Imfinzi/Pleural Effusion ?

[Staying Hopeful]

Hi - my 83 year old Dad has Stage 3 NSCLC - adenocarcinoma.  He had 60 gy radiation/30 tx, and 4 weekly carbo/taxol chemo treatments. He was in really good shape for an older person prior to this.  Before Covid, he would go to the gym 3x/week.  They were short workouts, but he was going!  He was definitely slowing down and showing his age, but you wouldn't have guessed he was 83.

Originally he was to have a bilobectomy, but during surgery they realized the tumor extended into the RUL and didn't proceed as they didn't think he could handle whole lung removal (he's strong, but 83 strong is still 83).  Huge disappointment of course. IDK why they couldn't see that BEFORE they went it. The worst part of that was he still had to recover from the thorocotomy, which he thought was to be VATS, but the 6 inch+scar and the surgeon's report to not bear that out. IDK how there was a disconnect as he and his wife made all surgical arrangements. This is actually something that drives me crazy regularly, but I am trying to let it go as it does not change where we are now.  He's never fully gotten his strength back, but was making huge improvements in March.

Anyway, he had his first Imfinzi treatment a week ago Tues. and beginning Sun morning he felt awful - increasing SOB, so weak he was using a walker, NO appetite (and it's a lousy appetite to start with).  I finally convince him he needs to see the Dr. I made his appt. on  Tues for Wed., he also had CT scan today.  CT scan shows pleural effusion he will need drained. Dr. (really the PA) says he thinks the effusion is causing his increased SOB, cough and general overall malaise.  It's not clear whether they think the Imfinzi caused this.  I haven't yet directly spoken to his Dr. about this as I did not take him to these appointments and they called him directly with the CT results. (I live about 1200 miles away - spent 4.5 months with him but came home end of March).

Wondering if anyone has heard of Imfinzi side effects happening so quickly and extreme.  Pre-Imfinzi, the Dr. mentioned side effects, but said the would be immune related - eg pneumonitis, colitis, thryroid, etc.  No mention of effusion nor flu-like feelings to be expected.  Apparently prior to the actual Imfinzi infusion, the PA DID mention flu-like symptoms could be expected, so very different than what the Dr. had said when my Dad said he'd give the treatment a chance.

Sorry for the ramble - if you've made it this far, thanks!

[LexieCat]

Hi, Hopeful,

I'm not that familiar with Imfinzi side effects, but there's a VERY long thread here on Durvalumab (also known as Imfinzi). https://forums.lungevity.org/topic/44842-durvalumab/ You might want to go through that thread and see if there's any relevant info. We have a few members on Durva/Imfinzi, so hopefully you will hear from some of them.

 

[Staying Hopeful]

Hi Lexie - thank you for replying!  I actually went through ALL 55 pages last night - not that I read each post..lol.  I saw a couple of effusion mentions, but nothing that happened so fast.  I'm trying to understand if this is Imfinzi related, or was building unrelated. Prior scan from 6 weeks ago says 'small loculated pleural effusion', and there was also a mention of it back in early  December.  His cough, which used to be wet and horrendous was down to dry and minimal for some time, but had been ramping up a bit the last few weeks,  But there seemed to be an explosion of blah (non medical term) on Sunday.

It's all so confusing. I thought I had a pretty good handle on the medication part of things, but this is throwing me.  I mean, you knew what chemo side effects were coming and when, this is all new.

Thanks for having a space where I can ask!

 

 

[Tom Galli]

Hopeful,

Welcome here.

When I faced my first lung cancer surgery, I well recall my surgeon saying if he discovered more cancer than shown on scans, he would stop the surgery. I'm surprised your dad's surgeon didn't mention that point. It seems to be a standard in lung cancer surgery.

A pleural effusion can occur for many reasons. The effusion happens in the pleural space--the exterior of the lung wall and interior of the chest wall tissue. His scan noted a small effusion, but they can enlarge quickly. It is a common symptom for lung cancer patients and when drained, I bet a lot of your dad's symptoms will be relieved. It can be very hard to breathe with a pleural effusion so I think your dad's doctor is correct in saying SOB, cough and general malaise is likely caused by the effusion.

I've not had Imfinzi during my treatments but I'm sure others who have will be along to add their explanations.

Stay the course.

Tom

[Staying Hopeful]

Thank you so much for your response, Tom. I wasn't personally involved in the conversations pre surgery, but my Dad and his wife both seemed shocked by the thorocotomy, so I'm not sure what the heck happened.

Tnorocentesis (sp?) scheduled on Tuesday. So glad to know substantive relief can be had for him. 🙏 fluid is not malignant, but I guess one thing at a time. 

I've read your story.. very inspirational and so glad oate doing so well for so long!