Keytruda question - 1292417

stevea
Posts:18

My wife's biopsy shows 70% PD-L1 so they are going to start her on Keytruda this week, my concern is she has been feeling terrible, fever, shortness of breath, fatigue. She stopped Tarceva 2 weeks ago and a recent bronchastomy revealed a tumor in her esophagus that didn't show on a Pet scan less then a month ago, the Pet only showed a 1.4 cm local recurrence nothing else, the only other metastases she had was a single brain met that was cyberknifed and has since had several clean MRI. They gave her antibiotics but they haven't seemed to help much. So my question is it ok to start her on Keytruda with her feeling this way or should they give her a chance to feel better first ?

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Reply # - September 17, 2017, 02:42 PM

catdander
Posts:

Hi Steve,

If the symptoms are from the cancer then it's not likely they will get better without treatment. I have a request into a faculty to take a look at your question and we should hear back by tomorrow.

I hope she is able to get started, with a high percentage of pd l1 her chances are good that it will be effective. Fingers crossed x!

All best,
Janine

Reply # - September 18, 2017, 07:08 AM

dr walko
Posts: 102

Stevea,

I'm glad to hear she has a high PD-L1 of 70%, this is very encouraging in terms of hopefully responding to the pembrolizumab (Keytruda). While traditional cytotoxic chemotherapy may not be started during times of suspected bacterial illness, the immunotherapy drugs like pembrolizumab work very differently. Unlike cytotoxic chemotherapy that often decreases the white blood cells involved in fighting bacterial illness, pembrolizumab does not have much negative effect on these cells. It works by allowing the lymphocytes to upregulate and recognize the tumor. Lymphocytes are still involved in fighting infections but in this case, Janine made a great point that some of the symptoms may be due to the cancer itself and may improve if there is response to the pembrolizumab.

Hope she is feeling better soon, best wishes,
Dr. Walko

Reply # - September 20, 2017, 11:39 AM

stevea
Posts: 18

Thanks for the reply, i ended up taking her to the ER to get her checked and she has obstructive pneumonia, shes being treated in the hospital and her Oncologist said as soon as shes better they will start treatment. Thanks

Reply # - October 4, 2017, 11:50 PM

stevea
Posts: 18

Dr. Walko,

My wife has been in the hospital for over two weeks now battling obstructive pneumonia , they placed a stent in her bronchial tube to open the airway and she has been on oxygen and antibiotics since she arrived, our regular oncologist has been on vacation but the Oncologist that is covering for him told us that they would not give my wife any treatment until she was able to walk in their office on her own to show she was strong enough, well my problem with that is she hasn't had any cancer treatment since middle of august and who knows how long this pneumonia will take to get better, frustrating that she has this opportunity to potentially do well with Keytruda but she might not get the chance. But if I understand your earlier post she should be able to start the Keytruda without potentially harming herself, is this true?

Steve A

Reply # - October 5, 2017, 11:12 AM

JimC
Posts: 2753

Hi Steve,

Although you may want to discuss this with the oncologist, I think the concern may be that for some patients Keytruda can cause pneumonitis, which can become life-threatening. The Keytruda prescribing information suggests discontinuation in moderate cases and permanent discontinuation if it's severe. With her lungs already compromised by the pneumonia, it may not be a risk worth taking.

JimC
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Reply # - October 5, 2017, 11:40 AM

catdander
Posts:

Steve,

I'm so sorry your mom is still in the hospital. We aren't able to say whether or not your mom is well enough to withstand treatment. The fact that she's still in the hospital suggests she's not strong enough to withstand any form of anti cancer treatment. What Dr. Walko said was immunotherapies like keytruda don't lower white blood cells like typical cytotoxic chemotherapy. However all of our systemic anticancer therapies have side effects that can greatly effect healthy people not to mention the health of one who is so debilitated as to need round the clock care.

There is a pulmonology specialty called interventional pulmonology that specializes in these types of problems. I wonder if you mom has been seen by one of these specialists or if she has access to one in the hospital where she is. If not perhaps a pulmonologist who sees a lot of lung cancer would be helpful.

I hope she is comfortable and better soon.
All best,
Janine

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