Last two chemos or covid booster?

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JMRWife
Posts: 99
Joined: Mon Oct 05, 2015 9:41 pm

Last two chemos or covid booster?

Postby JMRWife » Fri Dec 03, 2021 9:12 pm

10 folfox treatments in the books.

Post-surgery: stage 1. Good margins.

I work in a homeless shelter.

3 confirmed covid cases this week. Surely more to come.

Oncologist says do the treatments because pre-surgery cat scan showed a few "suspicious" lymph nodes.

But post surgery pathology showed 0/36 nodes were cancerous.

I want a booster shot yesterday. Oncologist says it will be ineffective because of chemo.

But I work in a homeless shelter and many are unvaccinated and we can't force the vaccine.

What would you do: booster, flu shot, or remaining 2 chemo treatments?
Age 58.
4/27/2021 - Dx obstructing "apple core" sigmoid tumor at 30cm. MMR proficient. 4/28: Diverting colostomy.
Neoadjuvant Folfox 5/18; CEA 107.
9/8: 9 rounds Folfox completed. CEA 2.1.
Pathology: COLON, SIGMOID: -- INVASIVE ADENOCARCINOMA, MOD DIFFERENTIATED Clinical stage IIA.

9/28/21 CAT scan: Tumor was 6.4 x 3.8 cm, now 2.6 x 4.5 cm.

10/4/21: Sigmoid colectomy. 36 lymph nodes removed, 0 cancerous. Stage T2N0M0.

Dennyp
Posts: 24
Joined: Thu Oct 29, 2020 9:28 pm

Re: Last two chemos or covid booster?

Postby Dennyp » Fri Dec 03, 2021 10:07 pm

I would follow the advice of my oncologist.
5/19 IIIC sigmoid cancer 2/25 lymph nodes positive
5/19 surgery
7/19 FOLFOX 6 months
9/20 recurrence to single lymph node
10/20 FOLFIRI 5 rounds
1/21 surgery to remove lymph node
4/21 CT NED
8/21 CT NED
11/2 CT NED

User avatar
beach sunrise
Posts: 581
Joined: Thu Mar 05, 2020 7:14 pm

Re: Last two chemos or covid booster?

Postby beach sunrise » Fri Dec 03, 2021 11:25 pm

Personal opinion here: No real data yet on vaccine, especially for cancer patients. None of my doctors had an answer for the tough questions I asked. I was only curious anyway as I would never get the vaccine. Surgeon did recommend the pneumonia and/or flu shot at appt last week. But flu shot only protects to a certain percentage I have read. A nurse friend of mine said the pneumonia shot used to be good for about 4 years and not sure why it changed.
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: 204
Joined: Sun Jan 12, 2020 8:46 pm

Re: Last two chemos or covid booster?

Postby roadrunner » Sat Dec 04, 2021 12:00 am

I don’t think it’s one or the other. You mentioned that it’s a booster. There is good evidence that the booster can produce improved, and likely effective, immunity in cancer patients on active chemo. I think you can do both.

Here’s just one link, but there are many studies on this.

https://www.reuters.com/business/health ... 021-10-06/
7/19: Rectal cancer: Staged as IIIA, T2N1M0
approx 4.25 cm, low/mid rectum, mod. well diff.
8/22 -10/14 4 rounds FOLFOX neoadjuvant, 3 w/Oxiplatin (side effects/reduced size est. 70-75%)
neoadjuvant chemorad 11/19
4 rounds of FOLFOX July-August 2020
ncCR found 10/20; 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)
VATS 12/8/21 to remove sub-pleural met 7mm. Considering SBRT for remaining nodule.

roadrunner
Posts: 204
Joined: Sun Jan 12, 2020 8:46 pm

Re: Last two chemos or covid booster?

Postby roadrunner » Sat Dec 04, 2021 12:17 am

Here’s another study. This one seems directly on point.

https://jamanetwork.com/journals/jamaon ... le/2786532
7/19: Rectal cancer: Staged as IIIA, T2N1M0
approx 4.25 cm, low/mid rectum, mod. well diff.
8/22 -10/14 4 rounds FOLFOX neoadjuvant, 3 w/Oxiplatin (side effects/reduced size est. 70-75%)
neoadjuvant chemorad 11/19
4 rounds of FOLFOX July-August 2020
ncCR found 10/20; 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)
VATS 12/8/21 to remove sub-pleural met 7mm. Considering SBRT for remaining nodule.

