Nisha Mohindra, MD

Additional Resources

 We've talked a lot today about a lot of different things, and I want to take a moment to thank both Dr. Towe and Dr. Mohindra for their time and perspectives today. I also want to direct anyone watching to where you can go for more information. To learn more about lung cancer, GO2 for Lung Cancer is a great resource. Visit us at GO2.org. That's GO2.org. And if you've heard us talk a bit today about 

, for the treatment of early-stage non-small cell lung cancer. For more information on 

. And please continue listening for some Important Safety Information.

OPDIVO® (nivolumab) is a prescription medicine used in combination with chemotherapy that contains platinum and another chemotherapy medicine, before you have surgery, for adults with early-stage lung cancer (called non-small cell lung cancer).

It is not known if OPDIVO is safe and effective in children younger than 12 years of age with melanoma or MSI- H or dMMR metastatic colorectal cancer.

It is not known if OPDIVO is safe and effective in children for the treatment of any other cancers.

Important Safety Information for OPDIVO® (nivolumab)

What is the most important information I should know about OPDIVO?

OPDIVO is a medicine that may treat certain cancers by working with your immune system. OPDIVO can cause your immune system to attack normal organs and tissues in any area of your body and can affect the way they work. These problems can sometimes become severe or life-threatening and can lead to death. These problems may happen anytime during treatment or even after your treatment has ended. You may have more than one of these problems at the same time. Some of these problems may happen more often when OPDIVO is used in combination with another therapy.

Call or see your healthcare provider right away if you develop any new or worse signs or symptoms, including:

 new or worsening cough; shortness of breath; chest pain

 diarrhea (loose stools) or more frequent bowel movements than usual; stools that are black, tarry, sticky, or have blood or mucus; severe stomach-area (abdominal) pain or tenderness

 yellowing of your skin or the whites of your eyes; severe nausea or vomiting; pain on the right side of your stomach area (abdomen); dark urine (tea colored); bleeding or bruising more easily than normal

 headaches that will not go away or unusual headaches; eye sensitivity to light; eye problems; rapid heart beat; increased sweating; extreme tiredness; weight gain or weight loss; feeling more hungry or thirsty than usual; urinating more often than usual; hair loss; feeling cold; constipation; your voice gets deeper; dizziness or fainting; changes in mood or behavior, such as decreased sex drive, irritability, or forgetfulness

: decrease in your amount of urine; blood in your urine; swelling in your ankles; loss of appetite

rash; itching; skin blistering or peeling; painful sores or ulcers in the mouth or nose, throat, or genital area

Problems can also happen in other organs and tissues. These are not all of the signs and symptoms of immune system problems that can happen with OPDIVO. Call or see your healthcare provider right away for any new or worsening signs or symptoms, which may include:

Chest pain; irregular heartbeat; shortness of breath; swelling of ankles

Confusion; sleepiness; memory problems; changes in mood or behavior; stiff neck; balance problems; tingling or numbness of the arms or legs

Double vision; blurry vision; sensitivity to light; eye pain; changes in eye sight

Persistent or severe muscle pain or weakness; muscle cramps

Getting medical help right away may help keep these problems from becoming more serious. 

Your healthcare team will check you for these problems during treatment and may treat you with corticosteroid or hormone replacement medicines. Your healthcare team may also need to delay or completely stop your treatment if you have severe side effects.

Possible side effects of OPDIVO
OPDIVO can cause serious side effects, including:

See “What is the most important information I should know about OPDIVO?”

Tell your healthcare team right away if you get these symptoms during an infusion of OPDIVO: chills or shaking; itching or rash; flushing; shortness of breath or wheezing; dizziness; feel like passing out; fever; back or neck pain

Complications of bone marrow (stem cell) transplant that uses donor stem cells (allogeneic). 

These complications can be severe and can lead to death. These complications may happen if you underwent transplantation either before or after being treated with OPDIVO. Your healthcare provider will monitor you for these complications.

