One month NED. Now back to the fight again.

[LMighty]

Hi everyone,

My 64 year old mother went through 6 rounds of xelox plus avastin to treat her invisible lung mets (no visible tumor, only found adenocarcinoma cells in pleural fluid). After one month of being happily NED (with 2 rounds of xeloda plus avastin as maintenance) the pleural fluid accumulates again.

600 cc of yellow cloudy fluid was drained. Test shows presence of adenocarcinoma cells. We are going to meet the onc tomorrow and we expect another round of painful chemo would be underway.

It's like fighting an invisible enemy in the dark. There is no visible tumor or nodule shown on even the PET scan we did a month ago, but the fluid just comes back. Very frustrating

Right now we really have no idea what to expect. Does this mean the chemo is not working? Will the fluid ever go away despite the absence of visible tumor?

[stu]

Hi,
I can not answer some of your questions and it must be difficult to tackle something that you can't see. But I thought I would bump this back up so others might be able to help you.
I would say though my mum had a few bumps along the way but seemed to keep going.
Take care
Stu

[DarknessEmbraced]

I'm so sorry your mother is going through this and hope her chemo goes well!*hugs*

[LMighty]

Hi guys,

Thanks for your kind words.

We met the onc yesterday to decide our next steps.

Unfortunately in terms of curability (if any), he said my mom's condition is less favorable than visible tumor because there is no localized resectable target. Still, we have the solution that is redoing pleurodesis, which will prevent pleural fluid from accumulating IF done perfectly. He also mentioned that a perfect pleurodesis would have sort of "preventive" benefit, as it eliminates space for malignant fluid accumulation which may lead to tumor development. It certainly does not mean that the disease won't progress in other ways, but we will take it if it at least means permanent or long-term elimination of pleural effusion.

The pleurodesis will be done in weeks once X-ray shows "sufficient" accumulation of fluid -- after the fluid is drained of course. We will then take a 2-month break starting today before she undergoes the coming rounds of Irinotecan + Avastin + Xeloda. Finger crossed the cancer does not progress during the break and the new drug works better than Oxaliplatin. I try to be optimistic. It is really tough enjoying only one month of NED and having to watch her going through the ordeal again

[stu]

Hi ,
I will be thinking of your mum as she faces the next procedure.
I hope she enjoys her two months off. It will build her up nicely. My mum had quite long gaps without chemo. We are more inclined to do that over here. Quality of life balance but it works out ok.
Take care,
Stu

[dianetavegia]

A quick thought, and I'm no expert on this, but my understanding is that Avastin cuts off the blood supply to tumors. I never understood oncs ordering Avastin if there is no known tumor.

The fluid is called ascites.

Best of luck to your mom.
Diane

[Achilles Torn]

My understanding is that Avastin prevents tumors from growing new blood vessels. For even a tiny group of cancer cells to grow they need to form blood supply....even if these cells are not visible to scans.

Cheers
AT

[LMighty]

Thanks for all your responses.

When we met the onc again two days ago he seemed to have changed his expectations -- after reconsideration he said we may not start another round of chemo so soon, meaning the 2-month break may become a longer one. My mom is now on observation. Chemo will be "reserved" for in case of further progression in view of her rather poor marrow reserve after Oxi. Scan to be performed in 2 months. Regardless, we will drain the fluid from the lung and redo a pleurodesis soon.

The coming 2 months is going to be pleasant and frightening at the same time. I really hope all the recurrent effusions are just some pseudoprogression