NSCLC with Plural effusion - 1293710

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.

JimC
Forum moderator