JMRWife
Posts: 99
Joined: Mon Oct 05, 2015 9:41 pm

Re: Last two chemos or covid booster?

Postby JMRWife » Sat Dec 04, 2021 5:33 am

Thank you. My oncologist told me the booster would do nothing. Thanks again!
Age 58.
4/27/2021 - Dx obstructing "apple core" sigmoid tumor at 30cm. MMR proficient. 4/28: Diverting colostomy.
Neoadjuvant Folfox 5/18; CEA 107.
9/8: 9 rounds Folfox completed. CEA 2.1.
Pathology: COLON, SIGMOID: -- INVASIVE ADENOCARCINOMA, MOD DIFFERENTIATED Clinical stage IIA.

9/28/21 CAT scan: Tumor was 6.4 x 3.8 cm, now 2.6 x 4.5 cm.

10/4/21: Sigmoid colectomy. 36 lymph nodes removed, 0 cancerous. Stage T2N0M0.

texazgal
Posts: 161
Joined: Fri Sep 28, 2007 4:40 pm
Location: central Texas

Re: Last two chemos or covid booster?

Postby texazgal » Sat Dec 04, 2021 12:41 pm

DH and I got the covid booster yesterday. I am currently getting chemo (paclitaxel) twice a month. No one questioned our decision to do this or said it would not help. In early November,
my 3 brothers, one sister and 2 in-laws all came down with covid. One brother spent 17 days in ICU and thought he was going to die. Another had a brief time in hospital to get oxygen-his level was about 60. Said it was like breathing into a plastic bag. I want no part of this disease and will do whatever it takes to hopefully avoid it.
DX rectal cancer Aug 04
Surgery Sept 04, perm ostomy, "BarbieButt" Sept 23, 04.
June 2019 stage 3 esophageal cancer
Aug. 2019 28 radiations, 5 chemo
Nov. PET shows original tumor and mets resolved, 2 new mets in liver and bone.
May 2020 port installed, started Folfox hope to do 12 rounds, cure not expected
Keytruda April 2021 8 rounds
scan showed small growth in tumors
Paclitaxol started summer 2021.
Scan July 30, 2021 showed small decrease in size of tumors in liver and bone

roadrunner
Posts: 204
Joined: Sun Jan 12, 2020 8:46 pm

Re: Last two chemos or covid booster?

Postby roadrunner » Sat Dec 04, 2021 2:28 pm

JMRWife: I kept a really close watch on my WBCs (as a rough measure of my immune system and its likely response to vaccines) throughout chemo. I assume you get regular CBC tests. For many vaccines, lymphocytes are I believe a better marker than neutrophils (that we cancer patients usually watch more closely because they are the main defense against bacteria/sepsis (lymphocytes provide the main defense against viruses, though of course things are more complex than that)).

If your numbers aren’t terrible (as they usually aren’t for FOLFOX (except perhaps at nadir)), you’ll probably be in decent shape after the booster (keep in mind that 50% of organ transplant folks even get a response). But there’s still a greater risk of a poor response. Since you can’t really avoid exposure, If I were you I’d feel good about the booster, but not ironclad. If you get an exposure or symptoms, I’d be very aggressive early about going in and seeking tests and treatments, including monoclonal antibodies, the Merck pill (Monupiravir (efficacy is not great but every little bit helps/some side effects, esp. for pregnant women, FDA approved but awaiting CDC)) or even better the Pfizer pill (Paxlovid (a little farther from approval but better in trials)). It also may be a good idea to reboost after you finish chemo. That is something to discuss with an immunologist. Honestly, while I’ve done it myself, asking an oncologist about vaccine response is almost like asking a cardiologist which chemo to use ; )
7/19: Rectal cancer: Staged as IIIA, T2N1M0
approx 4.25 cm, low/mid rectum, mod. well diff.
8/22 -10/14 4 rounds FOLFOX neoadjuvant, 3 w/Oxiplatin (side effects/reduced size est. 70-75%)
neoadjuvant chemorad 11/19
4 rounds of FOLFOX July-August 2020
ncCR found 10/20; 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)
VATS 12/8/21 to remove sub-pleural met 7mm. Considering SBRT for remaining nodule.

zephyr
Posts: 325
Joined: Thu Aug 18, 2016 7:31 am

Re: Last two chemos or covid booster?

