Need Advice - DH Is Very Sick After Latest Chemo - Update

Please feel free to read, share your thoughts, your stories and connect with others!
Val*pal
Posts: 860
Joined: Sun Feb 10, 2013 1:24 pm
Facebook Username: Valerie Barkus Kantner
Location: Metro Detroit, Michigan

Re: Need Advice - DH Is Very Sick After Latest Chemo - Updat

Postby Val*pal » Sun May 04, 2014 4:16 pm

My DH went in for his next scheduled chemo infusion on Thursday, May 1, and again was very weak. Fortunately, this time there was objective data via blood work and blood pressure reading to make the oncology staff realize he was definitely not up to chemo, something I felt was also true two weeks ago. This past Thursday his blood pressure was something like 78/60 and there were indications in the blood work that he was dehydrated. Also, and most scary, he had lost 8 pounds over the last two weeks, in addition to ongoing weight loss over the last 3-4 months that totals at least 39 pounds. Though he was not scheduled to see his onc, only her assistant, the assistant went and found the oncologist who quickly appeared and put the chemo on hold and ordered IV fluids instead. In the end, they ended up hospitalizing him for about 36 hours to make sure he was not also suffering from a partial bowel blockage, which was not the case.

The oncologist visited him while he was hospitalized and told DH that she feels there's a good chance his dramatic weight loss is cachexia, cancer related weight loss that goes after muscle mass as well. She is afraid that the chemo is no longer effective. He has a CT-scan scheduled for May 11, and we'll get the results on 5/16. He will also go into be checked by his oncologist's assistant this Thursday, May 8, to make sure he is okay.

At this point he has very little appetite, though he has started taking a med the doc prescribed to try and improve appetite. He is no longer able to walk throughout the cancer center like he used to. I now have to assist him with a wheelchair.
DH dx'ed May '11, age 62
Jul '11: resection Stage IV
10/11: 6 mo Folfox
8/12:thyr canc, surg/tx
2/13: peri mets
2/13: Firi/Avas
6/13: Ok
8/13: break
10/13: Lung, peri, mets
10/13: Firi/Erb
1/14: Erb Fail; spread
5/14: Tx stopped
6/20/14: At rest

User avatar
O Stoma Mia
Posts: 1692
Joined: Sat Jun 22, 2013 6:29 am
Location: On vacation. Off-line for now.

Re: Need Advice - DH Is Very Sick After Latest Chemo - Updat

Postby O Stoma Mia » Sun May 04, 2014 6:14 pm

Val*pal wrote:...The oncologist visited him while he was hospitalized and told DH that she feels there's a good chance his dramatic weight loss is cachexia, cancer related weight loss that goes after muscle mass as well....At this point he has very little appetite, though he has started taking a med the doc prescribed to try and improve appetite. He is no longer able to walk throughout the cancer center like he used to. I now have to assist him with a wheelchair.

Hi Val*pal -

I was wondering if you keep track of DH's Body Mass Index (BMI); It should stay between 18.5 and 25. If it gets below 18.5, then he is in the cachexia, "wasting syndrome" danger zone.

BMI_______Weight Category
Under 18.5 .Underweight
18.5- 24.9 ..Healthy Weight
25 - 29.9 ....Overweight
30 or over ..Obese

You can check his current BMI with the online BMI Calculator: BMI Calculator
Last edited by O Stoma Mia on Wed Aug 15, 2018 12:42 pm, edited 2 times in total.

pfCml73183
Posts: 653
Joined: Sat Jun 22, 2013 7:49 pm
Facebook Username: Celeste Marie Comeau
Location: FL

Re: Need Advice - DH Is Very Sick After Latest Chemo - Updat

Postby pfCml73183 » Sun May 04, 2014 7:34 pm

I am sorry that your husband feels so crappy. I hope it will pass and he can feel better.
I am sad you have to go through this stress with him. It must be so hard.
I hope you can get some R&R while waiting for the next step.
Thinking of you, God bless, Celeste
Wife and BF to Peter, 54
mCRC/IV/BRAF+
Erbitux and Urelumab trial @MSKCC 3/15
went home 5/8/15

