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: 98
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 11:48 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
5/16: DX Stage III, mets found; right groin lymph node and soft tissue
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)
9/17: At peace

LMighty
Posts: 98
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
5/16: DX Stage III, mets found; right groin lymph node and soft tissue
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)
9/17: At peace

User avatar
Maia
Posts: 2436
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: 98
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
5/16: DX Stage III, mets found; right groin lymph node and soft tissue
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)
9/17: At peace

User avatar
Maia
Posts: 2436
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: 98
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
5/16: DX Stage III, mets found; right groin lymph node and soft tissue
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)
9/17: At peace

LMighty
Posts: 98
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
5/16: DX Stage III, mets found; right groin lymph node and soft tissue
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)
9/17: At peace

User avatar
Maia
Posts: 2436
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: 98
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
5/16: DX Stage III, mets found; right groin lymph node and soft tissue
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)
9/17: At peace

LMighty
Posts: 98
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 Aug 26, 2017 1:13 pm

Hi everyone, sorry I haven't posted for quite a while.

Update #7: The past weeks were full of ups and downs. The good news was that the chest + abdomen CT scan confirmed that no blood clot is present, and that peritoneal met is indeterminate, at worst minimal despite months of ascites accumulation. The bad news though was that our onc thinks that my mom's left lung suffered too much structural damage from both tumour invasion and scarring, meaning that even if she achieves NED, its function is mostly lost and irreversible. In other words, it is very likely that my mom will need supplemental oxygen for the rest of her life, NED or not, which she has been on all the time since July. Onc even suggested stopping treatment due to the possibility of relying on only one lung and compromised quality of life.

My mom and our family is prepared and determined, so we continued treatment.

The second cycle started 10 days ago with lowered dose of cobimetinib (3 tablets-> 2 tablets per day). We are draining 400-600 ml of ascites daily but the recent X-ray (last Thursday) showed visible improvement in both lungs. Most side effects are well managed so far except for constipation and fatigue. Our onc believes the disease is at least stable, and we briefly discussed a modified regimen for long term use in the future.
Supporter to my mom (64 yr); KRAS wild type; MSS

2012: DX Stage I, rectal cancer; resection and colostomy
5/16: DX Stage III, mets found; right groin lymph node and soft tissue
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)
9/17: At peace

User avatar
Maia
Posts: 2436
Joined: Fri Aug 24, 2012 8:00 am

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

Postby Maia » Sat Aug 26, 2017 5:36 pm

LMighty wrote:Update #7: The past weeks were full of ups and downs. The good news was that the chest + abdomen CT scan confirmed that no blood clot is present, and that peritoneal met is indeterminate, at worst minimal despite months of ascites accumulation. The bad news though was that our onc thinks that my mom's left lung suffered too much structural damage from both tumour invasion and scarring, meaning that even if she achieves NED, its function is mostly lost and irreversible. In other words, it is very likely that my mom will need supplemental oxygen for the rest of her life, NED or not, which she has been on all the time since July. Onc even suggested stopping treatment due to the possibility of relying on only one lung and compromised quality of life.
/.../ We are draining 400-600 ml of ascites daily but the recent X-ray (last Thursday) showed visible improvement in both lungs. Most side effects are well managed so far except for constipation and fatigue. Our onc believes the disease is at least stable, and we briefly discussed a modified regimen for long term use in the future.

LMighty, I'm happy to hear from you again. Your mom has been indeed going through ups and downs. This ''chest + abdomen CT scan confirmed that no blood clot is present, and that peritoneal met is indeterminate, at worst minimal despite months of ascites accumulation'' and ''the recent X-ray (last Thursday) showed visible improvement in both lungs. Most side effects are well managed'' is really, really good. It means that the treatment is working, to some extent.
About the lung function... hang in there. The general condition of your mom might be what worries your mom's onc, but do you know that there are plenty of people living with even one lung since years ago? : )

LMighty
Posts: 98
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 29, 2017 11:03 am

Maia wrote:About the lung function... hang in there. The general condition of your mom might be what worries your mom's onc, but do you know that there are plenty of people living with even one lung since years ago? : )


Yes we do! which is why we are all determined to continue treatment :)

With luck my mom may be able to gain some left lung function back!
Supporter to my mom (64 yr); KRAS wild type; MSS

2012: DX Stage I, rectal cancer; resection and colostomy
5/16: DX Stage III, mets found; right groin lymph node and soft tissue
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)
9/17: At peace

User avatar
Maia
Posts: 2436
Joined: Fri Aug 24, 2012 8:00 am

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

Postby Maia » Wed Aug 30, 2017 11:21 am

I hope your mom continue improving!
LMighty, in case you missed her: you have a fellow from HK looking after her mom, too: viewtopic.php?f=1&t=58637 viewtopic.php?f=1&t=58739

LMighty
Posts: 98
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 Aug 31, 2017 7:22 am

Update #8: Met with onc today for blood test, X-ray and 4th infusion of TECENTRIQ. Scan shows further improvement -- left lung slightly expanded (possibly implying less tumour!), right lung stable. Hypothyroidism is still there but it's not causing major discomfort. Definitely positive result :)
Supporter to my mom (64 yr); KRAS wild type; MSS

2012: DX Stage I, rectal cancer; resection and colostomy
5/16: DX Stage III, mets found; right groin lymph node and soft tissue
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)
9/17: At peace


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