Docetaxel - 1248257

Sat, 09/22/2012 - 03:56

My husband is having Docetaxel as 2nd line treatment for lung cancer. Since starting it he's been very short of breath.

Around day 3 of each round he's suddenly developed a temperature found himself struggling to breathe and has had to be rushed to hospital to be given oxygen and treated for a chest infection. (He's having GCSF injections for 3 days following the chemo to help his white blood cells.) The oncologist gave him less chemo this last time because of the previous 2 infections but he still got another one.

Is constant shortness of breath and repeated chest infections common with Docetaxel? ( I read on the internet about pneumonitis and it got me worried)

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christineleeds

DearJane
Pneumonitis is something you get after radiation but several weeks after not 2 years so I don,t think it will be that.Sounds like repeated chest infections following chemo and low blood counts but again day 3 of the round seems very quick.Blood counts do not go down that fast.Is it possible that they are not really getting rid of the infection each time just calming it down and that is why it comes back so quickly.Certain Spring has experience of chest infections and the need to know exactly what infection one has and she may post on this.
Regards
Christine

catdander

Janet, I'm sorry to hear your husband is having these problems. I can imagine how stressful it is.

Like Christine said it sounds like he's not really getting rid of it.

Dr. Wiess wrote about it, pretty much saying what Certain Spring figured out on her own,
"I do not have any great insights but I can share a little of my thinking about infections in the hope that it helps. When empiric therapy doesn't cure infection, the standard approach, when possible is to obtain cultures (sputum or bronchoscopy) to identify the bug and test which antibiotics it will be susceptible to. Consultation with a pulmonologist and infectious disease doctor may be helpful in the case of challenging pulmonary infections". http://cancergrace.org/forums/index.php?topic=3410.0

Janine
fm

janetintheuk

Thank you very much for the very helpful replies...I feel better knowing it's probably not pneumonitis. (I didn't realise people got it after radiation--I thought it came from just the Docetaxel. )
Looking now as though it is a chest infection, maybe pneumonia which suggests they didn't perhaps get rid of the initial infection a few weeks ago and the subsequent one.

certain spring

Hi Janet - I'm sorry your husband had to drop the Tarceva, though glad in a way as he was obviously having a horrible time with it.
Breathlessness and chest infections are common in lung cancer full stop, unfortunately - sometimes the tumour forms a blockage behind which bacteria can collect (as in my own situation). Your husband may be particularly vulnerable because chemotherapy depresses the immune system. However, hopefully they can blast this one with antibiotics - there are lots of different ones they can try. A sputum sample (which should be done first thing in the morning) can help to identify which bacterium is causing the infection, and therefore which antibiotics have the best chance of helping. I would suggest being quite pushy about getting one done (perhaps get the GP onto it?) as you want to knock these infections on the head as soon as possible. Full-blown pneumonia (high temperature, chills, nasty productive cough with green or yellow sputum, breathlessness, sometimes pain in the affected lung) tends to weaken a person, quite apart from being uncomfortable and unpleasant. Best wishes to you and your husband.
I

Dr West

It's not common, but I have heard of some patients developing transient shortness of breath with it. It would lead me to want to follow the patient very closely and repeat a scan promptly, likely after two cycles, to clarify whether the treatment is helping or whether progression may be contributing to symptoms.

Good luck. We'll be eager to learn more when he has more follow-up.

-Dr. West

janetintheuk

Thank you certain Spring and Dr West.

The shortness of breath was much worse on this last occasion, and despite oxygen, he was really struggling to breathe in the ambulance on the way to hospital. The hospital think the breathlessness this time was so severe because his heart specialist had recently taken him off digoxin and his heart rate was far too fast. (There didn't seem to be any liason between the heart specialist and the oncologist when this was done)

He's now much better and is being treated for pneumonia (and back on the digoxin)

He's due to have round 4 of Docetaxel in a couple of weeks, maybe they'll delay it or scan him first. I'm dreading yet another chest infection after the chemo.

He has squamous lung cancer and since he can't have Tarceva he's running out of options if Docetaxel has to be stopped.

certain spring

Your poor husband. It is very upsetting being breathless - and almost as upsetting for the person who's there with you. I am glad he is feeling better now.
Hopefully he will get on better with the Docetaxel next time round. However I completely recognise that feeling of "There's nothing else". We aren't very good with clinical trials for lung cancer in the UK, but there are some new ones specifically for squamous, depending on where you live - and, of course, whether your husband feels he would like to go down that road.
Re the cardiology/oncology non-communication, my GP has been really good at coordinating the various aspects of my treatment. She will get on the phone and talk to the consultant if necessary. It really helps take the strain off me.

janetintheuk

Hi Certain Spring,

Thank you for the info on clinical trials--I'll see what I can find out.
The doctors are looking at my husbands recent x-rays on Wednesday to try to find out why he's having these repeated infections and to see if there is a possibility of sucking out the infection/blockage? (I'm not quite sure what they might be able to suck out) out with a bronscopy on Thursday.

I thought the infection was in the lung that has the tumour, but my husband says it's in the other lung. But I'll know more on Wednesday. In the meantime he's coming home for part of each day returning to the hospital in the evenings.

