Clot in heart and increased lung mass with suspected pneumonia, chemo okay?

Portal Forums Cancer Treatments / Symptom Management Conventional Chemotherapy Clot in heart and increased lung mass with suspected pneumonia, chemo okay?

This topic contains 4 replies, has 3 voices, and was last updated by  bh 1 year, 10 months ago.

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January 9, 2016 at 6:57 am  #1272515    

bh

Mom has been on a chemo break since September of 2014, the latest CT was in September 2015 and she was asked to return in 6 months for a check up. She started having breathlessness, took her in on December 29th and she was on IV lasix for suspected congestive heart failure and sent home. I suspected the cancer was back as it was exactly in the same fashion she had been diagnosed in 2011 – first suspected heart failure then treatment for pneumonia then the cancer diagnosis. She became breathless again two days ago and was admitted to the hospital on Thursday. The CT now shows a lung mass in her right lung and a clot in her heart. Echo study to be done on Monday to determine size of clot. They are continuing to treat her with vancomycin and zosyn for pneumonia but after a talk with her onc, mom will be starting Alimta again on Monday with Lovenox injections instead of Coumadin.

Is it safe for her to continue to be on the antibiotics while re-starting Alimta? Onc suggested trying Keytruda but mom has responded well to Alimta – cancer free for a year the first time and cancer free for more than another year after her second chemo rounds with Alimta. Doc agreed we could try Alimta again. Any thing better about Keytruda?

Thanks, any info will be gratefully appreciated.


77 yr old mom, never smoker, ER on 9/1/11 for breathlessness, diagnosed with malignant pleural effusion 9/8/11, stage 1V bronchiogenic adenocarcinoma of the lung. Tarceva 9/24/11; 4th thoracentesis on 9/26; diarrhea & nausea on 10/5 with rashes EGFR & ALK tests negative 10/7, stop tarceva 10/8, ER – 10/13, 5th thoracentesis, renal failure 10/15 – blood transfusion 10/27; Alimta, well tolerated; 11/9 stroke – lost right side and speech, 4/3 – hospitalized sugars of 803 due to decadron, 4/7 seventh round of Alimta with ongoing rehab for stroke. CT of 6/24/13 showed recurrence, re-start Alimta 7/11/13.On and off Alimta since 2013, usually NED and off chemo for periods of no less than 8 months to 14 months. Recent re-occurrence- Jan 2016, Alimta from Jan thru April 2016, NED April 2016. Re-occurrence of cancer Jan 2017, re-started Alimta. Tested positive for ROS1 June 2017, appt with onc to discuss future tx plans.

January 9, 2016 at 7:52 am  #1272518    
JimC Forum Moderator
JimC Forum Moderator

Hi bh,

I don’t see any problem with continuing antibiotics while on Alimta. When my wife was receiving a combination of Alimta and Tarceva, she used Bactrim to treat the skin toxicities. On the other hand, given the lung mass and clot, you may want to discuss with her oncologist whether she actually needs those antibiotics. It is possible that her imaging and clinical factors point to a simultaneous case of pneumonia.

It’s not unreasonable to return to Alimta after the lasting success your mom has previously experienced with it, although many oncologist would prefer to switch to something new. There just isn’t a right or wrong answer. The problem with Keytruda is that immunotherapies tend to take longer than chemotherapy to show anti-tumor effect, and are only effective for a subset of patients, those you will want to discuss those issues with her doctor as well.

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

January 9, 2016 at 8:05 am  #1272520    

bh

Jim, how are you doing? Happy New Year!

What is simultaneous pneumonia? I looked it up but didn’t see anything about antibiotics relating to that?
They did a respiratory culture to check and we don’t have the results yet.
Do you know about the efficacy of Tagrisso as compared to either Alimta or Keytruda?

Thank you so much for the prompt reply. I have been sleepless trying to figure out the pros and cons of continuing antibiotics.