The most common side effects of OPDIVO, when used in combination with chemotherapy, include: 

nausea; decreased appetite; feeling tired; rash; pain in muscles, bones, and joints; vomiting; constipation; and pain, tingling, or burning in your hands and feet.

These are not all the possible side effects. For more information, ask your healthcare provider or pharmacist. You are encouraged to report side effects of prescription drugs to the FDA. Call 1-800-FDA-1088.

Before receiving OPDIVO, tell your healthcare provider about all of your medical conditions, including if you:

have immune system problems such as Crohn’s disease, ulcerative colitis, or lupus

have received or plan to receive a stem cell transplant that uses donor stem cells (allogeneic)

have received radiation treatment to your chest area in the past and have received other medicines that are like OPDIVO

have a condition that affects your nervous system, such as myasthenia gravis or Guillain-Barré syndrome

are pregnant or plan to become pregnant. OPDIVO can harm your unborn baby.

are breastfeeding or plan to breastfeed. It is not known if OPDIVO passes into your breast milk. Do not breastfeed during treatment with OPDIVO and for 5 months after the last dose of OPDIVO.

Your healthcare provider should do a pregnancy test before you start receiving OPDIVO.

You should use an effective method of birth control during your treatment and for 5 months after the last dose of OPDIVO. Talk to your healthcare provider about birth control methods that you can use during this time.

Tell your healthcare provider right away if you become pregnant or think you may be pregnant during treatment with OPDIVO.

Tell your healthcare provider about all the medicines you take, including prescription and over-the- counter medicines, vitamins, and herbal supplements.

Please see U.S. Full Prescribing Information and Medication Guide for 

OPDIVO® is a registered trademark of Bristol-Myers Squibb Company

Videos

OPDIVO (nivolumab) is a prescription medication used with chemotherapy for early-stage non-small cell lung cancer. It works by engaging the immune system, but can cause it to attack normal organs, leading to severe or life-threatening issues. Patients should be vigilant for symptoms like lung, intestinal, liver, hormone gland, kidney, and skin problems. Severe infusion reactions and complications from stem cell transplants are possible. Patients must inform healthcare providers of their medical history, including immune disorders, transplants, and pregnancy status, to manage potential side effects effectively.

The panel concludes with Danielle Hicks sharing where viewers can go to learn more about the information and resources discussed in the panel, including safety information. Sponsored by Bristol Myers Squibb.

Advice for Caregivers, from a Caregiver

 Now, I'd like to offer some advice for caregivers having been a caregiver to my mom. Anyone caring for a loved one with non-small cell lung cancer has a lot to learn. Just, you know, they're walking the walk with their person. I want to share a little bit about my journey as a caregiver. My mom was diagnosed with stage IIIB non-small cell lung cancer in 2003. I became a caregiver at the very onset of her diagnosis and it was one of the most terrifying things I had ever faced. The hardest part about it was here was my mom, who had been the matriarch of our family. She was the caregiver. She was the one, you know, bossing everybody around all the time. And I had these terrible fears that my youngest son was not going to remember her, that the Sunday dinners that were tradition in my extended family were going to, you know, come to an end. And, it just didn't sit right with any of us. She was someone that was there with us through the good times and the bad. She was our rock and it was really my turn, and our collective turn, my siblings and I, to be that rock for her. Some days were harder than others. She would often hide how she was truly feeling with forced laughter or a smile. Throughout all of this, even though it wasn't easy, being a part of her care team was a beautiful experience, and I really found my reason and my passion. What I experienced when my mom was first diagnosed was that, I had a hard time finding a single resource that was credible, up-to-date, easy-to-understand on my mom's specific diagnosis. And even today, caregivers that I talk to, and people diagnosed may still feel confused about where to find this information. I learned several important lessons that might be useful to caregivers, loved ones, or close friends. First, be an emotional support to the person diagnosed. Listening is more important than speaking when someone truly needs you. They may experience a range of emotions such as fear, confusion, anger, and sadness. Give them time to absorb the news and avoid rushing them into making any immediate decisions. Second, act as an advocate. Offer to go to doctors’ appointments with them and take notes, do research and ask questions about diagnosis and treatment. Help them wrap their brain around complex medical information. Third, pivot. As my mom, her wants and needs changed throughout her cancer journey, I adjusted and used different strategies to help her based on what she was going through at that time. For example, when she did not feel like smiling, we’d bring in her grandchildren as a reminder that there was always a reason to smile. Any additional advice from you two for caregivers?

