Sigmoid 2A cancer-on Xeloda

[justin case]

Is this what you were looking for, B? Looks like the 5-year rate for Stage IIA is 87% (keeping in mind that those numbers are a decade old).

http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorectal-cancer-survival-rates

This is one of the things I have recently talked about. The chosen group was between 2004, and 2010. If you will notice, a stage 3 has a better chance of living to 5 years, than a stage 2, because chemo was not considered needed, for a stage 2a. There are more recent studies, although I don't know where to find them. I don't have the statistics of how many people have been diagnosed with colon or rectal cancer, I imagine 2% would make a lot more survivors
Michael

[lpas]

Is this what you were looking for, B? Looks like the 5-year rate for Stage IIA is 87% (keeping in mind that those numbers are a decade old).

http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorectal-cancer-survival-rates

This is one of the things I have recently talked about. The chosen group was between 2004, and 2010. If you will notice, a stage 3 has a better chance of living to 5 years, than a stage 2, because chemo was not considered needed, for a stage 2a. There are more recent studies, although I don't know where to find them. I don't have the statistics of how many people have been diagnosed with colon or rectal cancer, I imagine 2% would make a lot more survivors
Michael

What a horrible thing for those poor stage IIs who were told they were "cured". I wonder how many would have preferred to do chemo but were denied coverage because it wasn't considered to be the "standard of care" at that time.

Makes me wonder too about the stage I people who are told the same thing. Just saw a post the other day from someone who was diagnosed stage I but is now stage IV. How rare are stage I recurrences really? It would be interesting to see some more up-to-date numbers. Of course, maybe I'm just being paranoid.

[justin case]

Is this what you were looking for, B? Looks like the 5-year rate for Stage IIA is 87% (keeping in mind that those numbers are a decade old).

http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorectal-cancer-survival-rates

This is one of the things I have recently talked about. The chosen group was between 2004, and 2010. If you will notice, a stage 3 has a better chance of living to 5 years, than a stage 2, because chemo was not considered needed, for a stage 2a. There are more recent studies, although I don't know where to find them. I don't have the statistics of how many people have been diagnosed with colon or rectal cancer, I imagine 2% would make a lot more survivors
Michael

What a horrible thing for those poor stage IIs who were told they were "cured". I wonder how many would have preferred to do chemo but were denied coverage because it wasn't considered to be the "standard of care" at that time.

Makes me wonder too about the stage I people who are told the same thing. Just saw a post the other day from someone who was diagnosed stage I but is now stage IV. How rare are stage I recurrences really? It would be interesting to see some more up-to-date numbers. Of course, maybe I'm just being paranoid.

This is why relying on internet searches, can make you either complacent, or paranoid. Relying on your doctors advice, and getting first hand knowledge ,can be of exorbitant value. I learned from many before me, I just have a big mouth
Regards,
Michael

[B in Canada]

Hi, Thank-you all for replying to my questions or even reading my posts. I did decide to go ahead with the Xeloda(Capecitabine) and have been on it for only 1 week so far with no significant side-effects to complain about yet. My GP and Surgeon agreed with me to go ahead so I felt a lot better about my decision. (Onc did phone me back and must have looked up some newer Colon 2A stats as she said it was a 2.5% benefit.) I still have to find out my future monitoring/tests that will be needed; my Surgeon has me down for a colonscopy in one year=Aug.2015.
(crguy- I am also going to the 2 day InspireHealth program this week.) Dr. there ordered a VitD level(26=insufficient) and I now take 3,000 IU/day & said my daughters should take 1,000 IU/day. Sounds like most everyone should be taking it I guess.
My 2A Colon Cancer problems are so trivial compared to what I read on this Forum and I don't know if I am overly sensitive or what, but after reading so many sad,sad posts I think I will not be so obsessive about coming to this website to read the posts as it really makes me feel so sad. (I am glad I could make one helpful post with someone asking about lap sigmoid resection, but I really have no other advice to give.) I am sorry but I am going to only come to this site occasionally as my youngest daughter sees me on it and I think about whether I am dwelling on my cancer (which should be gone now I hope). I wonder how I answer people when I go back to work...'I had my cancer removed by surgery and am on oral chemo to mop-up any stray cancer cells' ...sounds about right. I may also go for some counselling (as I am feeling sad/?depressed(for no good reason)) if the feeling continues; I need to 'snap out of it' so I thought perhaps not coming here as often may help me.

