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Prednisone as it relates to Shingles during Chemo

patsy2
Posts: 1
Joined: Jul 2018

One individual on the Cancer Support Network indicated that she'd been told by her doctor that Prednisone was the worst thing that could be prescribed for what turned out to be Shingles.  It turns out that I am undergoing treatment and have devoloped Shingles.  The Chemo - called CHOP - includes 5 doses of Prednisone.  I am curious what's known about the connection between Shingles and Prednisone.

Evarista
Posts: 261
Joined: May 2017

My understanding has always been that anything that dampens your immune system (illness, stress, cancer, chemo, etc) puts you at increased risk of a shingles episode, which is a re-emergence of the virus that causes chickenpox. Prednisone is one of those things that dampens the immune system. But the goal of our lymphoma chemo is to wipe out malignant immune cells.  In the process, we also wipe out or severely diminish our normal immune cells and our immune responses.  So nothing to hold the virus in check. To help prevent shingles while on immuno-suprressive chemo, we are prescibed acyclovir (at least I was).  

I am sorry you have shingles; I remember how painful that is.  But your best guide on how to treat both your shingles and your lymphoma is your doctor.  

FYI: when I had shingles 14 years ago (no cancer then), the treatment was Valtrex + Prednisone:  the first to control the virus and the second to control inflammation and prevent development of Post-Herpetic Neuralgia.  Good luck getting through it.

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3293
Joined: May 2012

Patsy,

Many, perhaps even all, chemo drugs have potentially nasty side-effects.  Never having used Prednisone as a chemo agent myself, I have not much researched it, but it seems Evarista gave great information.  To paraphrase an old Ford ad, killing the cancer becomes "Job 1" for every oncologist; dealing with secondary effects is, of necessity, secondary.

Development of shingles by Lymphoma patients either with active disease or in remission is extremely common, so the vaccine is very much to be encouraged for patints who can receive it.  This is true also for patients who never had Prednisone.  Hence, Prednisone's degree of responsibility in causing shingles (if any) is perhaps not entirely clear.  I'm sorry you got shingles.

Besides its most common role as an anti-inflammatory, Prednisone against lymphoma also has a cancer-killing role, acting as a sort of catalyst, rendering the other drugs in CHOP more effective.  Each of the drugs included in any given popular chemo cocktail has tens of millions of dollars of research behind its use, massive amounts of statistical analysis regarding its effectiveness.  Occassionally an oncoogist will delete one of the drugs in a combination for medical reasons (for instance, removing or reducing the dose of Vincristine from a patient with bad neuropathy), but this weakens the probable effectiveness of the remaining combination.

No oncologist can accurately predict which side-effects any given patient is likely to get from any of the hundreds of chemotherapy drugs available, so they just have to proceed (there are well over 200 FDA-approved chemotherapy agents in the US today).  Many, many patients in relapse or multiple relapses have to receive many times the lifetime recommended dosing of numerous drugs over time, dramatically increasing the liklihood of serious side-effects, and other difficult treatment decisions.  It is an unfortunate state of affairs, but saving lives is indeed Job 1.

max

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