On Folfox, just learned I was exposed to covid

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JMRWife
Posts: 71
Joined: Mon Oct 05, 2015 9:41 pm

On Folfox, just learned I was exposed to covid

Postby JMRWife » Fri Jul 30, 2021 5:57 pm

Just finished round 6, doing well. Just got a call from my boss that a client I had contact with has been diagnosed with covid.

I am vaccinated with two doses of Moderna.

Googled, but not much advice on what to do if you're being treated for cancer and are exposed.

Any thoughts, suggestions? I tried calling my oncologist but it's a Friday night.
Age 58.
4/27/2021 - Dx obstructing "apple core" sigmoid tumor at 30cm. MMR proficient. 4/28: Diverting colostomy.
Started neoadjuvant Folfox 5/18; CEA 107.
Aug 11: 7 rounds Folfox completed. CEA 3.2.
Pathology: COLON, SIGMOID (COLONOSCOPY): -- INVASIVE ADENOCARCINOMA, MOD DIFFERENTIATED

Clinical stage stage IIA. (negative lymph nodes). By imaging at least clinical stage 3 (abnormal lymph nodes on CT), but given negative mesenteric lymph nodes biopsy - considered at least stage 2.

saltygirl
Posts: 39
Joined: Sun Feb 07, 2021 4:46 pm
Facebook Username: Salty.girl

Re: On Folfox, just learned I was exposed to covid

Postby saltygirl » Fri Jul 30, 2021 6:11 pm

I would not worry too much. I was also exposed to covid while on treatment. You can have a covid test ASAP. And another in 10 days. Try to relax.

roadrunner
Posts: 163
Joined: Sun Jan 12, 2020 8:46 pm

Re: On Folfox, just learned I was exposed to covid

Postby roadrunner » Fri Jul 30, 2021 7:18 pm

A few things:

(1) When was your last dose of vaccine? Were you already in treatment?
(2) In general, solid tumor cancer patients—even those on chemo—mount a decent response to the mRNA vaccines. Not quite as strong as healthy controls, but decent. That said, everyone is different, and the Delta variant is still somewhat of an unknown. You haven’t posted a signature, so it’s a little hard to say much specifically, but youth (even relative youth), absence of co-morbidities (including obesity), good levels of vitamin D, female gender, solid blood counts, general fitness, and non smoker status are all advantages (some of these apply to vaccine response, some to fighting disease, and many to both). (With the CBC, I would look at your lymphocytes in particular, and not so much your neutrophils, which we usually concentrate on as cancer patients undergoing chemo.) You likely have a recent CBC (blood draw).
(3) By the way, FOLFOX is not considered particularly damaging to the immune system (as chemo regimens go) so with luck your immune system is not too bad.
(4) Are you on a blood thinner, in particular enoxiparin (Lovenox)? If so, great, there is lots of evidence it is protective against COVID in various ways.
(5) You’re right to talk to your oncologist ASAP. Presumably they have an on-call person? You will need to ask if they view you as immunocompromised (you likely are, at least to some extent), and what your best course of action is. If it were me, *and I noticed any symptoms*, I’d get tested and, if positive, start advocating hard for monoclonal antibody treatment (3/4 available in the US are effective against Delta, but it must be administered early in the course of disease). (You may want/need to get tested regardless of symptoms, follow your doctor’s advice.) You may also want to ask about Lovenox if you’re not on it—you can say you heard from some nut on the Internet ; ) that low molecular weight heparin was a good idea for COVID patients because of its anticoagulant and anti-viral properties.
(6) All THAT said, with luck you’ll miss out on getting infected. But know also that solid tumor patients also generally do ok with COVID, and some studies I’ve seen don’t assign much increased risk even to active chemo. But I would err on the side of caution and discuss the situation with your doctors ASAP.
(7) Oh yeah, and follow any applicable quarantine, testing, and masking guidelines.
Sorry this occurred and Good luck!
7/19: Rectal cancer: Initially staged as IIIA, T2N1M0
Initially approx 4.25 cm, low/mid rectum, mod. well diff. adenocarcinoma
8/22 -10/14 4 rounds FOLFOX neoadjuvant, 3 w/Oxiplatin (lots of side effects/reduced size est. 70-75%)
neoadjuvant chemorad 11/19
4 rounds of FOLFOX July-August 2020
ncCR found 10/20; multiple biopsies negative
TAE 11/20, small amount of tumor removed, lung nodules orig id’d 6/20 stable Nov 2020
Chest CT 3/30/21 small growth in 2 nodules (3 and 5mm)
Stable in 6/28 scan.