I truly wish everyone here the best health outcome, enjoy your life as much as possible, and hope for NED!
May a person never be in pain or discomfort at the 'end'.
This site is invaluable for people or their caregivers with colon cancer for advice, information, friendship, venting about stuff, some laughs even(! ) and I thank-you all especially the 'long-timers' who are amazing, 'strong' people.
Take care. Bye for now.
(Please, no one needs to reply to this post as I just wanted to let you know where I 'am' as I will not post often at all, but will continue reading/lurking-maybe posting- about once a month. I hope this post reads how I mean it to....I am not good at writing.)
B in Canada

[meatie]

@B in Canada

This may seem heartless. But from the financial point of view, your oncologist will likely recommend that you go through with chemo.

[chrissyrice]

B, you are doing the right thing for your health and treating cancer.

That's the point too... you have/had cancer and there are no small cancers in my book. Cancer in any form is serious.

So stop thinking it's nothing... believe me if you had the smallest of lumps removed for breast cancer you would be treated in a much different manner.

Like the song "It's All About the Bass" for us no Trouble

There are so many good reasons for you to do the chemo mop up. I am not sure what tests you had done on your tumor as far as gene testing and all the many tests they can do now for CRC. If you have siblings and cousins they can benefit from your first hand knowledge.

Keep coming back here and read and post as we are getting more and more Stage IIs and they need you and your experience.

Chrissy

[Valorie]

B- thank you for posting. I hope that you will do well on Xeloda and remain side effect free. It isn't always fun, but I think you may feel as I do. I just wanted to do everything I could to prevent recurrence. I hope you will not only read/lurk but participate. You can be of help to other newly diagnosed stage 2's. Yes, there are people here dealing with some tough situations. I've never been made to feel that I didn't belong because I'm "only" a stage 2. I always appreciate and am in awe of the people here. They are generous and compassionate no matter what stage the person posting is. Hope you will stick around and let us know how your journey is going. Don't look at it as dwelling on cancer. Rather, your hangin' with a group of friends. As it is with most friendships, when a member is hurting the others hurt too. Conversely, when one celebrates a milestone or good scan, etc. we all celebrate! There are some major hilarious posts too. Always a spirit lifter.

I wish you well and NED forever.

Valorie

[Carolinabluetec]

@B in Canada

This may seem heartless. But from the financial point of view, your oncologist will likely recommend that you go through with chemo.

It is not only heartless, but incorrect. My Oncologist Group is going to get paid a grand total of $953 during my course of treatment, which includes 10 office visits ($95.30 per). The hospital gets paid for the lab work and the drug company/pharmacy get the money from the Xeloda. Hardly seems like much of a profit motivation for them.

[Maia]

B, since you have decided to take capecitabine (Xeloda), I feel like mentioning two issues.

1. There is an experimental combination of Xeloda plus a NSAID (an anti-arthritic medication: celecoxib (Celebrex)) in Phase II trial, with the idea of try and keep NED status (it's tried also on Stage IV patients). Everything about it has been posted in all the pages in this thread: XCEL-ADAPT trial Phase II -OPEN viewtopic.php?f=1&t=39924 (all the pages)

2. Also, if not for the previous, there is certain literature about the fact that celecoxib (Celebrex) may help to ameliorate an usual side-effect of capecitabine (Xeloda) -hand-foot syndrome.