User avatar
Maia
Posts: 2443
Joined: Fri Aug 24, 2012 8:00 am

Re: Need Advice - DH Is Very Sick After Latest Chemo - Updat

Postby Maia » Sun May 04, 2014 7:41 pm

Val... so sorry to read this.
I don't know if it helps that I mention this but there is a monoclonal antibody in trials that treats both, CRC *and* cachexia _Xilonix I posted about it one year ago here: viewtopic.php?f=1&t=39860 It was FDA fast-tracked in 2012, went to Phase III trial past year, I *think* they have results already (will try to find them later). In Detroit, Michigan, it's at the Karmanos Cancer Institute (the trial is this, scroll down to Locations and you have there the contact info -phone, email: A Study Using MABp1 To Increase Overall Survival In Patients With Colorectal Cancer And Weight Loss
I'm thinking about this trial mainly as a way to achieve better quality of life. Just sharing the info for your consideration.
Sending strength and love your way
xoxo
m.

vickitwo
Posts: 696
Joined: Thu Apr 26, 2012 9:56 am
Location: USA

Re: Need Advice - DH Is Very Sick After Latest Chemo - Updat

Postby vickitwo » Sun May 04, 2014 8:21 pm

Val,

Hope the appetite stimulants work. Thinking of you.
Vicki

DH Dx 1/2012 @ age 52
stage IV CC
transverse colon,omentum, cecum,liver,lungs,L5
9 rounds of Folfox, Avastin,
5FU/Leucovorin/Avastin
radiation tx to L5 and hips
Folfiri/Zaltrap
12/13/13 Folfox/Avastin
1/4/2014 passed away @ Hospice House- age 54

Val*pal
Posts: 860
Joined: Sun Feb 10, 2013 1:24 pm
Facebook Username: Valerie Barkus Kantner
Location: Metro Detroit, Michigan

Re: Need Advice - DH Is Very Sick After Latest Chemo - Updat

Postby Val*pal » Mon May 05, 2014 8:05 pm

Thanks for all the messages of support.

Maia, Karmanos is very close to us, and I will definitely ask my husband's oncologist about the trial. Like you said, it's something to consider, especially for quality of life. I think I stumbled across that study when I searched cachexia on this board, and I saw your info on it. You do all of us a great service publicizing various trials, etc.

O Stoma Mia, thanks for the info on BMI. This is very helpful. My DH is hovering at the top of the "underweight" category. Hopefully, if he can maintain where he's at right now, he can at least retain some lean muscle, though it's noticeable how much less muscular he is now. He's trying his darnedest to eat, but he just hasn't much of an appetite. Plus, the recent chemo has definitely blunted his taste buds.

Celeste and Vickietwo, thanks for the words of support. It's definitely making me very anxious to see him losing ground, but perhaps he can bounce back for a bit if he is able to consume more calories. He is trying to drink Ensure -- one that his brother found that has even more extra calories than the others. We're also working off a nutrition sheet the hospital gave us in hopes of increasing his protein intake.

Val :)
DH dx'ed May '11, age 62
Jul '11: resection Stage IV
10/11: 6 mo Folfox
8/12:thyr canc, surg/tx
2/13: peri mets
2/13: Firi/Avas
6/13: Ok
8/13: break
10/13: Lung, peri, mets
10/13: Firi/Erb
1/14: Erb Fail; spread
5/14: Tx stopped
6/20/14: At rest

pfCml73183
Posts: 653
Joined: Sat Jun 22, 2013 7:49 pm
Facebook Username: Celeste Marie Comeau
Location: FL

Re: Need Advice - DH Is Very Sick After Latest Chemo - Updat

Postby pfCml73183 » Mon May 05, 2014 9:40 pm

You're doing a great job for you husband. I know he appreciates everything you do for him.
Do things for yourself as well.
Peace, Celeste
Wife and BF to Peter, 54
mCRC/IV/BRAF+
Erbitux and Urelumab trial @MSKCC 3/15
went home 5/8/15

User avatar
Maia
Posts: 2443
Joined: Fri Aug 24, 2012 8:00 am

Re: Need Advice - DH Is Very Sick After Latest Chemo - Updat

Postby Maia » Wed May 07, 2014 7:36 am

Val, some articles for your husband doc to maybe consider.

