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Onto 2nd Line Treatment... hoping for better response


Good Bro

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Well, my brother was supposed to have another Alimta/Keytruda infusion yesterday but his oncologist had a different plan after reviewing his latest scans.  Basically, his onc told him that his body does not seem to be responding to the 1st line treatments.  Also, there were some new tumors found (in liver and arm pit lymph node).  Also, the main tumor in his lung has grown enough to block his airway and actually collapsed a portion of his lung (explains his increase coughing and extreme SOB).  Only positive news came from the radiation onc who did his treatment on the 18 brain lesions.  She said that targeted lesions there have shown some positive response and are shrinking. 

So, the proposed next steps are to perform some bronchial procedure where they will remove a portion of the tumor blocking his airway and likely insert a stint to hold the lung open.  Then, after some short recovery from that procedure, they will go in and hit that tumor with some targeted radiation (daily treatments for 5 days then 2 days off, over 2 weeks).  Wondering if anyone has had this type of procedure done and what side effects his is likely to experience from the procedure and also the radiation? 

Once all of this is done, they will start a different chemo/immunotherapy combo (not exactly sure what drug combo yet but my SiL thought maybe the Taxotere or Taxol as the one drug).  I will find out and share once I do. 

Trying to stay strong for him, his wife, and my parents.  Very hard on all of us to see him this way.  Less than a year ago, he was running 3-5 miles a day and now, he can barely walk across the room without stopping for a breather.  :( 

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So sorry to hear about this turn of events.  Hopefully, they can relieve some of the SOB to make him more comfortable and this different protocol will yield more positive results.  Sending out good vibes and your brother and family are in my prayers.

Lou

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GoodBro,

I've never had a resection by bronchoscopy but have had plenty of the procedures to look around, install stents, and sample tumors. Your brother will be sedated. There are two types of instruments: a flexible bronchoscope and a rigid bronchoscope. If he has the former, he'll likely have light anesthesia; the latter will require general anesthesia. I'm thinking a rigid instrument will be required. I've had a number of airway stents installed and removed. Mine caused a great deal of coughing and this was a predicted side effect. Airway or trachea stents are not intended to be permanent. They use a special alloy made from Nickel and Titanium called Nitinol. Because of the temperature sensitivity, they can safely and relatively easily be installed and removed by bronchoscope. But, your brother should expect to feel some irritation at the epiglottis and the normal symptoms of anesthesia recovery.  My procedures were performed by a thoracic surgeon but pulmonologists and interventional radiologists also perform these procedures.

From your description of the radiation, it sounds like they are trying to kill the tumor blocking his airway. It is pretty aggressive therapy and in combination with the stent, should dramatically improve his breathing. But, the stent might trade shortness of breath for rigorous coughing. Hopefully, the stent will be removed quickly once his doctors determine the airway tumor is fried.

I'm not exactly sure of the type of radiation your brother will receive from your description. But, from the timing, it sounds like conventional fractional radiation. It can be very effective, especially if it can be focused to a discrete area. I think your brother will experience more side effects from the stent than the radiation. I hope this helps you understand.

Stay the course.

Tom

 

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Thank you Tom for the great insight.  

He did find out that his procedure will be Monday (12/13) and a pulmonologist will perform it.  They did tell him he will be put under.  So, I also assume the rigid bronchoscope.  I guess the stent idea is not a for sure thing but sounded likely they will need to put it in and yes, it is temporary and will be removed at a later date.  Thank you for sharing your side effect associated with this.  Not sure how he could cough any more than he is now but hearing about this side effect, I'm now hoping that they don't need to do the stent then.

I'm also not 100% certain on the type of radiation yet.  My SiL couldn't remember the response when I told her to ask the doc.  Trying to get them to take better notes.  I also assume it will be the conventional fractional type.  

 

Thx again

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Quick update on my brother after his procedure to remove part of his tumor and install a stent in his collapsed lung...

Well, it was supposed to be a relatively quick and easy procedure... which the procedure itself kind of was.  However, the recovery didn't quite go as expected.  Sure, the docs did mention that there was a chance they would keep him overnight for observation.  But, nothing was mentioned about the possibility of his oxygen levels plummeting and blood pressure skyrocketing to the point they would need to rush him down to ICU.  Scared the crap out of him where he started praying and making the Sign of the Cross.  He is better now but still being weened off of the ventilator mask.  Still in ICU (since Monday early afternoon) but they are hoping to move him to a regular room later today.  Still unsure what caused the crash of some vitals but they did x-rays and another CT scan to confirm the stent hasn't migrated and also confirm the lung hadn't collapsed again.  All came back very good.  He is starting to eat a little and hoping he can come home in the next day or two.  Docs are all collaborating now on his 2nd line treatment plan.  Hope he can start that soon then.  If he can get home and recover well from this procedure and be able to actually breathe, that will be the best X-mas present for him, and really for all of us.  It is so hard seeing such an athletic 47 year old in this condition.

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That definitely sounds like a scary situation your brother found himself in.  I once had a bad reaction to general anesthesia and while not needing ICU I was definitely in a bad way for almost two days.  I'm glad your brothers condition appears to be stabilizing and improving.  Please keep us updated and know that we are pulling for your brother to get through this treatment with marked improvement.

Lou

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  • 1 month later...

Well, my brother completed the radiation to the tumor that caused his lung to collapse a couple days ago.  Now, today he finally starts his 2nd line treatment.  This will be Docetaxel (Taxotere) and Ramucirumab (Cyramza).  Any experience from anyone on this combo?  His onc told him there would likely be more side effects than what he experienced with the triplet as his 1st line.

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Finally progress. Hopefully 2nd line treatment will be easier on him. Ramucirumab is a monoclonal antibody (perhaps it works like an immunotherapy drug) and a relatively newly approved cancer therapy. I don't have any first hand knowledge about it. Taxotere has been around for years and causes fewer side effects than Taxol that it replaced in most treatment situations.

Stay the course.

Tom

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