My husband has mild ascites and right pleural effusion. These problems started when he was given 900 mg Alimta maintenance dose whereas he had only been having 750 mg for nine months. Due to deteriorating condition he had a pet ct scan which showed progression. So the alimta was discarded and Tarceva 150 mg started in September. He responded very well to the Tarceva and pet ct scan in November showed miliary nodules disappeared but progression on some bones and mediastinal nodes and persistent mild ascites and pleural effusion.
Our onc suggested biopsying the mediastinal lymph nodes and I remember Dr. West wondering why my husband should be put through this unnecessary pain. We however went ahead and did the mediastinal biopsy wich did not yield any results as the nodes which lit up on the scan were not found. This doctor carried out the procedure without referring to the pet scans at all. After the procedure he was very weakened.
He now has persistent stomach problems which may be due to the mild ascites combined with Tarceva. He is unable to eat due to a feeling of fullness and is consequently losing weight.
His pleural fluid was tapped and sent for mutation testing. This testing came back with a report of negative for EGFR and Alk.
When we met the onc with the test reports and complaints of stomach fullness, pain and inability to eat along with some breathlessness, the onc decided to change him to Gemcitabne Carboplatin palliative chemo. I asked whether a pet scan or ct can would first be ordered but he said tht would be unnecessary as the management would remain the same.
My questions are:
1. Can mutation testing from pleural fluid be relied upon ?
2. Just because he as some breathing problems and the pleural fluid is accumulating again and again does this mean Tarceva is not working?
3. What are the chances of Gemzar and Carboplatin combine working in this scenario?
Thank you once again for your interest.