1. Ann Oncol. 2012 May;23(5):1348-53. doi: 10.1093/annonc/mdr400. Epub 2011 Sep 22.
Celecoxib can prevent capecitabine-related hand-foot syndrome in stage II and III colorectal cancer patients: result of a single-center, prospective randomized phase III trial. Full article: http://annonc.oxfordjournals.org/content/23/5/1348.long
Zhang RX, Wu XJ, Wan DS, Lu ZH, Kong LH, Pan ZZ, Chen G.

Abstract

BACKGROUND:
Hand-foot syndrome (HFS) is the most common adverse event induced by capecitabine. Some clinicians think that HFS is a type of inflammation limited to the hands and feet and can be prevented with a COX-2 inhibitor (celecoxib).

METHODS:
We designed a single-center, prospective randomized clinical trial to test the hypothesis. From August 2008 to December 2010, stage II and III colorectal cancer patients receiving capecitabine-based chemotherapy enrolled in the trial voluntarily. All patients were divided randomly into two groups treated with or without celecoxib. All adverse events were recorded.

RESULTS:
Grade 1 and grade 2 HFS were more common in the capecitabine group than in the capecitabine/celecoxib group (74.6% versus 57.4%, P = 0.034, 29.6% versus 14.7% P = 0.035). The use of celecoxib (P < 0.001, P = 0.003) and the level of dihydropyrimidine dehydrogenase (P = 0.048, P = 0.014) affected the incidence of grade 1 and 2 HFS, as determined by log-rank analysis. Multivariate Cox proportional hazards regression analysis indicated that the use of celecoxib was the only factor that affected the incidence of ≥ grade 1 HFS [Hazard Ratio (HR): 0.556, P = 0.001] and ≥ grade 2 HFS (HR: 0.414, P = 0.005).

CONCLUSIONS:
Celecoxib can be used effectively and safely to prevent capecitabine-related HFS.


2. Am J Clin Oncol. 2006 Jun;29(3):232-9.
Retrospective study of capecitabine and celecoxib in metastatic colorectal cancer: potential benefits and COX-2 as the common mediator in pain, toxicities and survival?
Lin EH, Curley SA, Crane CC, Feig B, Skibber J, Delcos M, Vadhan SR, Morris J, Ayers GD, Ross A, Brown T, Rodriguez-Bigas MA, Janjan N.

Abstract

OBJECTIVE:
COX-2 activation may mediate capecitabine induced toxicities, eg, hand-foot syndrome (HFS) and colorectal cancer progression, both of which may be improved by concurrent celecoxib.

PATIENTS AND METHODS:
From October 2000 to December 2003, 66 patients with metastatic colorectal cancer received concurrent capecitabine at 1000 mg/m/d b.i.d. and celecoxib at 200 mg b.i.d. (XCEL). Twenty-four patients were chemo-naive, 42 patients were second-line; while 34 had XCEL with radiation.

RESULTS:
The median duration of XCEL was 7.2 months (range, 1.5-38 months). Ninety percent of Grade 2/3 HFS (17%) occurred after 6 months and incidence of grade 3/4 diarrheas was 8%. The overall response rate was 38% (95% confidence interval [CI], 26-51%), with 11 patients (17%) achieving complete responses and 2 patients (3%) with near complete responses. Six patients (9%) become resectable after sustaining treatment response. The median progression-free survival (PFS) and overall survival (OS) was 8.3 months (95% CI, 7.0-11.0 months) and 22 months (95% CI, 17.8-31.5 months), respectively. Improved median PFS of 14.5 months (P = 0.0001) and OS of 31.5 months (P = 0.005) were noted in patients with normal lactate dehydrogenase (LDH) levels (n = 37) than patients with high levels of LDH (n = 29).

CONCLUSIONS:
XCEL integrating radiation may improve response rate and survival and reduce toxicities, notably HFS for patients with metastatic colorectal cancer, leading to a randomized phase III study.