Bee


77 yr old mom, never smoker, ER on 9/1/11 for breathlessness, diagnosed with malignant pleural effusion 9/8/11, stage 1V bronchiogenic adenocarcinoma of the lung. Tarceva 9/24/11; 4th thoracentesis on 9/26; diarrhea & nausea on 10/5 with rashes EGFR & ALK tests negative 10/7, stop tarceva 10/8, ER – 10/13, 5th thoracentesis, renal failure 10/15 – blood transfusion 10/27; Alimta, well tolerated; 11/9 stroke – lost right side and speech, 4/3 – hospitalized sugars of 803 due to decadron, 4/7 seventh round of Alimta with ongoing rehab for stroke. CT of 6/24/13 showed recurrence, re-start Alimta 7/11/13.On and off Alimta since 2013, usually NED and off chemo for periods of no less than 8 months to 14 months. Recent re-occurrence- Jan 2016, Alimta from Jan thru April 2016, NED April 2016. Re-occurrence of cancer Jan 2017, re-started Alimta. Tested positive for ROS1 June 2017, appt with onc to discuss future tx plans.

January 10, 2016 at 5:22 pm  #1272541    
catdander forum moderator
catdander forum moderator

Hi Bee, I hope your mom is feeling alright. Simultaneous pneumonia just means that cancer and some type of pneumonia are happening at the same time.

In your mom’s case it may be they find that what they thought to be pneumonia is the cancer. They will most likely be able to determine whether she has both or cancer only.

Tagrisso is given for lung cancer with an egfr mutation that has acquired a resistance to tarceva. Since your mom doesn’t have a mutation it’s not an option.

The following 2 quotes are from the FDA and explain that Keytruda is approved for those with a PD-L1 expression while Opdivo, a similar drug has been approved without testing. However they both seem to be most effective for those with the pd-l1 expression.

“The U.S. Food and Drug Administration today granted accelerated approval for Keytruda (pembrolizumab) to treat patients with advanced (metastatic) non-small cell lung cancer (NSCLC) whose disease has progressed after other treatments and with tumors that express a protein called PD-L1. Keytruda is approved for use with a companion diagnostic, the PD-L1 IHC 22C3 pharmDx test, the first test designed to detect PD-L1 expression in non-small cell lung tumors.” http://www.fda.gov/newsevents/newsroom/pressannouncements/ucm465444.htm

“The U.S. Food and Drug Administration today approved Opdivo (nivolumab) to treat patients with advanced (metastatic) non-small cell lung cancer whose disease progressed during or after platinum-based chemotherapy.” http://www.fda.gov/newsevents/newsroom/pressannouncements/ucm466413.htm

I hope your mom does well on Alimta for a good while.

All best,
Janine

January 11, 2016 at 6:35 am  #1272546    

bh

Hi Janine,
Thank you for the detailed response. So very happy to know your husband remains NED. Good wishes to both of you.
Mom is home, they discharged her last night with a Lovenox prescription, robitussin, and provair for her cardiac asthma. Her renal failure reversed and the hospital sent her home. She had an episode of cardiac asthma (?) yesterday morning and they restarted lasix to flush out the fluids. She starts Alimta this afternoon. She is resting well, sleeping soundly in her own bed so keeping my fingers and toes crossed. In the meantime, will do more research about the new drugs. Thank you so much again.
Bee


77 yr old mom, never smoker, ER on 9/1/11 for breathlessness, diagnosed with malignant pleural effusion 9/8/11, stage 1V bronchiogenic adenocarcinoma of the lung. Tarceva 9/24/11; 4th thoracentesis on 9/26; diarrhea & nausea on 10/5 with rashes EGFR & ALK tests negative 10/7, stop tarceva 10/8, ER – 10/13, 5th thoracentesis, renal failure 10/15 – blood transfusion 10/27; Alimta, well tolerated; 11/9 stroke – lost right side and speech, 4/3 – hospitalized sugars of 803 due to decadron, 4/7 seventh round of Alimta with ongoing rehab for stroke. CT of 6/24/13 showed recurrence, re-start Alimta 7/11/13.On and off Alimta since 2013, usually NED and off chemo for periods of no less than 8 months to 14 months. Recent re-occurrence- Jan 2016, Alimta from Jan thru April 2016, NED April 2016. Re-occurrence of cancer Jan 2017, re-started Alimta. Tested positive for ROS1 June 2017, appt with onc to discuss future tx plans.

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