NSCLC intrapleural chemo therapy - 1256536

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NSCLC intrapleural chemo therapy - 1256536

Dear Dr West,

I was dx stage IV NSCLA adeno on 1/28/2013. A primary tumor 3.8x3.9cm between mid-lower lobe of right lung, a1.0cm lym node near by, numerous nodules along the base of the lung, and massive pleural effusion of 2L+. No distant met by CT/PET.

Mutation: KRAS+/RET+, and rests are -. Chemo sensitivity test: generally responsive to platinum based chemo, with combo with Gimzar being the most sensitive. PL-L1 test was not successful due to biopsy failure.

Started 15x radiation on primary tumor and shrunk the tumor to 1.1x1.8cm (Feb).

Started Alimta/Carbo in March, and complete 3 rounds right now. A CT after 2 round showed the primary tumor is "no long detectable", lym node sized reduced, nodules along the based of the lung responded favorably, and pleural fluid still exists.

The pain in the front chest totally gone, but still felt on the right chest of lower rib site.

I would like to ask my onc to do a intrapleural chemo injection a treat nodules and pleural fluid. I would appreciate your opinion.

Thank you in advance,


Reply To: NSLCA intrapleural chemo therapy

Sorry the title was a typo, means "NSCLA"


Reply To: NSLCA intrapleural chemo therapy

Hi Frank,

Welcome to GRACE, and congratulations on your good response to chemo.

Intrapleural chemo is not the typical management choice for a malignant pleural effusion since chemo is systemic therapy, reaching all parts of the body. There is also a concern with alimta and pleural effusions, as described by Dr. Weiss:

"I would add that the toxicity of alimta can increase in patients with fluid collections because the alimta can accumulate there and be cleared more slowly. While the level of concern for this is sometimes overstated, I've seen it happen a few times and am convinced that it's not just a theoretical possibility." - http://cancergrace.org/forums/index.php?topic=10845.msg88149#msg88149

You can read about treatment of pleural effusions in Dr. West's post here: http://cancergrace.org/lung/2007/03/18/mpe-managment-options/

Forum moderator

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>

Dr West
Reply To: NSLCA intrapleural chemo therapy

I would really wonder why that would be considered. You've had a great response thus far, and intrapleural chemotherapy hasn't been established as beneficial. One of my colleagues, Dr. Alex Farivar, is a thoracic surgeon who did this procedure in his training at Brigham and Women's Hospital in Boston, where they sometimes pursued this approach for mesothelioma. He describes patients becoming exceptionally sick, so much so that hearing him describe it makes it seem like he's got PTSD from the experience.

I couldn't imagine being tempted to do something relatively untested and potentially extremely toxic in someone who is feeling generally well and has been responding extremely well to a standard, well established treatment approach already.

I hope that helps.

-Dr. West

Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education