Was seen by two oncologists and their treatment plans

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boswind
Posts: 61
Joined: Fri Apr 11, 2014 12:04 pm

Was seen by two oncologists and their treatment plans

Postby boswind » Fri Feb 27, 2015 4:51 pm

Hi All,

I visited two oncologists today and yesterday, respectively.

The treatment plan of onc 1 (in a local hospital) is
1. Have a liver biopsy
2. Start treatment in two weeks using Folfiri.

The treatment plan of onc 2 (in a major cancer center in Boston)
1. Have a liver biopsy
2. Start treatment possibly next Friday using Folfox.

Both of them stated that a biopsy is necessary to determine whether it is colorectal cancer. Their difference in comments is

Onc 1 said the side effect of Folfox is accumulative and some patients could not complete the Folfox treatment. On the other hand, onc 2 said Folfox is their choice for first chemo treatment for stage 4.

Thank you again for your advise and comments.

Boswind

boswind wrote (02-25-2015)
:

Hi All,

I had a PET scan yesterday and MRI scan today. Sadly, both reports indicate liver mets. The biggest liver met tumor measures 2.4cm x 4.8cm while the ultrasound scan of last Aug did not show any thing. The cancer developed so quickly within 6 months.

(additional notes: the reports also indicate involvement of L4 Vertebral body)



boswind wrote (02-18-2015):

Hi All,

I got phone call today from my Oncologist. He told me the blood work of last week indicated my CEA level is 50 (my pre-surgery level was normal: 1.5). I will be scheduled to have a PET scan asap. I am kind of scared: either local recurrence or distanced new tumor is bad. Moreover, I have liver Cirrhosis and may be unable to take some chemos.

I would appreciate your advise.

Boswind
01.24.2014 Male, DX @54 Rectosigmoid Cancer, MRI: T3N0M0
03.19.2014 Completed 5-week Radia+Xeloda
05.07.2014 Had surgery
02.25.2015 CT showed liver and L4 Spine involvement.
03.2015 - 08.2015, folfox + Avastin
08.2015 - 07.2017, 5FU + leucovorin + Avastin for Maintenance
07.2017 - 01.2018, Folfuri + Avastin
02.07.2018 - 03.06.2019, Centuximab + Irinotecan
90 rounds of chemos received (as of 12.27.18)
CEA: 9.8 as of 12.27.18
MSS, KRAS wild type, BRAF wild type
TMB = 12 mut/MB
03.14.2019 - Keytruda

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ConnieSPK
Posts: 144
Joined: Tue May 07, 2013 6:28 pm
Facebook Username: Connie Perkins Kreienheder
Location: Dardenne Prairie, MO

Re: Was seen by two oncologists and their treatment plans

Postby ConnieSPK » Fri Feb 27, 2015 9:02 pm

I believe FOLFOX is typical 1st line treatment for Stage IV's, but it may be that either is recommended. Oxaliplatin causes sensitivity to cold and neuropathy (hands/feet). Sometimes the neuropathy doesn't go completely away. Irinotecan thins your hair (it comes back) and really messes with your bowels, i.e., usually diarrhea problems. There are ways to cope with either and both are known effective treatments. Hope this helps. Hang in there, sending positive thoughts your way.

Connie K.
Dx08@54,StgIV Colon,Liver,Lung, ColonSurg,FOLFOX+Beva
09 LiverSurg
10 FOLFIRI+Beva
11 FOLFOX+Beva,ox reaction
12 Bi-lat LungVATS
13 New mets L lung FOLFIRI+Zaltrap,5FU reaction
14 Return mets L lung SBRT,successful
15 Lung Spots, Irinotecan

Steph20021
Posts: 553
Joined: Sat Dec 27, 2014 4:58 pm
Location: Ontario, Canada

Re: Was seen by two oncologists and their treatment plans

Postby Steph20021 » Fri Feb 27, 2015 9:34 pm

When I was first diagnosed, the government was going to fund me for folfiri. My local hospital wanted me on Folfox so my hospital paid for it. I never understood why. Both seem to have the same effectiveness from what Ive gathered.
DX 1/31/14 @ 33- SPS-T4a(invades visceral peri), N2a(6/106 LN), M1a(ovary) (Stage 4a) MSS; BRAF V600E
2/1/14-subtotal col, lost R ovary, temp ileo
3/14-9/14- folfox; sepsis
11/14-CT/PET: L ovary met, pelvic met, (?)ghost liver met(?)
12/14-folfiri -13 rds kept me stable from 3/15-6/15
8/15-HIPEC, NED
09/15- cea 0.9
05/16- recurrence in abdo wall and lymph nodes
01/17- pulmonary embolism
02/17- 1 wk radiation to abdo wall
08/16- on folfiri
01/18-folfox
11/18- Beacon trial-encorafenib & cetuximab