 Yeah, I'd like to add it's important to accept help and take care of yourself as a caregiver. You know, being a caregiver is hard. I see the wear and tear on the families of my patients and even as a caregiver, you can't do it alone. You need to accept help yourself and when someone offers for it, you take it. And find that community of caregivers even to help support your journey. And, there are communities, either locally or online, to provide that support. And, you know, if you have emotions you can get professional help. It's not a sign of weakness. It's a sign of strength.

: I think this is truly something that takes a village and a village for all of us. You have communities built in through family, friends, care teams, online communities. And I think you said it so nicely, it's important to listen first and to pivot when your loved one is telling you it's time to change direction.

Caregiving for a loved one with non-small cell lung cancer involves emotional support, advocacy, and adaptability. The caregiver's journey can be challenging, as they transition from being cared for to providing care. Emotional support is crucial, allowing the patient to process emotions without pressure. Advocacy includes attending medical appointments and understanding complex information. Adaptability is necessary as the patient's needs evolve. Caregivers should also accept help, seek community support, and prioritize self-care. Professional help is encouraged to manage emotions, emphasizing strength rather than weakness.

Danielle Hicks, a patient advocate, details her journey as a caregiver for her mother and provides advice for other caring for loved ones with lung cancer. Sponsored by Bristol Myers Squibb.

Advice for Caregivers, from a Caregiver  

Advice for Someone with Early-Stage Non-Small Cell Lung Cancer

I want to provide some advice for those watching, who may have been diagnosed with non-small cell lung cancer in the early stages. A lung cancer diagnosis can be scary and overwhelming for both patients and their caregivers or loved ones. They may experience fear and shock. This can prevent them from absorbing information from their doctor at time of diagnosis and through treatment. It may prevent them from asking questions. Dr. Towe, have you experienced this in your practice?

 Yeah. Certainly, as a lung cancer surgeon, I'm the kind of doctor that no one wants, but I do see that in my patients that shock, that fear. And, to me, I think it's important to recognize that it's difficult to do it alone. It takes a village. And, you know, for individuals who are newly diagnosed, I advise them to look for sources of support— that could be friends or loved ones or even communities online if they find of patients with similar diagnoses. And that support system can help them even when they're talking to their doctors about treatment options, take notes, or help decode some of this complex language, so that they understand what's really happening.

Yeah, it's really interesting because I remember, at the time of my mom’s diagnosis, being someone who was in the room with the healthcare provider, listening to what they were saying because she was busy thinking about her own diagnosis and what that meant for her and not necessarily what her healthcare provider was, the information her healthcare provider was sharing with her.

 Yeah, it's definitely difficult to absorb, but I think, it's important. And then once you've absorbed the news and sort of the shock, it's also important to understand treatment options. I think it's unfortunate that we have preconceptions about what these treatments are or what they might feel like. So it's important to keep an open mind and when you meet with your providers, ask clarifying questions. If you're not clear what they're talking about, ask them and really advocate for those things that are important to you. A lot of my patients are scared of surgery. And we go well out of our way to make sure they understand the risks and benefits of surgery, so that they understand what's happening. And I also think it's important to really keep an open mind. You know, these treatments are changing. The things that we learned about in my training ten years ago, or even in my practice five years ago have changed. So go to your appointments with an open mind and be ready to discuss these with your doctors.

