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My Father has Stage IV SCLC


seanmdevine

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Hello all,

My 78 yr old father with advanced COPD was diagnosed with stage IV sclc about a month ago. He starts chemo tomorrow, 1/10/22. I'm trying to educate myself more on what to expect over the next few months. Getting information from him has always been difficult and this new development has not changed things. I live pretty far away from him and have been asked by he and my mom to hold tight for now, but I cannot stop thinking I should be there right now. I would love any input and advice I can get.

I see from others posts that his treatment plan is very consistent with others. I'm curious why treatment takes place over the course of 3 days.

I am brand new here, please forgive my ignorance, I am trying to learn. I've also attached a jpeg that shows the planned treatment.

Thank you,

Sean

Dads prognosis and plan.jpg

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Sean,

Welcome here.

Your dad is indeed fortunate that he is receiving combination chemotherapy that consists of the new immunotherapy drug atezolizumab in combination with two conventional drugs, carboplatin and etoposide. These dictate a 3-day treatment period for each cycle. On day 1, he'll receive infusions for atezolizumab and carboplatin. On each day, he'll receive etoposide. The other drugs on the list are used to prevent side effects during and after the infusion sessions.

Atezolizumab is an exciting new development. It is an immunotherapy drug that is a checkpoint inhibitor. It works by blocking a protein called PD-L1 that prevents the body's immune cells from attacking cancer cells. Studies suggest works best when given in combination with conventional chemotherapy, in your dad's case, carboplatin and etoposide. Here is additional information on checkpoint inhibitors and how they work. (read starting at the right arrow [>] Immune checkpoint inhibitors.

The reason the therapy takes place over the course of 3 days is that studies show the best results occur from this treatment frequency. I do hope your dad's treatment is a success.

You may have other questions and this is the place for answers.

Stay the course.

Tom

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Nobody likes going for chemo, obviously. I just saw that the treatment plan states his prognosis as good. That's very encouraging.

Tom has given you a great explanation of the chemo regimen. It's impossible to know what side effects your father might have, but he'll be monitored closely. I hope he tolerates his treatments well. 

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My name is Dennis Devine, and am the father of Sean who began this thread. As you can tell from Sean's letter, I have a very loving and involved support system. I completed the first cycle of chemo treatments yesterday, and so far, outside of feeling week, I've experienced no side effects (knock on wood). Thank you for your explanation of what I am experiencing; and especially the good wishes.

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Welcome Dennis,

I'm glad to hear you've completed your first cycle and weakness is your only problem. Let's hope it stays that way.

Here is something I normally pass along to the newly diagnosed.

Stay the course.

Tom

 

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  • 3 weeks later...

Good evening,

My father did really well the first week after his first round of chemo, then tanked about 10 days in. He was hospitalized with a neutropenic fever, pneumonia, and septic shock. It took several days in the hospital to get him stabilized and back to some semblance of normal. He went home this past Saturday and his fever spiked again overnight. He's back in the hospital since Sunday afternoon and new things are popping up now. He has a football sized hematoma in his abdomen and is too weak to walk. Needless to say, the second round of chemo has been postponed. The point of all the back story is this... What now? Does he continue chemo and risk getter even more sick after, or are there other options? I'm at a loss. I want to him to be comfortable and at home, he is neither right now. Thank you.

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Sean,

Sorry to hear about what your father is going through.  I have not had chemo so I cannot speak from personal experience, but many others have and will share with you what they went through.  My only view of this is that you need to hear from the doctor what expected side effects were and what can be done to reduce them or if they may reduce on their own over time.  As I said, I'll let others share their experiences.  Some folks have had rough times with one treatment protocol and moved to another, or stopped one waited and then renewed the process with modifications, or took another course.  My sincere hope is that your father can recover and they can control side-effects enough to give him the benefit of the treatment.

Lou

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Sean,

Oh my, you report a number of serious medical conditions affecting your father. With a fever, pneumonia, septic shock and a large hematoma as complications to extensive stage SCLC and your question of what now is most relevant.

Recall, I'm not a physician. And, I have no insight into the future. But, my 18 years of experience dealing with this disease, especially medically serious side effects from treatment suggest a hard reality ahead for your dad. Your desire for him to be home and comfortable is likely the key to what may be next up given treatment complications.

I had a time where treatment was not working and had it not been for a new FDA approval on using precision radiation technology on lung tumors, I'd not be writing this today. When at that crossroads, my wife and I investigated hospice care as a path forward. We talked with several providers and checked credentials with physicians in my treatment circle. Hospice care at home was our choice going forward and it may be something for your consideration.

I do hope things turn around for your father and hope you can help your dad make an informed choice for future treatments.

Stay the course.

Tom

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Sean, I'm very sorry that your father has had these setbacks. Although I have NCSLC, I also had sepsis after completing chemo, from a perforated bowel. I would have died 2 years ago had it not been for emergency surgery. My recovery was very painful and took months of physical therapy. 

Obviously, your father is too ill to resume chemo right now. His doctors and nurses are the best judges of his ability to tolerate it going forward. You may want to ask for a palliative care consult in the hospital, it can't hurt. 

Best wishes to you and your father. 

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