3. Oncology (Williston Park). 2002 Dec;16(12 Suppl No 14):31-7.
Effect of celecoxib on capecitabine-induced hand-foot syndrome and antitumor activity.
Lin E, Morris JS, Ayers GD.

Abstract

We hypothesized that hand-foot syndrome is an inflammatory phenomenon mediated by the overexpression of cyclooxygenase 2 (COX-2). Therefore, a specific COX-2 inhibitor such as celecoxib (Celebrex) could attenuate both the incidence and severity of hand-foot syndrome. We undertook a retrospective study comparing the incidences of hand-foot syndrome in 67 patients with metastatic colorectal cancer who took capecitabine (Xeloda) with or without celecoxib. Surprisingly, celecoxib seemed to attenuate capecitabine-induced diarrhea as well. Capecitabine/celecoxib was also associated with increased tumor response, proportion of stable disease (62.5% vs 22.8%, P = .001), and increase in median time to tumor progression (6 vs 3 months, P = .002) compared with capecitabine alone, despite the fact that patients on capecitabine/celecoxib had less favorable disease characteristics (age, performance status, and prior chemotherapies). Overexpression of COX-2, implicated in promoting angiogenesis, enhanced tumor invasiveness, evasion of apoptosis, and immune suppression, is a bona fide molecular target for many solid tumors, including colorectal cancer. Combining capecitabine with celecoxib in the treatment of colorectal cancer has strong preclinical rationales. A prospective study is being designed to evaluate capecitabine and celecoxib with or without epidermal growth factor receptor antagonist ZD1839 in the frontline treatment of metastatic colorectal cancer. These regimens under study are orally based and may significantly impact quality of life in the frontline treatment of metastatic colorectal cancer.

4. Also:
Management of hand-foot syndrome induced by capecitabine

"Conclusion. Treatment interruption or dose reduction remain the only methods shown to effectively manage HFS, but supportive measures to reduce pain and discomfort and prevent secondary infection are very important. Many other prophylactic and treatment strategies have been investigated, with pyridoxine and COX-2 inhibitors being the most promising in case reports and retrospective studies; therefore, prospective, randomized, controlled trials are needed to prove their efficacy." (COX-2 inhibitor = celecoxib/Celebrex)

http://opp.sagepub.com/content/12/3/131.short

********
*If* you don't have a contraindication for taking Celebrex (like a propensity to cardiovascular problems) and still everything fails to convince your onc... as a friend of mine said once "Ask him again, tell him you have a sore thumb!".
Good luck.

[peanut_8]

I hate to get off track here, but it sounds like B, is not going to post in the thread anymore. I just wanted to comment on meatie's post that sometimes oncologists will recommend chemo with a potential profit motive for them. I have found this to be true. My first oncologist ordered Xeloda to compliment the radiation I was receiving. She insisted on procuring the pills from her office. She explained that was because it would be easier for her staff to deal with the insurance company, which she implied was evil and only motivated to save costs. My DH and DD were also at this appointment, and we pressed her on the cost for the pills, especially after she had made such a big deal about getting them. She hemmed and hawed, all three of us got after her, and finally she admitted they were $1000 a pill. Yikes! She also had her own infusion center at her office, and I suspect she was going to recommend FOLFOX, so I would need to receive treatment there. I can only imagine how much she was going to charge for that.

My current oncologist was happy to prescribe generic Xeloda, which we got through our insurance company's mail order service. At the time of radiation, the pills were running about $5000 a month. I don't remember exactly how many I was getting per month, but that is a considerable savings. He also did not have his own infusion center, as he thought there was an implication of gouging the patients. (not his exact words) It seems to me that the first oncologist was not exactly ethical, and I'm really glad I switched. Sorry for the long rant, but it really annoys me when so called professionals take advantage of sick people.
cheers, peanut

[mstults]

I agree that many times there is a profit motive involved. However, if insurance is involved I can't believe they would overpay for the drugs. I have more patience and understanding of insurance companies due to the fact that they are overcharged at every opportunity but I can't believe they would allow that much.

