Dennis has his first immunotherapy treatment at the Walker Family Cancer Centre today. Immunotherapy is a treatment option for many people living with advanced lung cancer. It helps your body’s immune system better find and destroy cancer cells, even when they try to hide. The breakthrough therapy is helping some people with hard-to-treat cancer feel better and live longer.
He'll be getting a drug called pembrolizumab (Keytruda) by infusion through an IV (intravenous) line, in his arm.
Each treatment takes about 60 to 90 minutes. He’ll receive a dose every 3 weeks until the cancer shows signs of improvement or he have certain side effects. The process will probably last a few months.
NOTES: Always tell your doctor about any side effects you have. It’s important for them to figure out if your symptoms are caused by the treatment or a sign that your cancer may be getting worse. Managing side effects early and well can help you stick to your cancer treatment plan.
Immunotherapy can cause flu-like side effects. This means your immune system is hard at work.
Common symptoms include:
- Fatigue
- Cough
- Loss of appetite
- Muscle aches and pains
- Joint pain
Other side effects of checkpoint inhibitors for lung cancer include:
- Nausea
- Diarrhea
- Constipation
- Itching
- Rash
Many of these problems are easy to treat with over-the-counter medicines.
- Severe side effects are less common. But sometimes, checkpoint inhibitors cause your immune system to attack otherwise healthy tissue. This can lead to life-threatening inflammation in your lungs, liver, kidneys, intestines, and other parts of the body. You may have to stop immunotherapy and get medicines to quiet down your immune system.
- Pneumonitis (inflammation of the lungs) is one serious side effect that often affects people taking checkpoint inhibitors. It can make it hard to breathe. You’ll need immediate treatment.
- Because immunotherapy for lung cancer is so new, doctors aren’t sure what the long-term effects or complications might be. They can include diabetes and thyroid problems, which would require ongoing medical care.
What Happens After Treatment Stops?
Doctors consider checkpoint inhibitors a breakthrough that can help people with advanced lung cancer live longer. However, they don’t work for everyone. Stay in touch with your doctor during treatment, and always go to all your follow-up appointments. Blood tests and imaging scans are done to check for signs of cancer disappearance or growth.
Ask your doctor how you can tell if your treatment isn’t working.
No one can tell you how well these treatments will work for you. There’s no blood test or other method to predict if the drug will shrink your tumor or make you feel better. However, there are some signs that it isn’t helping.
Tell your doctor if you have:
- Cough
- Pain
- Trouble breathing
- Any other symptoms that concern you
They may be a sign that your cancer is getting worse, or they may be side effects of treatment. Only a doctor can tell the difference.
Side effects don’t mean the medicine isn’t fighting your cancer -- but a severe reaction can be life threatening and may require you to stop treatment. Serious side effects are rare, but include inflammation of the lungs (pneumonitis), liver, kidneys, intestines, and other parts of the body.
When the Cancer Looks Worse but Isn’t
Your doctor will order CT scans of your tumor to keep track of it and make sure your treatment is working.
Your cancer might look worse on the first CT scan after you start immunotherapy. But it may really be getting better. Doctors call this “pseudoprogression." It doesn’t mean the drug isn’t working. Immunotherapy causes your immune system to attack cancer cells. The rush of helper immune cells can cause your tumor to swell and look bigger. The report may say your cancer has progressed, when it really hasn’t.
Your doctor will review your scans and discuss your symptoms. They’ll decide if your treatment is really working and your cancer is stable.
- If the scan shows a larger tumor but there are no new areas of cancer and you feel OK, it may be pseudoprogression. Doctors usually suggest you wait two or three more treatment cycles (about 2 months) then get another scan.
- If you feel worse and the scan shows a larger tumor and new lesions, immunotherapy likely isn’t working. The doctor will recommend you stop it and try something else, such as taking part in a clinical trial. They provide access to cutting-edge immunotherapy treatments that aren’t yet approved for lung cancer. These include other checkpoint inhibitors, therapeutic vaccines, and adoptive T-cell transfer.
- If nothing helps at all, it may be time to ask your doctor if it’s time to stop treatment and start hospice and palliative care to ease your symptoms and make you feel better. An honest discussion will help you and your family make the most of every day.
How to Manage Your Side Effects
Try these tips to help you handle some of the most common side effects of lung cancer treatment:
Nausea and vomiting. Take an anti-nausea medicine. You can get some over the counter, but your doctor may need to give you a prescription for others.
Also, eat several small meals during the day instead of three big ones. Avoid foods that smell strong, are greasy or spicy, or that bother your stomach.
Drink extra water and other fluids to keep your body hydrated.
