Question about Alimta and pleural effusion - 1260038

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Question about Alimta and pleural effusion - 1260038

Mom was re-started on her Alimta beginning of July, once every 21 days, she has completed 4 rounds and had a CT scan two weeks ago. The nodes, nodules, swelling have all decreased by over 1/3. The lining on her right lung at the bottom looks less swollen but the pleural effusion in that lung has increased. It was minimal before the start of the chemo but has increased to almost double the minimal amount. Still causes no significant symptoms and onc says we will keep an eye on it while continuing the Alimta.

I have been noticing though that since mom's last chemo, she brings up phlegm even when she laughs and sometimes starts choking/coughing on it. Her next chemo is on Nov 2nd.

I have been searching the net about the side-effects of Alimta and what I have come across says that Alimta could cause pleural effusion to increase. The onc said that there is no mixed bag response to cancer treatment usually and as mom's "cancer" itself has decreased, she sees no indication to stop the Alimta. She said we could add a second agent but she prefers not to, 'cause she "does not want to rock the boat". Is there any way to continue on Alimta but minimize this effusion? Has anyone else experienced this?

Mom's first round of treatment last year with Alimta had no such side effect.

Thanks for any light/suggestions/recommendations you could throw on this.

Reply To: Question about Alimta and pleural effusion

I'm so sorry your mom is still not rid of the pleural effusion. It's questions like this that makes "so what do we do about that" questions difficult, your mom has many co-morbidities and treatment decisions are a very individual at best.

Let me ask for help from a doctor.

All best,

dr johnson
Reply To: Question about Alimta and pleural effusion

Pleural effusions can really complicate things when you're trying to figure out whether a lung cancer is "coming" or "going"...Once cancer cells figure out how to get into the pleural lining, they tend to keep going there until you drain the fluid out (thoracentesis) or perform a procedure (pleurodesis) to stick the lining of the pleura back together. In other cases a catheter is needed in the pleural space to help drain the fluid and keep it drained (pleurex catheter).

In this case it sounds like there's all sorts of other evidence that the cancer is responding to the Alimta (that's great news!), but also signs that the fluid continues to drain into the pleural space and is causing your mom pulmonary symptoms like cough and phlegm. It may be that the fluid could be drained out (ie thoracentesis or by insertion of a pleurex cather), and your mom could still keep going with the Alimta treatments afterwards. I suppose it's also possible that the Alimta caused this, but I'd say that's a less likely explanation here, given the pleura was "swollen" before your mom started treatment.

Dr West
Reply To: Question about Alimta and pleural effusion

I would say that the hard evidence of measurable disease strongly suggests she's responding, while the size of a pleural effusion is a much softer finding. Moreover, it sounds like the effusion has only changed from very tiny to small. I would be very wary about over-interpreting that finding and causing more trouble than you're fixing by getting too caught up in a soft indicator compared with the better evidence that her cancer is responding to treatment. In other words, I can see why your oncologist is concerned about rocking the boat and would say that it's not necessary to "borrow trouble", searching for a very dubious negative in the face of more compelling positive developments.

Good luck.

-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

Reply To: Question about Alimta and pleural effusion

Dear Janine, thank you for your response and best wishes. How have you been? Just read that Certain Spring has left us, made me terribly sad.

Dr. Johnson, thank you, makes so much sense explained like that. Mom has had thoracentesis before so it is good to know that the Alimta treatment can be continued while draining the fluid, a viable option if the pleural effusion gets worse. We so desperately want the Alimta to keep working.

Dr. West, your words were so calming and encouraged us to see the silver lining which is what the onc was trying to get us to do as well, I guess. Yes, the effusion has only gone from tiny to small and really mom seems to be doing okay, almost normal. So will keep at that Alimta. Your words reminded me of the saying, "never trouble Trouble until Trouble troubles you." Thank you, and God bless.

Reply To: Question about Alimta and pleural effusion

Hi bh, My husband and I are well, He's still NED and I'm going to yoga. About a month ago we became co-caregivers to our 14 year old 100 lb German Shepherd. His back legs have become paralyzed of which there have been indicators for about a year. A friend borrowed for us a state of the art big dog walking cart that has given him new life by giving us the ability to get him on his feet and walking. It's been so wonderful for us to have more time with our friend.
I miss certain spring, everyday.

I hope your mom continues to do well on alimta and the PE doesn't cause anymore problems than has.

Keep us posted,

Reply To: Question about Alimta and pleural effusion

Dear Janine, wonderful to know your husband is doing great. And yoga, wow, that is nice, your words remind me I need to get back to it :)
You have a German Shepherd? We do too :) he is a pup tho but all of 110lbs, he bounces around like he is a mere few ounces. I could have let you have our cart, we lost one of our four legged friends last year. He was only 11 and unable to walk for a good six months because of bilateral hip dysplasia which lead to paralysis, he passed away peacefully one morning, cheerful and loving to the end.
Thank you for the wishes for mom. I hope too that the pleural effusion doesn't become a problem, have nightmares about how it used to be so bad for her.
Warm regards!