Stopping short of the full 11 treatments

[Angie'sKid]

As I've mentioned in other posts, my mom has had challenges all through chemo. Her dr. took her off 5-FU, put her on Xeloda, went from treatment every two weeks to every three weeks and she is continuing to have problems with low white blood cell and platelet counts, diarrhea and now issues with her spleen. It has been three weeks since her last chemo and her bloodcell counts havent sufficiently rebounded for her to get round 10.

The onc is advising that Mom stop chemo at the ninth treatment. I would be very interested in hearing from people who stopped chemo before the full course. I have been trying to research the efficacy of 8 or 9 versus 11 or 12 treatments and have only found one study, but couldn't find the results. I also read some articles that suggested that some parts of the country do 8 rounds of Folfox, while others do 12. I want Mom to feel that she has sufficient information to make a decision she can feel confident with, but I have not found any research to help her with a decision. Any ideas, insights are much appreciated. Thanks!

[Terry]

From what I've read on here many times, is that they say 8 is the number you really need to get to. I hope that whoever has researched that posts where they found in from. I have a question though that you can ask your onc. Did he change her to 3 weeks and keep her at the same dose, raise the dose or lower the dose. The reason I ask is I was on an every 3 week regime' because of traveling and had a higher dose than usual. I would think he would have at least kept her on the same dosing and not raised it since she was having trouble, but ask just to be sure. Could they lower the dose some more, or could they stop the oxi and just give her the 5FU?

I don't know, just some options.

[solace]

Hi,
Just thought you might like to hear my mum's eperience. We are from another part of the world and here you get 6-8. My mum has had this twice. The second year her chemo dose was redused by25%. Each year it has worked really well with significant reduction. So for some people 6 is enough.
Kind regards to you and your mum.

[waw4]

I understood the 2008 study publication "FOLFOX and FLOX Regimens for the Adjuvant Treatment of Resected Stage II and III Colon Cancer" results to mean 9 treatments with Oxi were as effective as 12, so I stopped at 9 as I was concerned about chronic neuropathy.

[Angie'sKid]

From what I've read on here many times, is that they say 8 is the number you really need to get to. I hope that whoever has researched that posts where they found in from. I have a question though that you can ask your onc. Did he change her to 3 weeks and keep her at the same dose, raise the dose or lower the dose. The reason I ask is I was on an every 3 week regime' because of traveling and had a higher dose than usual. I would think he would have at least kept her on the same dosing and not raised it since she was having trouble, but ask just to be sure. Could they lower the dose some more, or could they stop the oxi and just give her the 5FU?

I don't know, just some options.

They did lower the dose on the 5-FU before replacing it with the Xeloda and I'm pretty sure she is getting a reduced dose of Xeloda. I'll doublecheck the next time I talk to the onc. Thanks for the recommendation!

[Angie'sKid]

Thanks, everybody, for your comments. This is very helpful.

[Surroundedbylove]

With the switch from 5FU to Xeloda you need to be sure to calculate weeks, not cycles because the cycles are different on Xeloda (3 week cycles instead of 2 week cycles).

For example - 4 cycles of Xeloda equals 12 weeks which equals 6 cycles of 5FU. Also a "month" means exactly 4 weeks. So, you shouldn't look at total number of cycles since you're mixing FOLFOX and XELOX protocols. I had one cycle of FOLFOX and the remaining of XELOX but even in XELOX I did it differently (see below). After subtracting true chemo breaks (not just the one week off that is normal during a cycle) my onc has a total number of weeks goal.

So - to go back to your original question - I do see that there seem to be some regional differences but they may also be differences based on prognostic factors and we don't all talk about those in detail on here when comparing things. My onc's goals for a patient with reasonably good prognostic factors who is stage 3 is for the patient to have 5 months of treatment (20 weeks) minimum with the extra month or month and a half (4 to 6 weeks) as "icing on the cake." He frequently drops the oxaliplatin during the last month to month and a half and also frequently drops the dosage of the 5FU or Xeloda during that last month to month and a half. He claims that the studies show that in most cases the shorter course is just as effective.

For rectal cancer the 6 weeks of chemo during radiation, if given at normal dosages (which he does - and he includes oxaliplatin too) counts toward these weeks - but you count it a little differently because there aren't chemo breaks - the 6 weeks counts as 8 weeks (as if you had the 2 one week breaks).

Also - I was having a hard time with the oxaliplatin during my adjuvant chemo. I ended up getting lower dose weekly infusions - it greatly helped me to manage side effects and yet still get the total amount of oxaliplatin recommended. If your mom wants to explore that option, it isn't something the onc would likely bring up. She should discuss it with him/her.

I hope this helps.

Edited to add a little information

[simon031003]

My dh was considered for a clinical study for Stage 3 patients to see if 6 treatments were as good as 12. Onc said a few years back 1 year of chemo was the norm until they did study that showed 6 months was just as good. Now they are trying to determine if 3 months are just as good. Not saying it is, but I know they are researching it. He wasn't picked for study because the path report didn't clearly say that they got clear margins,so we don't know how it is going.

[tdsamal]

I was on Folfox and told I would have 12 tx. after my 7th I was so ill Dr said "no more". Kinda scared me but I was to sick to care at that point. I guess if there is a reoccurance I will have wished that I had gotten all 12 but at stage IV I'm not sure that is really matters.
Tammy