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Nik Colon
Posts: 5210
Joined: Thu Jan 08, 2015 3:35 pm
Location: MN

Re: Was seen by two oncologists and their treatment plans

Postby Nik Colon » Fri Feb 27, 2015 9:54 pm

ConnieSPK wrote:I believe FOLFOX is typical 1st line treatment for Stage IV's

yes, I believe so
KRAS-mut G12V,MSS
Stage IVa Sig CC 2 lvr mets 1/12 Ln
(3, =<3 lng spots at dx til 5/16)
=T3N1aM1a 4cmX4mm (lng not included)
dx 12/2014 at age 39
CEA 1/15-4.9, 12/16-4.9 again
neoadj FOLFOX 1/15-3/15 (4tx, 3w/1wo oxi)
Col/Lvr surg 4/23/15 NED
adj FOLFIRI start 6/15-9/15 (8tx, 5w/3wo iri)
1 sml lvr spot/cyst
12/6/16 multi lung spots/mets?
No longer NED :(
My tx ongoing-start 1/20/15
Adding your SIGNATURE, etc

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Bev G
Posts: 5856
Joined: Thu Jan 07, 2010 11:19 pm
Facebook Username: Bev Golde
Location: Quechee, VT

Re: Was seen by two oncologists and their treatment plans

Postby Bev G » Fri Feb 27, 2015 10:45 pm

FOLFOX and FOLFIRI are both acceptable for 1st line therapy. If you have any predisposing risks for neuropathy I believed FOLFIRI might be a better choice. I WOULD NOT LET ANYONE BIOPSY YOUR LIVER. I think is pretty clear liver resection is the way to go for you, especially since this fairly large lesion wasn't there last year. Do you have only one tumor in your liver? That would be very good.

Best wishes to you.

Bev
58 yo Type1 DM 48 years
12/09 Stage IV 2/22 nodes + liver met, colon resec
3 tx FOLFIRI, liver resec 4/10
9/10 6 mos off chemo, Neg PET&CTC CEA nl
2/11 finished total 10 rounds chemo

9/13 ^17th clean PET/CT NED for now

mymom
Posts: 1269
Joined: Fri Aug 12, 2011 11:07 pm
Location: Connecticut

Re: Was seen by two oncologists and their treatment plans

Postby mymom » Sat Feb 28, 2015 6:56 am

We were told that Folfox is the first line and that is what my mom did. Now she does Folfiri due to neuropathy. Both effective it seems.

I totally agree with Bev. NO BIOPSY. Seeding can take place. If the Pet and MRI made it pretty clear then why not a liver resection right from the start.
Stage 4 CC DX 5/11
colon/livr rsct 5/11(1 met)
Folfox July-11/11
NED to 5/12
New Primry BC-4/12,Stage 1
2 livermet 5/2012
Liver rsct,HAI 6/12,Folfiri
NED to 10/13,1 liver met,ablation, Folfiri
NED to 12/14, another spot
3/15 NED
Ablation 1 liver met 10/15
1/16-current NED

plastikos
Posts: 330
Joined: Wed Jan 14, 2015 6:09 am

Re: Was seen by two oncologists and their treatment plans

Postby plastikos » Sat Feb 28, 2015 8:53 am

Consult a surgeon and go for an outright resection if possible. That'll give you better odds.
St. IV Colon CA @ 37, male, Kras wild, MSI-high (2014)
11/2014 Right Hemicolectomy + Liver Resection
12/2014 - 6/2015 FOLFOX + Cetuximab
10/2015 - Recurrence liver
Liver resection 10/2015
FOLFIRI 11/2015 - 5/2016
Recurrence liver, nodes 11/2016
Pembrolizumab started 12/2016 -> pseudoprogression(?) -> biliary obstruction -> biliary stenting
Chemo 4x: most mets inactive and smaller on PET-CT
March 2017 - Back on Pembrolizumab again
Sept 2017 - SIRT - > NED
2019 NED

CM35
Posts: 265
Joined: Tue Dec 03, 2013 1:16 pm

Re: Was seen by two oncologists and their treatment plans

Postby CM35 » Sat Feb 28, 2015 10:14 am

Please, please REFUSE the biopsy. Like others said, it is basically stirring up the hornets nest, and can cause microscopic cells to jump ship to other places, so to speak. The positive PET is sufficient to confirm that the liver lesion is cancer. Please also consult with a surgeon, not an oncologist, about resection of the liver lesion. If you have only one lesion, having it resected could give you a very decent prognosis. Best wishes.
stg IV 4/2013 @34 - liver, ovary/peritoneum
Lots of chemo, surgery and good luck - still doing well 03/2016...

boswind
Posts: 61
Joined: Fri Apr 11, 2014 12:04 pm

Re: Was seen by two oncologists and their treatment plans

Postby boswind » Sat Feb 28, 2015 10:40 am

Thank you all for the valuable advises. I will talk to the oncs and try to skip the liver biopsy.

