TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib) for Stage IV, starting 11/7/2017

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Maia
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Re: TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib) for Stage IV, starting 11/7/2017

Postby Maia » Thu Jul 27, 2017 11:30 am

Sorry to hear that ascites are still a problem, but it does sound like some improvement is seen.
Fever ---and the thyroid disorder-- sound like side effects from the immunotherapy.

The NCCN has published some recent lines for side effects managment and has a tool for patients https://www.nccn.org/immunotherapy-tool ... g_Tool.pdf See https://www.nccn.org/about/news/newsinf ... NewsID=846 That might be of interest for her doctor.

LMighty
Posts: 90
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Location: Hong Kong

Re: TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib) for Stage IV, starting 11/7/2017

Postby LMighty » Thu Jul 27, 2017 11:48 am

Thanks Maia for the additional info!

Our onc keep saying the ascites and pleural fluid are the result of rapid death of cancer cell. I am not sure how that works but I do hope that is what's happening.

It also seems that the fluids in my mom's body build up and go away at irregular rate and location. Some days she had pretty swollen legs, some days she didn't. Also the choroidal effusion -- I never knew you can get effusion in the eyes. Onc said there should be pretty low risk of permanent sight damage.

Most concerning was the bad wheezing that really affected my mom's breathing during sleep for days. Even the pulmonary specialist who checked here and there couldn't make any guess. Only way to ease the wheezing is to sleep sitting up. Going forward, our onc may consider using low dose of steroids as a "last resort" to open up the airways because steroids may counteract immunotherapy.
Supporter to my mom (64 yr); KRAS wild type; MSS

2012: DX Stage I, rectal cancer; resection and colostomy, no chemo
5/16: DX Stage III, mets found; right groin lymph node and soft tissue nodules
5-6/16: Radiation + Xeloda
7/16: DX Stage IV, pleural effusion; cancer cells found in fluid
7-12/16: Xelox + Avastin X 6
1/17: Clean PET scan, NED
2/17: Pleural effusion; recurrence
4/17: Iri + Erb X 3
5/17: Ascites; Chemo failed
6/17: Keytruda X 1
7/17: TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib)

LMighty
Posts: 90
Joined: Sun Aug 28, 2016 6:16 am
Location: Hong Kong

Re: TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib) for Stage IV, starting 11/7/2017

Postby LMighty » Thu Jul 27, 2017 11:50 am

Maia wrote:Fever ---and the thyroid disorder-- sound like side effects from the immunotherapy.


BTW to be exact the thyroid disorder seems to be hypothyroidism.
Supporter to my mom (64 yr); KRAS wild type; MSS

2012: DX Stage I, rectal cancer; resection and colostomy, no chemo
5/16: DX Stage III, mets found; right groin lymph node and soft tissue nodules
5-6/16: Radiation + Xeloda
7/16: DX Stage IV, pleural effusion; cancer cells found in fluid
7-12/16: Xelox + Avastin X 6
1/17: Clean PET scan, NED
2/17: Pleural effusion; recurrence
4/17: Iri + Erb X 3
5/17: Ascites; Chemo failed
6/17: Keytruda X 1
7/17: TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib)

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Maia
Posts: 2393
Joined: Fri Aug 24, 2012 8:00 am

Re: TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib) for Stage IV, starting 11/7/2017

Postby Maia » Thu Jul 27, 2017 6:40 pm

LMighty wrote:BTW to be exact the thyroid disorder seems to be hypothyroidism.


Yes. For her doctor to consider: http://www.cancernetwork.com/ata-2016-t ... hyroiditis

LMighty
Posts: 90
Joined: Sun Aug 28, 2016 6:16 am
Location: Hong Kong

Re: TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib) for Stage IV, starting 11/7/2017

Postby LMighty » Fri Jul 28, 2017 7:03 pm

Update #4: Ascites comes back in a manner almost like a revenge. Drained about 800ml yesterday. Not sure if we should be worried as it may be due to hypothyroidism-induced fluid retention.
Supporter to my mom (64 yr); KRAS wild type; MSS

2012: DX Stage I, rectal cancer; resection and colostomy, no chemo
5/16: DX Stage III, mets found; right groin lymph node and soft tissue nodules
5-6/16: Radiation + Xeloda
7/16: DX Stage IV, pleural effusion; cancer cells found in fluid
7-12/16: Xelox + Avastin X 6
1/17: Clean PET scan, NED
2/17: Pleural effusion; recurrence
4/17: Iri + Erb X 3
5/17: Ascites; Chemo failed
6/17: Keytruda X 1
7/17: TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib)

User avatar
Maia
Posts: 2393
Joined: Fri Aug 24, 2012 8:00 am

Re: TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib) for Stage IV, starting 11/7/2017

Postby Maia » Sat Jul 29, 2017 7:42 pm

LMighty, I'm so sorry. The top priority is to keep your mom comfortable, so draining the fluids is very important.
Wish I could offer other insight. Her doc seems very engaged in her care, so I'm hopeful he'll find a way to balance the pursuing of treatment with quality of life. I'm sending you my very, very best thoughts and strength your way. xoxo

LMighty
Posts: 90
Joined: Sun Aug 28, 2016 6:16 am
Location: Hong Kong

Re: TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib) for Stage IV, starting 11/7/2017

Postby LMighty » Sat Jul 29, 2017 9:05 pm

Hi Maia,

It went back down to around 200ml yesterday. This is so confusing. Maybe we should not be worried after all...