[elise]

I was in the same boat in 2012. I chose chemo and don't regret it even though I had a reoccurrence 18 months later. I'm in ON if you ever want a Canadian shoulder to lean on

Elise

[B in Canada]

Hi all, Sorry I have not updated my situation; I have only been lurking.
End of Dec.2015 I did start on Xeloda.(Thanks to our Cdn health system here in BC, I did not occur any expense for my Xeloda.) First cycle went fairly well. Felt like I was getting poisoned, with occl stabbing pain in abdomen, nausea, HFS starting. (I was really hoping I would be one of the lucky ones who only has minor problems.) Second cycle: terrible knife-like stabbing pains in abdomen, nausea worse, HFS way worse (the no fingerprints thing was interesting!), nocturnal diarrhea last few nights of cycle/off, all joints of body very sore/achey,could barely function. Went to Onc after second cycle and she said she could put me on 75% dose; I asked if that would make the abdominal pains go away=she said no. (I think she said the pains were bowel spasms.) So then I said I would like to quit Xeloda as I could not function at all; barely make myself swallow the last 3 days of pills in that 2nd cycle. By April my joints were still wonky-went to a Physio and she said talk to my GP about the problem. ANA test high titre and speckled pattern. Guess I got an inflammatory immune response (like an arthritis); Rheumatologist said it is probably from Xeloda and will hopefully go away in time. Started yoga in May as I could not move about easily, and Aug. I slowly started a fitness class. August I had my 1 year colonoscopy: 2 polyps:1 at anastomosis, 1 at 10cm both 'NON concerning' in the Path report. (Colorectal surgeon said I don't need another scope for 3 years; my GP said we will find someone to do one in another year if colorectal surgeon will not, as it was not a 'clear' scope.) Had to do some occupational therapy for my hands before I started back to work in Oct.; I still have arthritis-like problems but they are way better now. I have some ?ovarian-like pain (I hadn't had that for a few years since going through menopause) and was sent for a Pelvic ultrasound=nothing found in Nov. I am also getting hot flashes again.
I have some 'pulling' where my anastomosis is when I do certain exercises-but assume it is adhesions and not pulling where the titanium staples used.
I have been having CEA, liver function bloodwork appt with my Dr.every 3 months. I asked about CT scan and she said it wasn't needed according to the Onc report which is not clearly written. I may start a New Topic regarding this as I interpret the BC Cancer Agency Followup as Abd & Pelvic imaging 'once a year during the 5 year follow-up'. I see my GP this evening and will print it out and show her.
I would recommend anyone in my specific situation of Colon 2A to do the Xeloda as long as possible; then if side-effects get too bad and you stop,you can say you tried your best.
Sorry about the long post.

[Kick'nAssCancer'sAss]

I looked at the BC follow up and it says that stage II and III are only scanned if other test warrant it. I guess if your CEA elevates to high they can issue a scan. I was surprised at what I read because in Ontario the follow up is a CT scan yearly for five years after resection. That is what they are giving me. I would be pushing for a yearly scan.

http://www.bccancer.bc.ca/health-profes ... ive-Intent

[CRguy]

Thanks for posting that link muskokamike the BCCA has been changing their website regularly for a while now and it is hard to keep up with them !!!

B in Canada has CEA been a reliable marker for you ?
If not ( it is NOT for me ) I pushed my doc to start doing CA19-9 as well as CEA, as sometimes it will be more reliable .
I agree with you and your GP ... PUSH for a c-scope earlier than the recc'd 3 year mark.
Most recurrences will show up in the first three years so why wait until the end of the interval ????

Please check the link in my signature and you can see the follow up I received from BCCA.

PM me if you have any specific questions or need more info as I don't want to post exact specifics online, but we can compare notes if needed.

The Calling ALL Colorectal CANUCKS ! topic has been a bit quiet of late BUTT maybe we should liven it up !!!!

Mega Cheers
CRguy