Stomach Pain and Folfox/Keytruda?

@nuggetofmine, I'm tagging @davidwrenn @rk6344 @esop @socalkelly who have had Folfox and Keytruda for stage 4 esophageal cancer. I'm hoping they can offer helpful suggestions.

Clearly you are concerned about his pain as well as his not being to eat. I would definitely consult with your oncologist or symptom management nurse. He may require different pain management options. Has a feeding tube been discussed?

Thank you for responding.
He had a J tube, but it caused him so much pain! That pain was different from what he has now. When we found he wasn't a surgery candidate, we had it removed and he felt so much better. I see where some people tolerate it well, but he is so much better without it.
What he does, is take Ativan and Zolfran, then he can eat - the pain is when the food gets to his stomach, and for some reason, this combination together seems to help. Most of the time. Since the tumor hasn't changed, no mets, I can only figure the chemo or immuno therapy is causing the stomach pains. Maybe inflammation?

Idk. - Pain from the J-tube (when he had one) suggests to me that there may have been a problem with the J-tube insertion. I know such things happen because exactly that happened to my wife. She had her J-tube removed months ago (never having used it successfully). Sometimes, she thinks she may have residual pain/discomfort from that faulty procedure.

She's on Folfox and Keytruda now and experiences stomach pain, cramping, nausea, and dumping from time to time.

He had no good days after this last chemo/ immuno treatment, not even the nice two or three days he usually has from the steroids. It's been two weeks.

To make a long story short, his symptoms- severe stomach pain that doubles him over, nausea, sometimes vomiting, headache, diarrhea- all within a few minutes of swallowing a bite of food (and water this last treatment), seem to indicate a Gastritis type of issue. The symptoms are all there every time and last from a couple of minutes to 20 minutes. He's so thin, he can't afford to lose any more weight! We looked into the diet modifications for Gastritis and have been following them for the last two days. The two things that have made the biggest difference for him are eliminating caffeine and while continuing the twice daily Prilosec, also using Tums before eating and after eating. And using Tums during the day when his stomach hurts for any reason. The Prilosec helps heal the stomach lining, helping to reduce acid production, and the Tums help dilute the stomach acid that's already there, or that gets dumped during eating. Bland , low acid food has really helped, although we tried that before without the Tums, and without the caffeine elimination and it didn't help at all.

Last night, day 2, he stayed up late, just eating and eating. Pain free. He is eating better than he has in a couple of months. We have cancelled his Monday treatment and will be consulting with the oncologist. We've been trying to get to the bottom of this pain for months. From what I've read, there isn't really a treatment, other than strict diet and the acid reducers, and time. I guess that's why the doctor never offered anything to treat it with. The Oxycodone he has did not even touch this pain.

Hopefully this can help someone experiencing the same symptoms.

Maybe time for an endoscopy?
Sending well wishes to your husband during this tough time.
Dave

gastritis can be an adverse reaction to the immunotherapy. Please pursue this with your oncologist

So sorry your husband on going through this. My husband did keytruda after his esophagectomy. He didn’t have issue with his stomach but rather fibrous masses in his lungs (pulmonologist suspects side effect from keytruda). Still treatment and cancer took another run at him. He’s now doing chemo with oxiplatin (sp) and FOLFOX. It’s doing its job with the cancer but chemo side effects are in full force!
He has a jtube and it’s saving his life. It’s 90% of his nutrition. He sometimes has pain but it is managed with Tylenol/ibuprofen.
You mentioned Prilosec, is he on the prescription strength protonix? Maybe he needs a stronger dose. My husband takes it every night. Helps with the acid for sure!

UPDATE: We saw the Oncologist, explained the symptoms and the improvement after cutting out caffeine and eating very limited, bland foods. He offered a prescription level PPI, but we declined, since the Prilosec, alternated with Zantac seems to be working (along with the diet changes). Also, adding Tums before and after eating or any time there's too much stomach acid. The Oncologist set him up for fluids two days this week, which included steroids in yesterday's batch. He also said to skip treatment this time and we'll meet again in two weeks. My husband has been feeling so much better! Knowing he has two weeks off has been so good for him mentally, and just being able to eat again is wonderful. He lost 5 pounds from this Gastritis thing, and had previously been maintaining his low weight. So this will give him time to hopefully start gaining again.

UPDATE 2: He gained 12 pounds in the last two weeks according to his weigh in at the cancer center. He's gradually adding foods to see if he can tolerate them. Still no spices, including pepper. If we had looked in to this sooner, he wouldn't have lost 70 pounds. I think our mistake was attributing any stomach pain to the cancer. He has actually had no pain from the cancer since his tumor decreased back in March. Hopefully this information can help someone.

@nuggetofmine, this is such great news. I appreciate the updates and information. I think it’s quite natural to suspect that every symptom as being cause by the cancer or the treatments. I’m glad that you and your husband’s team got to the root cause of the stomach pain and that a solution was found.