CR Day 78: 14th Opdivo infusion

Two weeks ago, I didn't get a nivolumab infusion because I had so much lung congestion. Dr. Hahn didn't think that I had pneumonitis, but decided that the safest option was to postpone the infusion and wait for the congestion to ease. The day after I started the Z-pak of antibiotics, I noticed at my mucus changed from green to clear -- a good sign. But after 10 days I still had a productive cough, and began to wonder if I was in the 3% of nivolumab patients who develop pneumonitis. I reviewed the recent literature regarding nivolumab and pneumonitis and was concerned enough to send the following email to Dr. Hahn:

An update before the Labor Day weekend: The good news is that the day after starting the Z-Pak, my bronchial mucus went from green to clear. The bad news is that I still have lung congestion and a productive cough, albeit not quite as bad as it was when I saw you last week. This type of lingering chest congestion is very unusual for me. I am wondering if I might be developing the type of anti–PD-1–related pneumonitis that has been observed in a few of patients treated with nivolumab, and as described in Dr. Nishino's July 16, 2015 JAMA letter. I'm scheduled to see you again on Tuesday, Sept. 8. Let me know if you want me to come in earlier in the day for another CT, have a pulmonologist consult, or whether I'm jumping at shadows. 

As it turned out, after I sent the email I noticed a significant drop in the amount of mucus in my lungs. So yesterday I braved the post Labor Day traffic around the DC beltway and made my way to Hopkins. My port was easily accessed and my labs were fine (although my glucose was a bit higher than usual, probably due to my mobile breakfast of blueberry pop tarts). I met with Dr. Hahn and Galina, the clinical trial nurse. Dr. Hahn was happy to hear of my recent improvement, but carefully listened to my lungs to verify the drop in congestion.  He didn't think that my congestion was pneumonitis caused by my Opdivo therapy, but instead likely was due to a combination of a bacterial and viral infection from Africa to which my body was unaccustomed. He said that he was ok with proceeding with today's infusion, but that I should immediately notify him if I noticed any increase in bronchial mucus. If that happened, he'd recommend that I start on a steroid and not have any additional nivolumab treatments until the lungs were completely clear. 

After a two and a half hour wait for the pharmacy to compound my drug, I laid down in the infusion chair and read a recent Grisham book (Calico Joe) during the infusion cycle. It's old hat by now, but nevertheless I am grateful for each infusion, thankful to the doctors, nurses, and techs who provide my care, and for the years of research and hundreds of millions of dollars of investment by Bristol-Myers, that have made possible the administering of this drug.

Tomorrow I am off to Utah to get some more granddaughter time: it will be Rose's second birthday, and I can't wait to read some books with her, and also hold little Lily. When I think of joy and rejoicing in my posterity, this is what it's all about.