Pericardial Effusion, Afatinib - 1290352

not in a million, What a beautiful baby! Welcome to Grace. Afatinib is not known to cause PE or pulmonary embolism. Afatinib has even been tested in people with EGFR+ nsclc with pericardial effusions and found to be helpful for many.

It is most likely that both are caused by the cancer are best treated by treating the cancer. If time permits the afatinib may help. By what you've said about the lessening of the PE collections that afatinib may already be working. So a focus on anticancer treatment would be appropriate in that case. Everyone is individual and in your friends case they are lucky to have 3 heads on the case.

Here is what Dr. West has said about PE, " It's possible but extremely unlikely that a pericardial effusion, the fluid buildup around the heart, is caused by something other than the cancer. In patients who have had radiation to that area, inflammation afterward can cause this fluid collection, and rarely an infection or some other cause might. But in someone with lung cancer, it's far more likely that the cancer is the cause for pericardial effusion.

There are two potential reasons to remove fluid. One is to confirm that there are cancer cells there (which I wouldn't say is absolutely necessary), and the other is to remove the pressure on the heart. This decompression of the effusion and the pressure around the heart generally becomes an issue in the setting of larger effusions, which can cause a condition called cardiac tamponade, where the pumping function of the heart becomes compromised by the fluid pressure surrounding it. There is not as clear a need for a peridcardial effusion to be drained for a small or moderate effusion. This is a setting where clinical judgment and the clinical scenario are important." http://cancergrace.org/forums/index.php?topic=9573.0

Continued

I wanted to add what Dr. Pennell has had to say about blood thinners and PE which are most often given to those with nsclc and pulmonary embolism, "By and large, blood thinners (anticoagulation) can often be safely used after procedures and surgeries like pericardiocentesis or pericardial window if the doctors feels that the risk of bleeding is low enough, usually after enough time has passed for some healing to have taken place. This is not always easy to predict and can only be decided by the team of doctors caring for the patient. Sometimes if there is ongoing bleeding or the risk seems high, the doctor and patient must have a discussion about possible risks and decide either to try blood thinners despite the risk, or to decide the risk of clotting is lower than that of bleeding and put off starting blood thinners either temporarily or permanently.

As for choice of blood thinners, the medication that has the best evidence of preventing blood clots in lung cancer patients is low molecular weight heparin (LMWH), of which there are multiple brands. There are both advantages and disadvantages to this and all blood thinners (for example, it is not possible to completely stop the thinning of the blood with LMWH if dangerous bleeding starts). In the hospital and for high risk patients, doctors will sometimes use an intravenous medication called “unfractionated heparin” or just heparin, which acts quickly and can be shut off and/or reversed quickly if needed. There are multiple other choices for blood thinners, all with advantages and disadvantages that need to be personalized to the individual patient situation." http://cancergrace.org/topic/pericardial-effusion-and-blood-thinners

I hope your friend's dad gets over this bump in the road and can continue with EGFR TKIs for a long time.
All best,
Janine