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TB with lung cancer??

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We went to my husbands scheduled 5th Tecentriq immunotherapy appointment today and to get his scan results- 1st there are new growths - but the more alarming issue was the doctor came into the room with a mask and a mask for my husband and said he had the pulmonary doctor review my husbands scan and they believe he may have tuberculosis???? 

Has anyone ever heard of this? He claims it would have come from chemo/immunotherapy?? Any info would be greatly appreciated.

He has SCLC extensive- with brain mets. 

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I’m not a doctor and don’t know a lot about this. I do know the Tuberculosis can lay dormant in a person.  I don’t think chemo treatments can cause TB.  I imagine the treatments affected his bodies ability to continue to repress it and it is no longer dormant.  I use to have to get tested annually for TB with a PPD test for my job.  My test would always come back positive and I would have to get cleared by a chest X-ray.  The doctors were never concerned because they said I had no signs of active disease based on the X-Rays, but apparently I had been exposed to TB at some point.  When I first started tracking the lung nodule they tested me again for TB to be sure the spot wasn’t caused by that.  It came back negative.  I haven’t had to have chemo so I don’t know if I would encounter similar issues.  

TB is treated with antibiotics and is curable in most cases.  I hope your husband gets better soon and can complete his chemo and immunity treatments.  

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Thank you. He has completed his first round of chemo back in January, he is on Tecentriq for maintenance. He is a firefighter, he has been tested for that and was negative.

I appreciate your response- I will say the nurses didn’t make it seem like it is was going to be easy peasy if he is TB active disease, she made it seem like it cane with a lot of extra treatments etc. 

thank you

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I wouldn't know about immunotherapy and TB. I've read those with TB have an increased risk of developing lung cancer but there is little literature on TB and immunotherapy.  After all, immunotherapy lung cancer treatment is a relatively new treatment.

What is the plan for dealing with the new growth?

Stay the course.

Tom 

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Thanks Tom - according to his doctor, no plan. He doesn't think it is urgent.

I disagree. Now I don't think he should do anymore chemo - not in his condition - but I think a conversation should be had, about prognosis.

This is what his CT scan says for Slide 2 - New nodularity in the nondependent portions of the bilateral bronchi - possible endobronchial metastatic lesions. I am not a doctor - but that doesn't sound good.

There are the following new growths -  11mm, 5mm and 2.6 cm. The 2.6com was 2.2 on 1/18/2019.

I have called the patient advocacy line - I need someone else on their team to look at his chart - I have zero confidence in his oncologist. He says something different every time I talk to him. And I mean in the SAME day - he has said contradicting things.

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No since he was literally just informed yesterday. And I am saying his oncologist doesn't seem to know anything about his lung cancer. And he should know that right?

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I have contacted the patient advocate service at Fox Chase, so hopefully they can help. This oncologist has been an issue since the beginning. 

And I hope someone visiting this site has heard of this. Of all of my detective and dr. Google work and research, I had never come across TB - coming from chemo.

Thank you for all of your responses.

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It was difficult to find any information.   A lot of what is online is related to treating TB with chemo.  I was able to find this article https://www.sciencedirect.com/science/article/pii/S2212553115001090

I hope you find some answered soon.  

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This is also just a report of a single case, but it involves small-cell cancer and the outcome was encouraging.   So continuing with chemo and antibiotics at the same time seems feasible; don't know to what extent immunotherapy might be different.

https://www.jto.org/article/S1556-0864(15)34997-2/pdf

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When I was originally diagnosed with Limited SCLC, present at the Tumor site was a number of opportunistic bacteria. The more serious among theses was Non Tuberculosis Mycobacteria Avium Complex - This is a relative of the TB germ but is non contagious, though it presents with similar symptoms. I had originally been tested for TB which was negative. 

Many people carry this bacteria but it never becomes an issue as their immune system is strong and keeps it under control.  I as told that it had become an issue for me because the cancer had compromised my immune system enough for this “MAC Lung Disease” to take hold. As a result a decision was made to treat it concurrent with my cancer treatments. I was on 3 high dosage antibiotics concurrently for over a year. I’m currently disease free (MAC Lung disease). Though I’m being treated now for a local recurrence of SCLC, the MAC Lung did not return. 

Not sure if this is helpful, but figured I would provide.

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Leo it is helpful, I appreciate it. He has completed his first line chemo in January and is only on Tecentriq as maintenance. We should have the results Monday, and they did say if it isn’t Tuberculosis, that it would be that MAC disease.

just worried as he is extremely underweight now and I have heard that these antibiotics have side effects. 

Did you have any side effects from taking them? 

 

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And just to note he has had no symptoms whatsoever. His scans just stared showing this weird fungus or infection. Up til now the only thing on his scans was the cancer. 

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I did not really have any ongoing side effects from the antibiotics.

I took the meds every Monday, Wednesday and Friday of each week as follows 

3 Ethambutol tablets at 400 mg each tablet 

2 Rifampin at 400 mg each tablet ,

1 Azithromycin 500 mg. 

I was advised to get an eye exam prior to treatment and then have the eye test redone every 3 months. I did have 2 instances of light sensitivity outdoors ..it was like my eyes were not adjusting fast enough to bright light. But that was it . I was taking these medications throughout my Chemo/Radiation and PCI . 

National Jewish Health are the preeminent experts in this disease among others. They are based in Denver. Link below. 

https://www.nationaljewish.org/treatment-programs/directory/ntm

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Update - my husband is negative for TB and MAC disease. Still don’t know what is going on, DR has to call us tomorrow to discuss the rest of  his results. Still have an appointment with the pulmonologist- although I am not sure why if those tests were negative. Hoping to get some clarification tomorrow. Tumors are enlarging and there are new nodules - so feeling like it is progressing, despite the immunotherapy. Again, not surprised by this - as from what I understand this is oretty typical for SCLC.

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Well, glad he doesn't have TB--that's one less complication to worry about.

Pulmonologists are the lung experts--that doc is probably the one in the best position to figure out what's going on, beyond the cancer.  

Keep us posted--hope you get some helpful info soon.

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Thank you!

Question - Is it possible "because they can't rule out that it is cancer" (which by the way I thought was the most ridiculous thing his oncologist has ever said - well duh dude -  he has lung cancer!!!!) - that it is just more cancer and they are just trying to rule out an infection?

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I imagine it's possible.  And there are lung conditions other than infection that might benefit from treatment.  

I think those are questions for the pulmonologist.  Tell the docs what you are confused about--insist that they explain what they are looking for and what they are concerned about, and how any of those possibilities might impact the ongoing treatment or response.  I think doctors always want to know what is going on with the patient, regardless of whether it's directly related to the cancer or not.  It could be something related to the treatment, which needs to be reported for future investigation/research, or something related to a person's prior medical history.  There is still so much unknown about cancer and about why/how certain patients respond (or don't) in certain ways, I think all information gathered is valuable in terms of improving treatment.

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