JMRWife
Posts: 71
Joined: Mon Oct 05, 2015 9:41 pm

Re: On Folfox, just learned I was exposed to covid

Postby JMRWife » Fri Jul 30, 2021 9:22 pm

Roadrunner, I appreciate your thoughtful reply.

I got the first dose of Moderna in February, and the second a month later. I'm 58, was in excellent health before diagnosis, with no other chronic health conditions. Not on a blood thinner.

Clinical stage 2a but I've not had surgery; followed the surgeon's recommendation of neoadjuvant chemo because he felt it likely that I'd have some lymph node involvement. Looks like I'll do 8 rounds, have surgery, then the last four rounds.

I plan to call the oncologist tomorrow. Will certainly be tested. Feel like there's not much to be done unless I show symptoms and then I will definitely bring up the monoclonal antibodies. I just don't want to pass infection to anyone.

Thank you again for your insights. Much appreciated.
Age 58.
4/27/2021 - Dx obstructing "apple core" sigmoid tumor at 30cm. MMR proficient. 4/28: Diverting colostomy.
Started neoadjuvant Folfox 5/18; CEA 107.
Aug 11: 7 rounds Folfox completed. CEA 3.2.
Pathology: COLON, SIGMOID (COLONOSCOPY): -- INVASIVE ADENOCARCINOMA, MOD DIFFERENTIATED

Clinical stage stage IIA. (negative lymph nodes). By imaging at least clinical stage 3 (abnormal lymph nodes on CT), but given negative mesenteric lymph nodes biopsy - considered at least stage 2.

rp1954
Posts: 1574
Joined: Mon Jun 13, 2011 1:13 am

Re: On Folfox, just learned I was exposed to covid

Postby rp1954 » Sat Jul 31, 2021 8:32 am

I would consider doing ivermectin and higher dose vitamin D3 to reduce inflammation, viral activity, spike protein effects, and improve immunity, but you'll likely need an outside doctor with specialized interests for that. Some patients and drs may have relevant prior 5FU/folfox - ivermectin experience.

I of course have no chemo experience, but I've always been extra susceptible to respiratory illness like the canary in a coal mine. I've been places that I needed higher performance against covid infection post exposure, like I want 99% against infection, so I use high dose / high frequency ivermectin and vitamin D3 for starters, with other stuff.
watchful, active researcher and caregiver for stage IVb/c CC. surgeries 4/10 sigmoid etc & 5/11 para-aortic LN cluster; 8 yrs immuno-Chemo for mCRC; now no chemo
most of 2010 Life Extension recommendations and possibilities + more, some (much) higher, peaking ~2011-12, taper to almost nothing mid 2018, mostly IV C

JMRWife
Posts: 71
Joined: Mon Oct 05, 2015 9:41 pm

Re: On Folfox, just learned I was exposed to covid

Postby JMRWife » Sat Jul 31, 2021 9:50 am

Thank you rp154. My oncologist office says don't get tested unless you have symptoms. So far so good. I'll be very watchful though. I'll also report back here in case other people unfortunately I have the exact same experience.
Age 58.
4/27/2021 - Dx obstructing "apple core" sigmoid tumor at 30cm. MMR proficient. 4/28: Diverting colostomy.
Started neoadjuvant Folfox 5/18; CEA 107.
Aug 11: 7 rounds Folfox completed. CEA 3.2.
Pathology: COLON, SIGMOID (COLONOSCOPY): -- INVASIVE ADENOCARCINOMA, MOD DIFFERENTIATED

Clinical stage stage IIA. (negative lymph nodes). By imaging at least clinical stage 3 (abnormal lymph nodes on CT), but given negative mesenteric lymph nodes biopsy - considered at least stage 2.