Postby zephyr » Sat Dec 04, 2021 3:13 pm

My circumstances are very different in that I've been at this for 5 years and my mets are very slow growing. That said, when the boosters became available in August, I happened to have an appointment with my oncologist the day before chemo was scheduled and the day after boosters were available. I asked him when I should get the booster and he told me to postpone chemo and get the booster that week. He felt the booster was more important than chemo. I got the flu shot a few weeks later.
Nov-2009 Early stage CRC found during routine colonoscopy
2010, 2011, 2014 F/U colonoscopies, all clear
Jun-2016 CRC during followup colonoscopy, surgery, Stage 4, KRAS, MSS, inoperable lung mets
Aug-2016-May-2018 Folfox, 5FU & Avastin, 5FU, Folfiri & Cyramza
Aug/Sep-2018 YAG laser surgeries (Germany), 11 nodules removed
Nov-2018 clean CT scan
Mar-2019 New lung nodules
Apr-2019 Dec-2020 Xeloda/Avastin, SBRT, cont. Xeloda/Avastin
Dec-2020 Progression, considering all options
Mar-2021 Forfiri/Avastin

roadrunner
Posts: 204
Joined: Sun Jan 12, 2020 8:46 pm

Re: Last two chemos or covid booster?

Postby roadrunner » Sat Dec 04, 2021 3:27 pm

Yeah, Zephyr makes a very important point. It is sometimes possible to interrupt chemo to get optimal response from a vaccine or booster. Should’ve mentioned that. But Zephyr’s also right that his Stage 4 situation is very different from JMRWife’s Stage 1 adjuvant (my interpretation). Unfortunately, since this oncologist hasn’t exactly covered him/herself in glory on this question so far, that presents a bit of a conundrum. Maybe there’s someone else to ask? If not, again, I’d look at WBCs as a guide or just go with the boost and revisit later. Finally, it may be possible to check antibody titer after a boost (well, it is testable but I doubt insurance would cover it and it can be costly). Anyhow, that’s another approach if your work puts you at nearly daily risk.
7/19: Rectal cancer: Staged as IIIA, T2N1M0
approx 4.25 cm, low/mid rectum, mod. well diff.
8/22 -10/14 4 rounds FOLFOX neoadjuvant, 3 w/Oxiplatin (side effects/reduced size est. 70-75%)
neoadjuvant chemorad 11/19
4 rounds of FOLFOX July-August 2020
ncCR found 10/20; 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)
VATS 12/8/21 to remove sub-pleural met 7mm. Considering SBRT for remaining nodule.

JMRWife
Posts: 99
Joined: Mon Oct 05, 2015 9:41 pm

Re: Last two chemos or covid booster?

Postby JMRWife » Sat Dec 04, 2021 4:15 pm

Thank you for all your thoughtful responses. I feel this winter will be bad esp at the shelter. My small city reported 500 cases Thursday and today.

My 11th chemo is wednesday. Plan: covid test tomorrow. If negative I'll get booster. If positive, well....I'll inform my oncologist and let the chips fall where they may.
Age 58.
4/27/2021 - Dx obstructing "apple core" sigmoid tumor at 30cm. MMR proficient. 4/28: Diverting colostomy.
Neoadjuvant Folfox 5/18; CEA 107.
9/8: 9 rounds Folfox completed. CEA 2.1.
Pathology: COLON, SIGMOID: -- INVASIVE ADENOCARCINOMA, MOD DIFFERENTIATED Clinical stage IIA.

9/28/21 CAT scan: Tumor was 6.4 x 3.8 cm, now 2.6 x 4.5 cm.

