nivolumab - low blood count and joint pain - 1271211

Hi philly daughter, Joint pain is noted with nivo. I did a google search of nivolumab joint pain to find a quick answer to that without opening up any of the pages. FYI, google search for phrases or just main words such as nivolumab joint pain can be very useful. Another very fine and possibly the best resource for these questions is the investigating oncologist whose treating your mom. As Dr. Weiss has said the research oncologists provide the best care and have the most up to date info on the trial drugs they are testing, not the mention interest. So never hesitate to ask questions of these men and women.

I will ask our oncology pharmacologist to comment on your questions. I hope your mom gets relief from you symptoms and continues to do well on nivo.

All the very best,
Janine

Philly daughter, muscle pain (myalgia) and joint pain (arthralgia) was seen in about 2-5% of patients with lung cancer who received nivolumab in one of the large trials so this can be seen but was generally mild (less than grade 3). Targeted immune system inhibitors like infliximab (Remicade) can be used for serious autoimmune adverse effects to drugs similar to nivolumab but I would recommend trying to manage the pain with a more standard oral pain medication. I'm wondering if you mention the Embrel because your mother has an autoimmune disease in addition? If this is the case, autoimmune diseases can worsen with treatment of drugs like Nivolumab.

I will let the physicians further weigh in on the anemia, but if she has low iron (and subsequent anemia), then iron supplementation would be indicated.

Best wishes,
Dr. Walko

Just to clarify, Embrel is a drug that works to down regulate the immune system and is commonly used for autoimmune conditions that can cause joint pain, like rheumatoid arthritis. I have not seen it used for any of the side effects from the immune stimulating agents like nivolumab. There are many oral drugs that can be used for pain control so I definitely recommend asking your mother's oncologist, especially if the pain is starting to limit her activities. Quality of life is a big focus during therapy.

In terms of the Procrit, this is an excellent question. I'm glad to hear that she will be receiving iron infusions with the Procrit, this will definitely help correct the anemia. I actually wrote a post a while back about hematopoiesis and discuss drugs like Procrit a bit. Here is the excerpt from that post:
"The drugs are approved for the treatment of low red blood cell counts (hemoglobin less than 10 g/dL) due to chemotherapy in patients who are continuing to receive chemotherapy. There is a fair amount of controversy surrounding the agents because of toxicities and other findings in cancer trials. In some trials where the drugs were being given to achieve higher than usual hemoglobin values, there was an increased risk of cardiovascular toxicities and death. For this reason, it is recommended that the drugs not be started unless the hemoglobin is less than 10 g/dL and should be monitored closely. Additionally, a secondary analysis of some studies showed that the drugs may shorten overall survival and/or increase the risk of tumor progression or recurrence of disease. It is important to note that again these findings were seen in trials where higher than usual levels of hemoglobin were being targeted. Because the drugs do carry the benefit of decreasing transfusions, it is important to discuss your specific risks and benefits of the drug with your doctor who knows your own specific case".

Hope that helps,
Dr. Walko

Here is the post on growth factors I referenced above:
http://cancergrace.org/cancer-treatments/2012/04/13/hematopoiesis-and-g…