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beach sunrise
Posts: 517
Joined: Thu Mar 05, 2020 7:14 pm

Re: On Folfox, just learned I was exposed to covid

Postby beach sunrise » Sat Jul 31, 2021 2:39 pm

I have been on high dose Ivermectin since May. I am not taking the vaccine. Been exposed twice and have not gotten covid, knock on wood. I am also on xeloda and high dose supplements and other anti-bacterial/anti-fungal rx's. So, good so far.
I hope you do not contract covid. Keep us posted.
8/19 RC CEA 82.6 T3N0M0
Neoadj 5FU/rad 6 wk
High dose IVC 1 1/2 wks before surgery. Continue still twice a week
Surg 1/20 APR - margins T4bN1a IIIC G2 MSI- 1/20 LN+ LVI+ PNI-
pre cea 24/post 5.9
FOLFOX
7 rds 6-10 CEA 11.4 No more
7/20 CEA 11.1, 8.8
8/20 CEA 7.8
9/20 CEA 8.8, 9, 8.6
10/20 CEA 8.1
11/20 CEA 8's
12/20 CEA 8's & 9's
ADAPT+++ TM drug
MHL1+
PMS2+
MSH2+
MSH6+
POLD1 , KRAS Q61H
Chem-sens test NCI "Test failed, neo adj CR worked. Not enough ca cells to test"

roadrunner
Posts: 163
Joined: Sun Jan 12, 2020 8:46 pm

Re: On Folfox, just learned I was exposed to covid

Postby roadrunner » Sat Jul 31, 2021 5:38 pm

You sound like you’re in a good place to deal with anything that comes and have a good plan. The recent vaccination is a huge plus. You should be near your peak level of circulating antibody. I would be interested in where your WBCs/lymphocytes are/have been, though. If you have an app for test results (CBC) that should be easy to pull up. I have one from both health centers from which I get care, and they are awesome. The more these numbers have held up, the better off you are, I think. It’s at least a rough indicator for your response to the vaccine and the virus, and your immune status in general. The real key is jumping on the monoclonal antibodies if you develop any symptoms. That would replace a great part of what you might be missing, at least, should you need it. And given your status as a cancer patient I think it’s be pretty easy to persuade your Drs. and insurance to give you them timely if you get sick.
7/19: Rectal cancer: Initially staged as IIIA, T2N1M0
Initially approx 4.25 cm, low/mid rectum, mod. well diff. adenocarcinoma
8/22 -10/14 4 rounds FOLFOX neoadjuvant, 3 w/Oxiplatin (lots of side effects/reduced size est. 70-75%)
neoadjuvant chemorad 11/19
4 rounds of FOLFOX July-August 2020
ncCR found 10/20; multiple biopsies negative
TAE 11/20, small amount of tumor removed, lung nodules orig id’d 6/20 stable Nov 2020
Chest CT 3/30/21 small growth in 2 nodules (3 and 5mm)
Stable in 6/28 scan.

JMRWife
Posts: 71
Joined: Mon Oct 05, 2015 9:41 pm

Re: On Folfox, just learned I was exposed to covid

Postby JMRWife » Sat Jul 31, 2021 6:21 pm

I am on Udenyca and WBC and lymphocytes are within normal levels. Platelets and RBC are a bit low but I don't know how they figure into immune response.

I had covid in November 2020; both doses of Moderna well before diagnosis and chemo. I believe the client I was exposed to was not vaccinated and she is feeling quite ill.