Onc will be back from vacation tomorrow. Let's see how he thinks.
Supporter to my mom (64 yr); KRAS wild type; MSS

2012: DX Stage I, rectal cancer; resection and colostomy, no chemo
5/16: DX Stage III, mets found; right groin lymph node and soft tissue nodules
5-6/16: Radiation + Xeloda
7/16: DX Stage IV, pleural effusion; cancer cells found in fluid
7-12/16: Xelox + Avastin X 6
1/17: Clean PET scan, NED
2/17: Pleural effusion; recurrence
4/17: Iri + Erb X 3
5/17: Ascites; Chemo failed
6/17: Keytruda X 1
7/17: TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib)

LMighty
Posts: 90
Joined: Sun Aug 28, 2016 6:16 am
Location: Hong Kong

Re: TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib) for Stage IV, starting 11/7/2017

Postby LMighty » Tue Aug 01, 2017 11:10 am

Hi everyone,

Update #5: Today my mom is 3 weeks in with TECENTRIQ + COTELLIC. It marks the completion of the first cycle of treatment (biweekly infusion of TECENTRIQ + 3 weeks of COTELLIC taken orally). She will now take a break for a week, or a few days more if needed.

Starting yesterday her resting heart rate has been dropping to a much less worrying level (from ~105 to ~85 per min). Ascites accumulation also slows down again. Generally feeling better! Onc would like mom to stay at hospital for just a few more days to see if all the discomforts subside soon. If they do, onc would be sure that they are all side effects and have a plan for them in the next cycle of treatment.
Supporter to my mom (64 yr); KRAS wild type; MSS

2012: DX Stage I, rectal cancer; resection and colostomy, no chemo
5/16: DX Stage III, mets found; right groin lymph node and soft tissue nodules
5-6/16: Radiation + Xeloda
7/16: DX Stage IV, pleural effusion; cancer cells found in fluid
7-12/16: Xelox + Avastin X 6
1/17: Clean PET scan, NED
2/17: Pleural effusion; recurrence
4/17: Iri + Erb X 3
5/17: Ascites; Chemo failed
6/17: Keytruda X 1
7/17: TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib)

User avatar
Maia
Posts: 2393
Joined: Fri Aug 24, 2012 8:00 am

Re: TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib) for Stage IV, starting 11/7/2017

Postby Maia » Tue Aug 01, 2017 11:18 am

LMighty, I'm glad to hear that the ascites are slowing down again and that she's taking a break for a week. Immunotherapy works slowly, often, and acts long after administered --months, sometimes. So if this is going to work, she's probably covered. BUT she needs to recover and just regain some strength!! Very glad to know that her onc is keeping a close eye on her.
Many many good thoughts going your way, from the other side of the world.

LMighty
Posts: 90
Joined: Sun Aug 28, 2016 6:16 am
Location: Hong Kong

Re: TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib) for Stage IV, starting 11/7/2017

Postby LMighty » Wed Aug 09, 2017 11:49 am

Update #6: The second treatement cycle was supposed to start yesterday but my mom recently developed rapid heart rate (110+ resting), shortness of breath and extreme fatigue, with visibly swollen legs and sudden increase in ascites. The treatment was delayed. Doctors suspected deep vein thrombosis in her legs (which is closely related to pulmonary embolism) but ultrasound showed no blood clots in the legs. Only a CT scan can let the doctors truly determine the cause but my mom's breathing difficulties prevented her from going through a scan. Out of options, she has been put on blood thinner for 2 days and we can see the heart rate slowly improving. Doctor's said if there is significant improvement in the coming days, they can be quite sure that there is a blood clot somewhere, but a true diagnosis requires a CT scan.

Onc said blood thinner normally does not counteract the efficacy of immunotherapy. When and whether to start the next cycle of treatment now depends on my mom's recovery from this unconfirmed blood clot. He would rule out the possibility of a tumour-induced blood clot if blood thinner works.

It just happened so unexpectedly when she was taking a break and was supposed to get better and feel better...
Supporter to my mom (64 yr); KRAS wild type; MSS

2012: DX Stage I, rectal cancer; resection and colostomy, no chemo
5/16: DX Stage III, mets found; right groin lymph node and soft tissue nodules
5-6/16: Radiation + Xeloda
7/16: DX Stage IV, pleural effusion; cancer cells found in fluid
7-12/16: Xelox + Avastin X 6
1/17: Clean PET scan, NED
2/17: Pleural effusion; recurrence
4/17: Iri + Erb X 3
5/17: Ascites; Chemo failed
6/17: Keytruda X 1
7/17: TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib)


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