My spouse who had her left lobe removed January 2012 and was staged 2-3b NSLC changed to stage IV march of 2013. October she started Opdivo therapy blood work before the 5th treatment indicated her thyroid level was low and started taking medication for her low thyroid level 3 days after the 6th treatment she was not feeling well and I emailed her oncologist who said that her thyroid level w as still low and to c ome in to see him . She could not get into see him so she went to the urgent clinic and they did a chest xray or ct scan said she had Pneumonia or pneumonitis and to go to the emergency room
her oxygen level was 85 %. They out her on strong antibiotics and steroids. after a week in the hospital, she came home with supplemental oxygen using 6 to 8 parts per liter. Now after 14 days she is almost off using supplemental oxygen. They did a bronchoscopyand unfortuantely found cancer cells inside her lungs but no lesions My question is did Odivo do it's job and kill some of the cancer cells They mystery is inthe ct scans there is white fog like areas on her scans. Is it lymphatic spread? or something else.
Her pulmonologist called hospice in after sharing the results of the bronchoscopy . he also prescribed every two hours .25ML of morphine if required. I think the morphine and the oxygen has helped reduced the inflammation
The questions did the 6 treatment of Opdivo help hwat's this white appearance on her ct scans.
My thinking it's not good news the white cloudy areas as it's probably lymphatic spread.
Reply # - February 4, 2016, 09:38 PM
I forgot to mention her blood
I forgot to mention her blood level now is in the low 90's with just room air
2 parts per liter her oxygen level is 97-98%
Reply # - February 5, 2016, 01:39 PM
I'm very sorry your wife and
I'm very sorry your wife and you are going through this. It sounds as if her pulmonologist believes she won't recover enough to try another anti cancer treatment. When CT shows haziness in the lungs while taking opdivo it suggests pneumonitis which is basically pneumonia (inflammation) caused by the drug instead of a virus or bacteria. Steroids have shown to be helpful for many in this case though there's a balance to be found with ongoing steroid use.
It's possible for opdivo to have efficacy against the cancer and even an ongoing benefit has been shown for some months after stopping treatment. So yes it's possible and hopeful that she will continue to have regression and stability of the cancer.
It's never a bad idea to get a 2nd opinion from an lung cancer specialist with experience with immunotherapy drugs. This is an important blog post on the many good reasons why a 2nd is a appropriate. http://cancergrace.org/cancer-101/2011/11/13/an-insider%E2%80%99s-guide…
As for hospice, it's an excellent idea when someone has stage IV nsclc and not on anticancer treatment. They are the experts at living as long and well as possible, for both the person with cancer and those caring for her. If the pneumonitis reduces she has the option to quit hospice to start treatment.
We have a lot written on the subject of pneumonitis. http://cancergrace.org/search-results?q=treat%20pneumonitis%20
I will ask a doctor to reply on any new thought on the subject as it relates to opdivo specifically.
Best of luck and hopes,
Janine
Reply # - February 5, 2016, 02:41 PM
HI Halprint, thank you for
HI Halprint, thank you for sharing your wife's story and I am glad she is back home and feeling better.
I do not think I can tell you what is going on with her lungs or whether the Opdivo worked since I am not able to review her case and scans in detail. However, there are several things that can cause the issues she had, all of which you mentioned in your story.
The first thing we worry about when lungs have white or cloudy areas (they should be black on a scan) is infection (pneumonia), and antibiotics are the most important treatment. The second possibility in a patient with lung cancer is lymphangitic spread of the cancer; essentially the lymph channels of the lung get filled up with cancer and it looks very much like fluid in the lungs or infection. This would not get better with antibiotics or steroids, though, only with successful treatment of the cancer. Finally, in a patient on Opdivo we have to worry about pneumonitis, which is inflammation without infection but looks just the same. This happens 3-4% of the time with drugs like Opdivo and is treated with steroids, and usually will resolve.
It is also possible to have more than one of these happen at the same time.
Often there is no good way to differentiate these issues other than treat them and see what works. If antibiotics work, it was pneumonia. If not, try steroids and if they work, it is probably pneumonitis. If neither work it may be cancer.
Since your wife is getting better she may have had infection or pneumonitis. It sounds like her doctors, who know her best, have decided that she cannot get more treatment and have recommended hospice, and this may well be the best option but if you have doubts or questions I agree a second opinion at another center may be helpful to straighten out what is going on.