My wife’s CT scan last week indicated an increase in size of nodules in both lungs. The two representative examples mentioned were a nodule increasing from 7mm to 11mm and another 3mm to 6mm. The radiologist stated that “innumerable nodules in both lungs have shown a comparable increase in size”. In addition, this CT scan showed pericardial fluid around the base of the heart which is new from previous scans (no symptoms yet). She was switched from Alimta to Gemzar in August with her last Alimta infusion 7/1/13 due to recurring pleural infusions and a mass in lower left lung (site of originating tumor). VATS surgery 7/17/13 indicated that this mass was likely due to significant scar tissue and pathology reports came back benign for all left lung tissue removed as well as the pleural fluid. There is only a minimal pleural effusion now due to pleurodesis in July. Although she did have some increasing side effects from Alimta, these “innumerable lung nodules” had been decreasing in size or stable in scans during the 20 months of first line treatment with Alimta.
My question is - there are a lot of discussions on 2nd, 3rd, 4th etc. line treatment options, but are there any clinical trials or data that would exclude going back to Alimta? Possibly beginning with a carbo doublet and if that slows the progression, then continuing Alimta maintenance?