Constipation. To help with this problem, eat foods that are high in fiber, such as:
- Fruits
- Vegetables
- Whole-grain breads and cereals
- Drink at least 8 cups of fluids each day.
- And exercise for 15 to 30 minutes a day to keep your digestive system moving.
If these tips don't help, ask your doctor about over-the-counter medicines.
Diarrhea. To manage this problem, eat bland foods like the BRAT diet:
- Bananas
- Rice
- Applesauce
- Toast
- Drink 8 to 12 cups of water or other clear liquids every day to make up for the fluid you lose.
Tiredness. To get your energy back, try to exercise. Even a 15-minute daily walk can help.
Nap if you need the extra rest. Just limit your sleep breaks to less than 1 hour so you can fall asleep at night.
Avoid caffeine and alcohol, which can keep you awake.
Rash and other skin changes. Both chemo and radiation can leave your skin red, itchy, and sore.
To avoid irritating your skin even more, be gentle. Use mild cleansers and creams. Wash with warm -- not hot -- water. Don't scrub your skin. After a shower or bath, pat yourself dry.
Wear sunscreen when you go outside. Protect your lips with an SPF lip balm. And cover your head and face with a wide-brimmed hat.
Which Types of Exercise Are Best?
Carol Michaels, an exercise specialist and creator of Recovery Fitness, an exercise program to help people with cancer recover from treatment, divides exercises for people with lung cancer into four basic categories: breathing, stretching, aerobics, and strength – ideally done in that order. “If someone has lung cancer and undergone some treatment, they would get started slowly with nice deep breathing, stretching, then they will be able to very slowly add different types of exercises,” says Michaels.
Breathing exercises for lung cancer patients can make your diaphragm stronger. Your diaphragm is the muscle between your lungs and abdomen. Building its strength, in turn, makes it easier to breathe. One of the most effective breathing exercises is diaphragmatic breathing through pursed lips.
- Sit or stand with one hand on your abdomen.
- Inhale through your nose and feel your abdomen pushing out, lowering the diaphragm and allowing your lungs to fill with air.
- Exhale through pursed lips, pushing up and in with your hand to get all the air out.
Simple stretching exercises can also be done at any stage of disease and in any setting. These get your blood and oxygen flowing to the muscles. That makes your lungs stronger and increases the amount of air your lungs can hold. Stretching can also help with some of the side effects of radiation therapy, such as tight muscles, and help clear scar tissue from surgery. Stretching has the added benefit of improving your posture, which helps open your lungs.
Aerobic exercise, even short walks, makes your heart and lungs stronger and improves sleep quality in people with lung cancer. If your energy level is limited by symptoms or by treatment, try walking around the house, resting, then moving again. In one study, people with lung cancer who worked out with both aerobics and strength training three times a week for 12 weeks reported improved quality of life, fatigue, and cardiorespiratory (heart and lung) fitness.
Strength training can fight fatigue, build back muscles, make bones stronger, and improve balance and posture. Participants in one trial who did 20 minutes of warm-up, then resistance training 3 days a week for 12 weeks gained back all their muscle mass and strength. The people had stage I, II, or III lung cancer and had gone through some combination of surgery, chemotherapy, and radiation. Strength training can help with simple tasks, like going to the toilet, which some people find difficult after treatment.
Exercise for Advanced Lung Cancer
The goal of exercise for advanced lung cancer, or for those with earlier disease who can’t have surgery, is to ease symptoms, keep fitness level and quality of life, and reduce treatment side effects.
Moderate-intensity aerobics and resistance training have been shown to be safe and can lessen anxiety and improve physical abilities. One small study involving people with advanced NSCLC and extensive SCLC reported better oxygen intake and mental health. A similar plan of strength and endurance training improved muscle strength and shortness of breath in advanced-stage patients who were getting chemotherapy.
This, in turn, may improve survival. Research shows that people with better lung capacity in advanced NSCLC have slightly lower risk of dying.
Slow walking is a safe option for many. “I always recommend walking with somebody, maybe holding their hand,” says Michaels. “It gives you more confidence.” It also helps with balance.
Even people with cancer that has spread to the bones or who are getting palliative care (which focuses on relief from symptoms and stress of your condition) can benefit from exercise, as long as it’s done in partnership with a doctor or specialist.
Exercise has been shown to improve the quality of life for people who have lung cancer, in all stages. In fact, some people who have lung cancer say the quality of their lives is just as important as how long they live.
Is exercise good for Stage 4 lung cancer?
Low-intensity activities, like easy walking or light stretching, are great options for improving your cardiovascular health without overdoing it. Beyond cancer-related fatigue, light to moderate exercise during cancer treatment has multiple benefits, including: Reduced stress. Boosted self-esteem, mood and motivation.