10/4/21: Sigmoid colectomy. 36 lymph nodes removed, 0 cancerous. Stage T2N0M0.

boxhill
Posts: 767
Joined: Fri Apr 06, 2018 11:40 am

Re: Last two chemos or covid booster?

Postby boxhill » Sun Dec 05, 2021 7:47 pm

I'd get the booster AND chemo, but delaying chemo for a week or two is not a deal breaker. It has happened to many if not most of us at some point in 12 rounds of folfox. Worst case scenario your antibodies are only somewhat boosted.

I just read that in fact they are talking about a potential second booster for those whose immune systems are less likely to produce a good antibody response.

There is plenty of data about the efficacy of vaccines of keeping people out of the hospital and off of ventilators. I'd pay no attention to misinformation peddled by vaccine deniers.
F, 64 at DX CRC Stage IV
3/17/18 blockage, r hemi
11 of 25 LN,5 mesentery nodes
5mm liver met
pT3 pN2b pM1
BRAF wild, KRAS G12D
dMMR, MSI-H
5/18 FOLFOX
7/18 and 11/18 CT NED
12/18 MRI 5mm liver mass, 2 LNs in porta hepatis
12/31/18 Keytruda
6/19 Multiphasic CT LNs normal, Liver stable
6/28/19 Pause Key, predisone for joint pain
7/31/19 Restart Key
9/19 CT stable
Pain: all fails but Celebrex
12/23/19 CT stable
5/19 MRI stable/NED
6/20 Stop Key
All MRIs NED

roadrunner
Posts: 204
Joined: Sun Jan 12, 2020 8:46 pm

Re: Last two chemos or covid booster?

Postby roadrunner » Sun Dec 05, 2021 8:08 pm

Boxhill: That’s good advice as to the “extra” boost. Most immunologists believe it’s a three-dose vaccine for normal, healthy folks, but it is definitely appropriate to get a fourth shot if immunocompromised (though timing is an issue). I got my third in August, and while immunity seems to last much longer after three (than two), I will go for a fourth as soon as I get into the 5-6 month range, unless Israeli data (they track boosters very closely) establishes continued very strong protection. I haven’t had chemo in well over a year though, and my WBCs are low normal. If I were lower than that, or if I start active chemo again, I would definitely get shot #4.
7/19: Rectal cancer: Staged as IIIA, T2N1M0
approx 4.25 cm, low/mid rectum, mod. well diff.
8/22 -10/14 4 rounds FOLFOX neoadjuvant, 3 w/Oxiplatin (side effects/reduced size est. 70-75%)
neoadjuvant chemorad 11/19
4 rounds of FOLFOX July-August 2020
ncCR found 10/20; 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)
VATS 12/8/21 to remove sub-pleural met 7mm. Considering SBRT for remaining nodule.

Bpaint
Posts: 27
Joined: Sun Oct 11, 2020 8:54 pm

Re: Last two chemos or covid booster?

Postby Bpaint » Mon Dec 06, 2021 9:30 am

My husband’s oncologist recommended he get the vaccines and booster while on chemo. Said he hadn’t seen any research convincing him it would be a bad idea to do both.
My husband (age 41 at dx):
8/20 CRC Stage 4. Mets to lungs, liver, distant lymph nodes (25+)
MSS, KRAS wild
CEA 713 at dx
Folfox (12 rounds)
CEA 113
Liver, colon and lymph node resection 4/21
New lung mets, Vectibix monotherapy started 6/21

User avatar
CRguy
Posts: 10365
Joined: Sun Feb 10, 2008 6:00 pm

Re: Last two chemos or covid booster?

Postby CRguy » Mon Dec 06, 2021 10:14 pm

boxhill wrote:There is plenty of data about the efficacy of vaccines of keeping people out of the hospital and off of ventilators. I'd pay no attention to misinformation peddled by vaccine deniers.

WORD !!!!

I've had three Pfizers now and the flu vax

vaccines work

CRguy
Caregiver x 4
Stage IV A rectal cancer/lung met
14 Year survivor
my life is an ongoing totally randomized UNcontrolled experiment with N=1 !
Review of my Journey so far


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