My dad was diagnosed with a stage IV NSCLC adenocarcinoma around 4 weeks ago. He experienced a shortness of breath and difficulty in breathing prior to being hospitalized. Any simple exercise such as walking would tire him easily. His thorax photo showed a massive pleural effusion on the left side of the lung spreading toward the right side. The pleural fluid has since been drained using a small chest tube. My dad went through the pleurodesis procedure twice using a 30 mg bleomycin sclerosing agent each time. However, the procedure failed both times as the pleural fluid continues to come out at a rate of 300 ml per day. The color of the fluid is yellow.
He was tested EGFR and ALK negative but ROS1 positive. He plans on taking Xalkori (Crizotinib) after the pleurodesis succeeds. He has not undergone any chemotherapy.
Listed below are some of my questions that I need your help with:
1. Should an alternative pleurodesis sclerosing agent such as TALC be considered since bleomycin has failed both times? Or should the bleomycin dosage be increased? The TALC procedure would involve a bigger chest tube being inserted.
2. My dad's pleural effusion is not as massive as it once was (300 ml/day now vs 1000 ml in early February), his thorax image also showed his left lung's no longer covered with fluids, but why is he still unable to muster enough energy to walk? His eating appetite is still good.
3. Aside from the pleural effusion, his body tends to become rigid and numb occasionally, does this mean that the cancer might have spread to his nerve system?
4. Can he take Xalkori now or does he have to wait until the pleurodesis succeeds first?
Your kind assistance would be highly appreciated. Thank you very much.