wants to initiate the dentric cell therapy from Duderstadt, if you heard about it. Maybe I am bending the rules a bit by asking a to broad question - but what could be considered done in such a situation to treat the condition caused by the pleural effusion ? What to ask our oncologist?
kind regards
Malte Schuldt
Reply # - October 12, 2013, 06:04 AM
Reply To: Malignant pleural effusion: Failed pleurodesis caused
Hi Malte,
Welcome to GRACE. I'm sorry to hear of your father's diagnosis and the problems he's having with the effusion.
Dendritic cell therapy has not gained much traction as a lung cancer treatment. As Dr. West has said:
"I worked in the tumor immunology lab in my fellowship training and have written a review article on lung cancer vaccines for the journal Clinical Lung Cancer (many, many years old now), but I would say that such a recommendation is not grounded in any clinical evidence of benefit at all. I can only speak from the perspective of myself and the many other lung cancer experts I know in the world, but I don't know any that would consider that to be a recommendation they would make." - http://cancergrace.org/forums/index.php?topic=6428.msg44808#msg44808
More recently, he confirmed that opinion: "there is no more information about dendritic cell therapy for NSCLC, nor would I rank it among my personal top 50 most promising ideas in treating metastatic lung cancer." - http://cancergrace.org/forums/index.php?topic=9563.msg75759#msg75759
As far as the effusion, if the fluid is free-flowing, a PleuRx catheter may be worth a discussion; if not, draining the fluid by thoracentesis may be the best option. You can read about management of pleural effusions here: http://cancergrace.org/lung/2007/03/18/mpe-managment-options/
JimC
Forum moderator
Reply # - October 12, 2013, 09:05 PM
Reply To: Malignant pleural effusion: Failed pleurodesis caused
Jim has provided a great explanation of the leading points and the approaches I would recommend for the pleural effusion. The only other point I would make is that if the cancer is treated effectively, whether by chemotherapy or a targeted therapy approach, that can lead to good control of the pleural effusion as well, so it's far less likely to make a lot of fluid.
Good luck.
-Dr. West
Reply # - October 13, 2013, 01:03 AM
Reply To: Malignant pleural effusion: Failed pleurodesis caused
Thank you very much Jim C and Dr. West for the quick response. I have one last question:
I know you are a bit sceptic about intrapleural administration with chemo. I have however read this article:
http://www.ncbi.nlm.nih.gov/pubmed/19884858 , which claims that the intrapleural administration is well tolerated. Can this be trusted?
Reply # - October 13, 2013, 08:25 AM
Reply To: Malignant pleural effusion: Failed pleurodesis caused
Malte,
Those are encouraging results, but it should be remembered that this is a trial of only 15 patients, so it's by no means an established treatment regimen. As the abstract states, these results suggest that "further investigation is warranted".
JimC
Forum moderator
Reply # - October 13, 2013, 11:20 AM
Reply To: Malignant pleural effusion: Failed pleurodesis caused
Yes, that was a phase I trial, meaning it was just testing safety and feasibility. Since 2010, my perspective is that there hasn't been even the slightest increase in interest in intrapleural chemotherapy, and I know no lung cancer expert in the US or world who has ever done or even thought of doing it (among probably 75-100 experts I'm in regular contact with).
For what it's worth, Dr. Alex Farivar, a thoracic surgeon I work with who also helps out on GRACE and did some of his training doing intrathoracic chemotherapy as mesothelioma treatment with Dr. David Sugarbaker in Boston, has come out of that experience with absolutely no interest in doing it now -- and it looks like he is suffering from PTSD when he talks about how toxic it was for the patients there.
-Dr. West