In this month issue of The Lancet Oncology, it has been published an article about MABp1 (Xilonix) results from a Phase I trial (2010-2012) at the MD Anderson. This was a Phase I trial, to determine dose and safety profile. This other trial, the one recruiting at Karmanos (and Mayo, MD Anderson, etc.), is Phase III *and* they added other agent (megestrol acetate). The Xilonix is mainly a huge antiinflammatory with anticancer activity, the megestrol acetate (oral suspension) is for treatment of anorexia-cachexia. They are not cytotoxic/ chemotherapy.

1. About a previous trial (good side effects profile and modest antitumor activity:)

The Lancet Oncology, Volume 15, Issue 6, Pages 656 - 666, May 2014
Lancet Oncol. 2014 Apr 16. [Epub ahead of print]
MABp1, a first-in-class true human antibody targeting interleukin-1α in refractory cancers: an open-label, phase 1 dose-escalation and expansion study.
Hong DS, Hui D, Bruera E, Janku F, Naing A, Falchook GS, Piha-Paul S, Wheler JJ, Fu S, Tsimberidou AM, Stecher M, Mohanty P, Simard J, Kurzrock R.

Abstract

BACKGROUND:

Inflammation is an important feature of the malignant phenotype and promotes angiogenesis, tumour invasiveness, metastases, and cachexia. We used a first-in-class, monoclonal antibody (MABp1) cloned from a human being to target interleukin-1α, a mediator of chronic inflammation. We aimed to assess the safety and tolerability of MABp1 for interleukin-1α blockade in a refractory cancer population.

METHODS:

We did an open-label, dose-escalation, and phase 1 study of MABp1 in adults with metastatic cancer at the MD Anderson Clinical Center for Targeted Therapy (Houston, TX, USA). We used a standard 3+3 design to identify the maximum tolerated dose. Patients received MABp1 intravenously once every 3 weeks through four dose levels: 0·25 mg/kg, 0·75 mg/kg, 1·25 mg/kg, and 3·75 mg/kg. After the dose-escalation phase, a second dosing arm was started with dosing every 2 weeks at the maximum tolerated dose. The primary objectives were safety, tolerability, characterisation of the pharmacokinetic profile, and identification of the recommended phase 2 dose. Secondary endpoints included pharmacodynamic effects and antitumour activity. All patients who received at least one dose of MABp1 were included in the safety analyses. This trial is registered with ClinicalTrials.gov, NCT01021072.

FINDINGS:

Between March 15, 2010, and July 30, 2012, 52 patients with metastatic cancer (18 tumour types) received anti-interleukin-1α monotherapy in dose-escalation and expansion groups. MABp1 was well tolerated, with no dose-limiting toxicities or immunogenicity. Thus, the recommended phase 2 dose was concluded to be 3·75 mg/kg every 2 weeks. Pharmacokinetic data were consistent at all dose levels and showed no evidence of accumulation or increased clearance of MABp1 at increasing doses. For 42 assessable patients, median plasma interleukin-6 concentrations had decreased from baseline to week 8 by a median of 2·7 pg/mL (IQR -12·6 to 3·0; p=0·08). Of the 34 patients restaged, one patient had a partial response and ten had stable disease. 30 patients were assessable for change in lean body mass, which increased by a mean of 1·02 kg (SD 2·24; p=0·02) between baseline and week 8. The most common adverse events possibly related to the study drug were proteinuria (n=11; 21%), nausea (7; 13%), and fatigue (7; 13%). The most frequent grade 3-4 adverse events (regardless of relation to treatment) were fatigue (3; 6%), dyspnoea (2; 4%), and headache (2; 4%). Two patients (4%) had grade 5 events (death due to disease progression), which were unrelated to treatment.

INTERPRETATION:

MABp1 was well tolerated, no dose-limiting toxicities were experienced in this study, and disease control was observed. Further study of MABp1 anti-interleukin-1α antibody therapy for advanced stage cancer is warranted.



2. About megestrol acetate (full article)

Megestrol acetate for treatment of anorexia-cachexia syndrome
Ruiz Garcia V, López-Briz E, Carbonell Sanchis R, Gonzalvez Perales JL, Bort-Marti S. Cochrane Database of Systematic Reviews 2013, Issue 3. Art. No.: CD004310.


Return to “Colon Talk - Colon cancer (colorectal cancer) support forum”



Who is online

Users browsing this forum: MadMed, roadrunner and 10 guests