WelshIan wrote:... On my doctors visit before cycle 2 they said no problems will extend the infusion to 2 hours and stay in for observation so today cycle 2 started and 45 minutes after same thing Acute respiratory failure but this lasted this time for 1hr 40mins. all find again but the side effects from the oxi this time are worse. I must ad that I have had no issues with Capecitabine tablets 4000mgs per day
So should I refuse oxi on cycle 3?
...
Hello, and welcome to the Forum! I'm sorry to hear that you are having such a rough time with your chemo infusions.
Concerning the question you ask, we are not doctors here, so we cannot give advice on what treatments you should do or not do. That sort of advice should come from a doctor -- preferably an experienced oncologist with a Board-Certification in Medical Oncology.
Nevertheless, there may be a few thoughts that could be shared that might help you in your decision process.
One suggestion would be to examine the official documentation to see what the oxaliplatin manufacturer has to say about the drug, and then to examine the official list of adverse reactions usually reported for chemotherapy drugs.
- First, is the package insert published by the drug manufacturer telling what is known about the major Adverse Reactions associated with the drug. In this document, Section 5.1 (Hypersensitivity) and Section 5.5 (Pulmonary Toxicity) may be relevant to what you experienced in your first two infusion sessions.
https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/021759s023lbl.pdf
. - Second, is the full list of drug-related Adverse Reactions, for all drugs, sorted by category. (In this list, respiratory adverse reactions are located on page 123):
https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/CTCAE_v5_Quick_Reference_8.5x11.pdf
It should be noted that drug Adverse Reactions are usually coded on a 4-point scale ranging from Grade 1 through Grade 4:
- Grade 1: (Mild)
- Grade 2: (Moderate)
- Grade 3: (Severe)
- Grade 4: (Life-threatening)
If you look at the Acute Respiratory Distress Syndrome (ARDS) listed on page 123 of the document above, it says that this Adverse Reaction can be coded as either Grade 3 or Grade 4. It is important to note what is required of the doctor if Adverse Reactions are coded as Grade 3 or Grade 4:
For Grade 3 events, the doctor is supposed to
suspend further treatment with the drug until the cause of the reaction can be determined and the patient has returned to normal (e.g.,
"Pulmonary Toxicity: Withhold ELOXATIN until investigation excludes interstitial lung disease or pulmonary fibrosis. (5.5)" . In the case of Grade 4 events, the doctor is required to terminate treatment with the drug immediately and never administer that drug to the patient again.
From what you have said above, your doctor apparently coded your first-round Acute Respiratory Failure as Grade 3, and by the time of the start of your second round he had determined that you were fit enough to have another round as long as the drug was administered at a slower rate (i.e., over 2 hours?). However ... since your second round elicited the same type of reaction as in the first round, obviously something was missing in the underling logic. In other words, it turned out that you were not really fit to go through a second round, even at a slower infusion rate.
So, my own personal thoughts are that the doctor did not do a thorough enough job of diagnosing your pulmonary problem. In retrospect, it looks like he should not have chosen this particular way to deal with your first crisis and with your first admission to ICU. (This is just my personal opinion, and again, I am not a doctor. I am just a patient expressing my personal views.)