My wife was on Tarceva until we started to notice her white blood cell count was elevated. CT confirmed that her cancer has progressed with multiple tumors/nodules in her lung and enlarged lymph nodes. Her white blood cell count was 12 K on April 4. It was 33 K on June 17, before she was given the first infusion of Keytruda. She was tested PD-L1 positive (80%, intensity 3) and was prescribed pembrolizumab 2 mg/kg every 3 weeks. Her white blood cell count was 56 K yesterday on July 6, before she received her second infusion. About 70% of her white blood cells are neutrophil. Only 5% are Lymphocyte. What worries me the most is the speed her white cell count increases. It increases 7 K in one day, from 49 K on July 5 to 56 K on July 6.
She was put on antibiotics for 10 days in June. It did not change the trajectory of the white cell counts. My understanding is that white blood cell count over 50 K is termed as paraneoplastic leukemoid reaction. I was hoping that Keytruda could stabilize the white blood cell count and her cancer. Three weeks after one infusion, the WBC count continues to increase at a rapid rate. Our oncologist had never seen this kind of cases before, as I read that they are not very common. I would like to know if any physicians or patients had similar experience and/or know the proper course of action/treatment.
As a side note, I planned, three month ago, a 10-day family vacation in Europe, including a 7-day cruise. We were about to start the trip tomorrow. Given my wife's condition, do you think we should cancel the trip?
Thank you so much!