Yeah, I couldn't agree with you more. And how fast and furiously the lung cancer landscape is changing.

: I find that patients in that first appointment hear half or less of what I say. So I think it's important that patients feel encouraged and empowered to discuss their treatment goals and concerns over and over again with their oncologist and their care team. And that they feel confident in the treatment decisions that were made.

 Dr. Mohindra, as patients move through treatment, initial feelings can evolve. Some may be fearful that their cancer will get worse despite treatment, and others may worry that their disease will come back later in life.

: I strongly encourage that patients communicate with their care team. New symptoms are important. And have good regular follow up so we can ensure that the cancer is not coming back or get it at a stage where we can continue to treat it. Everyone's experience is different and unique and as Dr. Towe said earlier, it's important that you work closely with your medical team to come up with a treatment plan that is tailored to your specific needs or your goals of care, and that you discuss side effects along the way.

 Yeah and there are also other resources available for ongoing support, such as professional counseling, peer support, support groups, educational materials to help people manage their diagnosis, both emotionally and physically. Advocacy groups like mine GO2 for Lung Cancer can help connect patients to some of these resources.

Receiving a non-small cell lung cancer diagnosis can be overwhelming, often leading to shock and difficulty in processing information. Support systems, including friends, family, and online communities, are crucial for patients to navigate their diagnosis and treatment options. Open communication with healthcare providers is essential, as treatment landscapes evolve rapidly. Patients should feel empowered to ask questions and discuss their treatment goals and concerns. Regular follow-ups and communication with the care team are vital to monitor the disease and tailor treatment plans to individual needs.

Danielle Hicks, Nisha Mohindra, MD, and Christopher Towe, MD, share their perspectives and offer advice to those navigating an early-stage non-small cell lung cancer diagnosis. Sponsored by Bristol Myers Squibb.

What to Expect from Your Healthcare Team

When I'm speaking to a person diagnosed, particularly a person who's newly diagnosed, many of them have heard the term multidisciplinary or multidisciplinary team. Dr. Towe can you give an explanation of what we mean when we say multidisciplinary team?

 Sure. You know, managing early-stage lung cancer is a group effort, it takes a team. And collaboration between different specialties may help give a better understanding of all facets of a diagnosis. And this informs a well-rounded, holistic approach to how we treat someone and their cancer. For example, doctors may present a patient case at something called a tumor board, where many different specialties are present. That can include surgeons, oncologists, radiation oncologists, and pulmonologists to decide the best treatment to address the specific needs of an individual. And it's this collaborative effort that really gives, I think, the best care.

 That's a lot of people. What is the value of having so many people on your care team?

: I think by bringing together a group of experts, we share our expertise and our skill set, and that multidisciplinary team can then help come up with the best treatment plan for you as well as your disease. It's important that patients have well-coordinated care with a group of doctors and that they feel like their journey is streamlined with good communication across.

A multidisciplinary team in early-stage lung cancer management involves collaboration among various specialists, such as surgeons, oncologists, and pulmonologists, to provide comprehensive care. This team approach, often facilitated through tumor boards, ensures a holistic understanding of the patient's condition, leading to personalized treatment plans. The value of this approach lies in the shared expertise and coordinated care, which streamlines the patient's journey and enhances communication across the care team, ultimately aiming to deliver the best possible outcomes for the patient.

Nisha Mohindra, MD, and Christopher Towe, MD, define the term “multidisciplinary team” and explain why early-stage NSCLC care requires a diverse group of specialists. They also discuss the function and value of this collaborative model in guiding treatment plans. Sponsored by Bristol Myers Squibb.


Nisha Mohindra, MD

Additional Resources

Advice for Caregivers, from a Caregiver

Advice for Someone with Early-Stage Non-Small Cell Lung Cancer

What to Expect from Your Healthcare Team

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