I'm very glad to have been vaccinated.
Age 58.
4/27/2021 - Dx obstructing "apple core" sigmoid tumor at 30cm. MMR proficient. 4/28: Diverting colostomy.
Started neoadjuvant Folfox 5/18; CEA 107.
Aug 11: 7 rounds Folfox completed. CEA 3.2.
Pathology: COLON, SIGMOID (COLONOSCOPY): -- INVASIVE ADENOCARCINOMA, MOD DIFFERENTIATED

Clinical stage stage IIA. (negative lymph nodes). By imaging at least clinical stage 3 (abnormal lymph nodes on CT), but given negative mesenteric lymph nodes biopsy - considered at least stage 2.

roadrunner
Posts: 163
Joined: Sun Jan 12, 2020 8:46 pm

Re: On Folfox, just learned I was exposed to covid

Postby roadrunner » Sat Jul 31, 2021 7:46 pm

That’s all really good news. The prior infection + mRNA vaccine before chemo should put you in a very strong place. Not a scientific opinion, but from my extensive reading of the literature I’d say you’re already (in essence) working with a booster (the second shot, after the infection and the first shot). I fought for Neulasta during my pandemic chemo and was able to get it. I believe those drugs only boost lymphocytes modestly (they’re mostly for neutrophils), but if you’re within normal levels you’re really well-positioned. I can’t evaluate the effect of low platelet or RBC numbers, but I think any effects there would be less significant than those of WBCs.
7/19: Rectal cancer: Initially staged as IIIA, T2N1M0
Initially approx 4.25 cm, low/mid rectum, mod. well diff. adenocarcinoma
8/22 -10/14 4 rounds FOLFOX neoadjuvant, 3 w/Oxiplatin (lots of side effects/reduced size est. 70-75%)
neoadjuvant chemorad 11/19
4 rounds of FOLFOX July-August 2020
ncCR found 10/20; multiple biopsies negative
TAE 11/20, small amount of tumor removed, lung nodules orig id’d 6/20 stable Nov 2020
Chest CT 3/30/21 small growth in 2 nodules (3 and 5mm)
Stable in 6/28 scan.

bluebae
Posts: 4
Joined: Fri Jul 09, 2021 9:06 am

Re: On Folfox, just learned I was exposed to covid

Postby bluebae » Sun Aug 01, 2021 11:20 am

Hello JMRWife,

Last year, my BF had COVID a week after his 4th cycle of FOLFOX. There was no vaccine yet at that time. His symptoms was very similar to the side effects of FOLFOX itself, we didnt thought it was COVID at first. Then on the 7th day he said it's a little hard to breathe and it turned out that his oxygen saturation level dropped a little bit (92%). I took him to the hospital immediately, his test results came out positive, they gave him Remdesivir, dexamethasone, and lovenox (enoxaparin) injections. On the third day of he gets better and continued to get better. The next FOLFOX round was postponed for about 1 month after he was released from the hospital.

Based on that experience I think the early detection and treatment was one of the reasons for his good outcome. Be aware of every symptoms. It might be difficult because it can overlap with the side effects of FOLFOX. So I find it very convenient to have a pulse oxymetry at home. it's easy to use and if you can find a good one it's pretty accurate too That way we can check his oxygen saturation level regularly, and dont miss the slight drop of O2 saturation which is one of the early signs of COVID related pneumonia.

also if you are planning to be tested for COVID you should do it at the right time. In my country if you have no symptoms it's suggested to get the test 5-7 days after the exposure to avoid false negative result. But if there's symptoms especially ones that is typical for COVID, you should be tested right away. Of course it's different in every country so you might want to check with your health provider.

This is a tough situation especially in this condition. I hope you don't let it stress you out too much but still be aware of every symptoms you're experiencing. Early recognition is extremely important. Also, your history of vaccination is a huge plus point against the virus especially because it's Moderna which have a pretty high efficacy. I hope everything turns out okay for you.
Caring for BF
Dx 7/7/19, 33 yo
Rectal cancer, signet ring cell. T4N2Mx
APR surgery + permanent colostomy
Refused adjuvant chemo
8/8/20 nodule on gluteal area. biopsy: metastasis
CT: residive mass, infiltration to bladder, prostate
10/28/20 - 3/28/21 FOLFOX
4/7/21 CEA 18,1
5/9/21 CT: mass on pelvic cavity, infiltrating the lymph nodes, bladder, prostate, ureter
6/10/21 URS surgery, stenting failed
6/29/21 FOLFOX + avastin
7/15/21 bowel obstruction caused by residive mass. surgery + ileostomy

