2 Cancers - 2 Immunotherapies?

Cancer is the six-letter word no one wants to hear.  Most, not all, people will also hear the word metastasis (spread of original cancer) at some point during their treatment. I, on the other hand, have been "lucky" enough to hear the word Cancer twice - during the same time period - and it is not metastasis.

A Second Cancer Diagnosis

I was diagnosed with Lung Cancer in February 2014 and have survived surgery, chemo, radiation, and currently immunotherapy (Opdivo).  I have been in some type of treatment regimen since my diagnosis without any breaks.

So, what happens when I go for CT scans every three months to check for progression...and they tell me I have bladder cancer.

Bladder cancer is slightly different than most cancers, as it is commonly treated by a urologist, not a medical oncologist. This is where I need you to really pay attention. My advice to you - Do not begin treatment for bladder cancer until your urologist physically speaks to your medical oncologist who is treating your lung cancer.

If you find yourself in this same position, my story may save you many side effects and potentially serious medical issues. My bladder cancer was not invasive - meaning it was only on the bladder lining. I was able to have a simple surgical procedure to have it removed. Following this, bladder cancer treatment begins, typically with BCG intravesical treatments. (BCG is Bacillus Calmette-Guerin, an immunotherapy).  With intravesical therapy, the doctor puts a liquid drug directly into the bladder (through a catheter) rather than giving it by mouth or injecting it into a vein. The drug can affect the cells lining the bladder without having major effects in other parts of the body. As a cancer patient, the last sentence sounds fantastic.

BUT, according to the American Cancer Society, "(BCG) is the main intravesical immunotherapy for treating early-stage bladder cancer. BCG is a germ that is related to the one that causes tuberculosis (TB), but it doesn’t usually cause serious disease. BCG is put directly into the bladder through a catheter. The body’s immune system cell are attracted to the bladder and activated by BCG, which in turn affects the bladder cancer cells. Treatment is usually started a few weeks after a TURBT and is given once a week for 6 weeks. Sometimes long-term maintenance BCG therapy is given."1

I highlighted the words, "immune system cells" so I could grab your attention.  What this means is, for me, I am taking TWO different cancer-fighting drugs, both of which affect my immune system.

When Medical Teams Don't Communicate, It Can Cause Issues

My mistake was, I had 3 BCG treatments before seeing my medical oncologist for my monthly meeting. When I told her I was also receiving BCG, red flags went up everywhere.

The bottom line - there have been millions of dollars dedicated to research and FDA approval for numerous targeted therapy drugs and immunotherapy drugs for Cancer. We are living longer - we are surviving and enjoying life. BUT, we were unable to find research studies on a patient receiving TWO different immunotherapies at the same time.

Luckily for me, there are other alternative drugs that we can use. Please be sure all your doctors TALK to each other. As patients, we have a lot we can teach our physicians.  Oh, and by the way, my CT scan showed regression in size for all my tumors :)

Editor’s Note: We are extremely saddened to say that on January 28, 2020, Jennifer Toth passed away. Jennifer was a passionate advocate for the Lung Cancer community. She will be deeply missed.

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