You mentioned that sometimes the tumour forms a blockage behind which bacteria can collect and this happened in your situation. Were the doctors able to do anything to help? You've really been through it with collapsed lung and pneumonia.I do hope the Tarceva is working for you.

certain spring

They can suction out the infected mucus with a bronchoscope - this makes it easier for the antibiotics to work. That is what they did for me with the pneumonia. But they need to know what the offending microbe is so as to treat it with the right antibiotics. I think if I were in your situation I might inquire what information is coming back from the lab.
I do not know if your husband's heart condition might rule him out from participating from trials, but there is a worldwide trial coming up for Ipilimumab (Yervoy), a new drug described by Dr West as "promising, particularly in squamous cell carcinoma, though the results aren't electrifying". The placebo arm is chemotherapy (but not Taxotere). Its trial identifier number is NCT01285609 and it will be recruiting in Dundee, Truro, Guildford, Nottingham, Sheffield and Southampton. I would post the link but the UK clinical trials site (www.http://www.ukctg.nihr.ac.uk/) appears to be having some kind of nervous breakdown today.
Thank you for what you said. I have been lucky in that the Tarceva has worked very well for me, though I know it will not last.

janetintheuk

So pleased the Tarceva has worked well for you. My husband felt it was helping him (for the short time he was taking it) but the painful rash ruined his quality of life. Maybe before long there will be something to successfully counteract the rash --- and some way of enabling the Tarveva to work indefinitely. It sounds an amazing drug for those people who do well on it.

My husband's infection is in the lung that has the tumour. We found out today it's a deep seated bronch-pneumonia that will take 4-6 weeks to get better. The doctors are not going to do a bronscopy now 9I don't know why) but put a stent in my husband's vein (not quite sure where it will go--his lung?) to help his breathing. (probably in the next few days) but I don't know if he'll be told he has to take a break from the Docetaxel while he recovers from the infection, but I suspect he will. He's due for a fourth round in a couple of weeks.

Thank you so much for the news on the drug trial. I'll look into it.

certain spring

It's generous of you to say that. I feel guilty about it sometimes - there's a whole category of people who, like your husband, find the side-effects of Tarceva impossible to tolerate, and that seems very unfair.
Pneumonia really takes it out of someone. I imagine they will hold the docetaxel until the infection has cleared up. I think if you were going to get a second opinion or find out about trials, this might be a good time to do it, while there is a pause. My initial treatment was so chaotic and hand-to-mouth that I had no chance to step back and work out what was going on.
Not sure which kind of stent this is - if it's in a vein, that sounds as if it's something to do with your husband's heart; but if it's to help him breathe, it will be in one of the tubes going down to his lungs. I have a stent in my left bronchus - a small piece of plastic which has proved very useful.
Did you know you can do a forum signature, showing your husband's history and treatments so far? You fill in the box (not the one saying Biographical Information, the one saying Forum) on your Profile page, accessed via your user name or avatar. It helps the doctors to see a summary of what's going on. Here the wonderful Mark explains how to do it:
http://cancergrace.org/topic/grace-site-tips-profile-bio-forum-signature
Best wishes to your husband for a good recovery.

janetintheuk

I think it will be a stent in his lung if it's to keep the airway open.

I'll update my forum signature. I have one showing at the end of my posts but it doesn't mention this latest development.

certain spring

Sorry, that's my fault - I didn't see it for some reason. Best of luck with the stent.

Dr West

Right, the idea is that it's very easy to develop a pneumonia when the airway is blocked and the lung can't get air (called a post-obstructive pneumonia). It's like standing, stagnant water, so if the airway can be opened with a stent, that can help clear the infection.

-Dr. West

janetintheuk

Turns out the stent is going into a vein. Scans and X-rays taken over several weeks show there's a blockage .This is causing a fluid build-up in face and ---since yesterday---my husband's hand. I'm guessing it's also contributing to shortness of breath.

Dr West

Yes, that sounds like superior vena cava (SVC) syndrome, which isn't rare in people with lung cancer. Sounds like an appropriate intervention -- I hope it works. Good luck.

-Dr. West

janetintheuk

Thank you. Dr West and Certain spring. Followed the link and read the post --very helpful
This worries me though: "It’s been reported that SVC syndrome in the setting of NSCLC is associated with a worse prognosis."

catdander

I know how disheartening it is to read a statement like that.
When it comes to my husband's cancer I've read it and heard it many times and even seen it in the faces of health care pros.

I've always been one to play the odds, to enjoy a game of poker, I've always tried to balance my spending with what I'll get out of it. My brain works very methodically. As a matter of fact it was a sticking point with my ex. (your so d rational) :-| Strangly enough, enough that I noticed it almost immediately, all that turned on its head when D got sick, when told prognosis isn't good for this or that my mind has gone to winning against the odds. We've been lucky so far. But hearing it or reading or seeing it doesn't keep my heart from falling.
Those stats that you've read are only a range of outcomes. Your husband can fit anywhere on that spectrum.

I hope he will beat those odds really means I expect he will beat those odds.
Hoping for the best,
Janine

btw, cs does have the rare case of squamous with the egfr mutation. I believe the tissue was double checked for that.

Dr West

Those are general observations in populations, and there is a great deal of variability in how individual patients actually do. I have many patients who have done well overall despite developing an SVC syndrome somewhere along the way.

-Dr. West

1813r

My husband had same problems after docetaxel, had antibiotics, then bronchoscope which showed pneumonitis. Given steroids and then chemo with taxotere. Another hospitalization, bronchoscope, pneumonitis and steroids again. He is now home, still on steroids and oxygen 24/7. Very fatigued and short of breath. Now sure what happens next. Tarceva had previously caused a bleeding ulcer. We see pulmonologist and oncologist next week but think we are running out of options. Has anyone overcome this pneumonitis problem and still co tinned chemo to contain the cancer?

Dr West

We'll have a new podcast that covers chemotherapy-induced pneumonitis within the next few days, so look for that being posted soon.

-Dr. West

1813r

Thank you,, caldander. Your referal was very helpful. I guess I am just frustrateed since my husband has been on steroids since August 21st and he is not much improved with negative steroid effects. I just keep asking him if he would rather breath or walk.....

I look forward to your podcast, Dr. West as I am always learn more.

Thank you.