JMRWife
Posts: 71
Joined: Mon Oct 05, 2015 9:41 pm

Re: On Folfox, just learned I was exposed to covid

Postby JMRWife » Mon Aug 02, 2021 4:31 pm

Hi bluebae,

So glad your boyfriend escape the worst of covid-19! So far, no symptoms. My oncologist did call to check on me. I'm not worried, just aware. I will be reporting any unusual symptoms to him.
Age 58.
4/27/2021 - Dx obstructing "apple core" sigmoid tumor at 30cm. MMR proficient. 4/28: Diverting colostomy.
Started neoadjuvant Folfox 5/18; CEA 107.
Aug 11: 7 rounds Folfox completed. CEA 3.2.
Pathology: COLON, SIGMOID (COLONOSCOPY): -- INVASIVE ADENOCARCINOMA, MOD DIFFERENTIATED

Clinical stage stage IIA. (negative lymph nodes). By imaging at least clinical stage 3 (abnormal lymph nodes on CT), but given negative mesenteric lymph nodes biopsy - considered at least stage 2.

JMRWife
Posts: 71
Joined: Mon Oct 05, 2015 9:41 pm

Re: On Folfox, just learned I was exposed to covid

Postby JMRWife » Wed Aug 04, 2021 7:26 pm

Just popping in to say I have no symptoms of covid. Thank God for the vaccine.
Age 58.
4/27/2021 - Dx obstructing "apple core" sigmoid tumor at 30cm. MMR proficient. 4/28: Diverting colostomy.
Started neoadjuvant Folfox 5/18; CEA 107.
Aug 11: 7 rounds Folfox completed. CEA 3.2.
Pathology: COLON, SIGMOID (COLONOSCOPY): -- INVASIVE ADENOCARCINOMA, MOD DIFFERENTIATED

Clinical stage stage IIA. (negative lymph nodes). By imaging at least clinical stage 3 (abnormal lymph nodes on CT), but given negative mesenteric lymph nodes biopsy - considered at least stage 2.

roadrunner
Posts: 163
Joined: Sun Jan 12, 2020 8:46 pm

Re: On Folfox, just learned I was exposed to covid

Postby roadrunner » Wed Aug 04, 2021 8:40 pm

That is great news! The vaccines are indeed a miracle.
7/19: Rectal cancer: Initially staged as IIIA, T2N1M0
Initially approx 4.25 cm, low/mid rectum, mod. well diff. adenocarcinoma
8/22 -10/14 4 rounds FOLFOX neoadjuvant, 3 w/Oxiplatin (lots of side effects/reduced size est. 70-75%)
neoadjuvant chemorad 11/19
4 rounds of FOLFOX July-August 2020
ncCR found 10/20; multiple biopsies negative
TAE 11/20, small amount of tumor removed, lung nodules orig id’d 6/20 stable Nov 2020
Chest CT 3/30/21 small growth in 2 nodules (3 and 5mm)
Stable in 6/28 scan.

User avatar
O Stoma Mia
Posts: 1655
Joined: Sat Jun 22, 2013 6:29 am

Re: On Folfox, just learned I was exposed to covid

Postby O Stoma Mia » Wed Sep 08, 2021 12:56 am

rp1954 wrote:I would consider doing ivermectin and higher dose vitamin D3 to reduce inflammation, viral activity, spike protein effects, and improve immunity, but you'll likely need an outside doctor with specialized interests for that. Some patients and drs may have relevant prior 5FU/folfox - ivermectin experience.

I of course have no chemo experience, but I've always been extra susceptible to respiratory illness like the canary in a coal mine. I've been places that I needed higher performance against covid infection post exposure, like I want 99% against infection, so I use high dose / high frequency ivermectin and vitamin D3 for starters, with other stuff.

BUMP


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