Back again with Alimta question - 1290627

bh
Posts:66

Mom was hospitalized with breathlessness in January 2017. Chalked down to CHF then thoracentesis done and reoccurrence of MPE after a gap of 5 years was confirmed. Mom has been on Alimta since 2011 after a short try with Tarceva. The MPE which had to be drained every few days initially in 2011 went away completely. Even after periods of NED, when the cancer reoccurred, there was no MPE until this last time. She had her first dose of Alimta Jan 30th this year, missed the Feb dose because of a viral infection and high fevers. Lung drained of 800 ml. Had her second dose of Alimta March 30. Another March hospital visit for breathlessness but only 300 ml removed in ER, immediate relief, subsequent consultation with pulmonary. He felt the lung was not drained lower and hence only 300 ml. Left lung appeared to have no fluid or very little (Alimta working again??) but no new thoracentesis done.
Unfortunately Mom was hospitalized last Wednesday for viral bronchitis - onset of sepsis- so she was pumped with fluid in the ER to reverse the sepsis. Lasix not working to clear the excess fluid. X Ray shows fluid is more than when she was admitted. She is going home today as X Ray shows no improvement but internist agreed to make an appt with the pulmonary for a thoracentesis on Monday. Mom has her 3rd chemo scheduled for Tues. Internist feels we should postpone the chemo.
Have there been cases when Alimta has been effective in getting rid of MPE on reoccurrence? The lower mls drained gave me hope that perhaps it is working even tho in 2011, the disappearance of MPE was immediate. What is the longest a person has been/can be on Alimta?
Took mom to a teaching hospital for a consult - Chao Cancer Center- doc wants her tested for 8 diff mutations. If her insurance doesn't cover them, we were going to ask her regular onc at this upcoming chemo appt and if the onc refused, we were going to pursue testing on our own. Thank you for advising to get that consult. Thank you.

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Reply # - April 22, 2017, 05:17 PM

JimC
Posts: 2753

Hi bh,

I'm sorry to hear of these latest problems for your mom, and I certainly hope her doctors can find something to provide relief. Although a recurring pleural effusion in the context of an existing lung cancer diagnosis is suspicious for cancer progression, by itself the increase in such an effusion is not clear evidence of progression and is usually not a reason to alter treatment unless there is other evidence of progression. The reappearance of the effusion may be caused by the presence of cancer cells in the pleural space; if so, anti-cancer treatment such as Alimta may help eliminate it (or prevent its recurrence after draining the fluid). But it's possible to have a pleural effusion recur or grow in size without cancer progression, in which case an anti-cancer treatment is unlikely to resolve the problem, since it's not a question of killing cancer cells. In your mom's case, if cancer cells in the effusion have been confirmed even though no other progression is seen, that may be a reason to change therapy, since it would be considered that the cancer has been progressing despite the Alimta treatments. You don't expect that the same treatment regimen which allowed the cancer to progress will stop that progression.

As far as length of treatment with Alimta, as you've seen it can be effective for some patients for many years, as can targeted therapies or immunotherapies. There really isn't a specific limit.

Good luck getting answers and symptom relief.

JimC
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Reply # - April 24, 2017, 11:38 AM

bh
Posts: 66

Thanks, Jim, for the detailed response. I was just going back and reading mom's records again and it was the Tarceva that eliminated the MPE in 2011 before she started on Alimta. Hoping the effusion will continue to diminish - she has a thoracentesis appt for today. And before this fluid overload on Wednesday, the MPE had seemed to have cleared from the left lung. Keeping my fingers crossed, maybe foolish. The onc at the Chao Cancer Center recommended mom be tested for ros1, ret, NTRK, BRAF V600E, HER2 mutations, and MET exon 14.
Thank you for all the support and information.

Reply # - April 24, 2017, 01:49 PM

catdander
Posts:

Hi bh,

I hope your mom feels better soon. I wanted to say please never feel foolish for being hopeful. Simon said there's always something for which to be hopeful. Too, I now believe it's something we don't have that much control over. The testing could open possibilities of some promising trials.

All best,
Janine

Reply # - June 8, 2017, 07:06 PM

bh
Posts: 66

Hi Janine!
Sorry I took this long to respond. Thank you for the sweet words of support. Mom is doing better - no fluid retention since 4 weeks, no breathlessness, and on going chemo. Also, thanks to the advice from the forum, her testing was done and got her results this afternoon, she has ROS1 mutation. So need to read up on that.
Best regards,
Bee

Reply # - June 8, 2017, 11:44 PM

catdander
Posts:

The ROS 1 finding is really hopeful. The oral drug crizotinib is the standard 1st line treatment or in your mom's case the next treatment of choice. I hope she's able to benefit from it.
All best to her and you.
Janine

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