NSCLC stage 4 with chylothorax - 1263070

praying4mama
Posts:4

My 71 y/o mama was Dx with NSCLC Adenocarcinoma stage 4 in 11/2013. She is currently taking Tarceva 100 mg daily which helped with the lung masses but not the fluid. At the beginning, the fluid was identified as Malignant but now it's chylothorax. PleurX catheter placed more than 2 months ago. So far my mama tried clear fluid diet/TPN for 2 weeks but the thoracic ducts did not healed. She then underwent embolization of thoracic ducts but that did not work either. We were told chylothorax is very rare. Thoracic surgeon gave her the options of wait and see or do surgery. Since mama is feeling fine, onc recommends to continue to drain twice a week and follow up with blood tests for signs of malnutrition/malabsorption.
My questions to you are:
1. Any thoughts? Recommendations?
2. Continue draining PleurX catheter twice a week (550-930ml every 3 days)?
3. Is there anything she can do to help dry the fluid?
4. Will it dry up on its own?
5. Any cases similar to my Mama?
6. Efficacy of Tarceva 100mg vs 150mg? She was on 150mg but had diarrhea almost everyday sometimes up to 5 times a day. 100mg is much tolerable.

Thanks!

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Reply # - April 4, 2014, 09:44 AM

Dr West
Posts: 4735

I'm afraid that a chylothorax is too rare, and really not managed by any of the doctors who participate regularly here, to offer much insight. A thoracic surgeon is really the best person to address this. I would be very surprised if a patient or caregiver has had a similar enough situation to offer a recommendation, and frankly I'd be dubious that someone else's non-medical relating of their situation is appropriate to guide your mother's treatment.

Unfortunately, if the chylothorax has persisted for a long time, it's not likely to just dry up.

There is no evidence of a value to trying to increase the dose of Tarceva (erlotinib) beyond a truly tolerable level. Patients who have dose reductions for side effects do just as well as those who don't need a dose reduction.

Good luck.
-Dr. West

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