The reason both onc's want to have a liver biopsy is that I have early stage of liver Cirrhosis and so I am in higher risk of getting primary liver cancer (Hepatoma); by orderingg a biopsy the doctors would get some protection for themselves. I agree that the biopsy is not necessary because the MRI report clearly states that the images "favor liver metastases rather than multifocal hepatoma."
01.24.2014 Male, DX @54 Rectosigmoid Cancer, MRI: T3N0M0
03.19.2014 Completed 5-week Radia+Xeloda
05.07.2014 Had surgery
02.25.2015 CT showed liver and L4 Spine involvement.
03.2015 - 08.2015, folfox + Avastin
08.2015 - 07.2017, 5FU + leucovorin + Avastin for Maintenance
07.2017 - 01.2018, Folfuri + Avastin
02.07.2018 - 03.06.2019, Centuximab + Irinotecan
90 rounds of chemos received (as of 12.27.18)
CEA: 9.8 as of 12.27.18
MSS, KRAS wild type, BRAF wild type
TMB = 12 mut/MB
03.14.2019 - Keytruda

User avatar
ConnieSPK
Posts: 144
Joined: Tue May 07, 2013 6:28 pm
Facebook Username: Connie Perkins Kreienheder
Location: Dardenne Prairie, MO

Re: Was seen by two oncologists and their treatment plans

Postby ConnieSPK » Sat Feb 28, 2015 5:37 pm

Maybe I'm missing something here, but even if the liver spot did happen to be primary liver cancer instead of a colon cancer metastisis(sp?), wouldn't resection still be needed? Why biopsy, then resect? Are they concerned that the cirrosis may impair the liver regenerating? I'm not a doctor, or medical anything other than a patient, so my logic could be all wrong, but those may be questions worth asking. I'm not sure of your locale, but I know an excellent liver surgeon in the Midwest...he took about 1/2 of mine out ;-)

Connie K.
Dx08@54,StgIV Colon,Liver,Lung, ColonSurg,FOLFOX+Beva
09 LiverSurg
10 FOLFIRI+Beva
11 FOLFOX+Beva,ox reaction
12 Bi-lat LungVATS
13 New mets L lung FOLFIRI+Zaltrap,5FU reaction
14 Return mets L lung SBRT,successful
15 Lung Spots, Irinotecan

User avatar
mstults
Posts: 1327
Joined: Fri Nov 30, 2012 11:23 am

Re: Was seen by two oncologists and their treatment plans

Postby mstults » Sat Feb 28, 2015 5:50 pm

I've had both chemos. Started with Folfox. Avastin was added after a few rounds. After 2 rounds dosage of Oxaliplatin was cut to 80% due to neuropathy. I had 17 rounds total. After more than 2 years, the neuropathy is still quite debilitating, especially in the feet. After the Folfox, I was given 5-FU alone for a few months before being switched to Irinotecan. Folfox had depleted blood counts so Irinotecan was given at 50% dosage. When CEA started to rise Irinotecan was increased. Diarrhea had been pretty severe at 50% but at 100% was almost unbearable. I took Irinotecan alone for a little over a year. Even though the neuropathy of Folfox seems to be permanent and I can only walk short distances, I tolerated Folfox better than Irinotecan. Two weeks ago I was switched to Vectibix. Waiting for the rash to see how bad it is. I agree with the others. I would avoid a liver biopsy if at all possible.
Male Age 53. Dx CC with numerous liver mets 6/23/12. Colon res 6/24/12. Started folfox 7/24/12. Added avastin 8/27/12. CT 12/27/12 still showing shrink. Took 17 rounds of FOLFOX. Then 5-FU + Avastin. Switched to Irinotecan for 1 yr. CEA rose to >400. Switched to Vectibix 2/18/15. CEA decreasing. Scans show some growth in liver mets. Lung Mets stable to shrinking.

https://www.facebook.com/michael.stults2/about?ref=home_edit_profile&section=work


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