Chemo question - no leucovorin

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

Chemo question - no leucovorin

Postby plastikos » Thu Nov 19, 2015 3:05 am

Just finished my first infusion of chemo after resection of my liver recurrence. Talked to my onc and the regimen we are giving is technically not FOLFIRI but Irinotecan followed by a long infusion (over 2 days) of high dose 5FU. No Leucovorin. According to my onc its a protocol being used at MDA with good results and less toxicity. So far in terms of side effects it seems ok. Much better than when I was on FOLFOX definitely. Anyone familiar or undergoing the same regimen? Just wondering.
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

Ron50
Posts: 695
Joined: Fri Feb 10, 2006 7:04 pm

Re: Chemo question - no leucovorin

Postby Ron50 » Thu Nov 19, 2015 7:22 am

Hi,
When I was having chemo (over 16 years ago) leucovorin was the new in thing. I was told that it would help with the side effects of the 5Fu. It did not help in fact it helped get me off that regime of 5 days straight infusions of 5fu with leucovorin. It nearly killed me and I switched to 48 weeks of 5fu and levamisole(banned in 2001 for often fatal side effects). The next time I came in contact with leucovorin was when I was taking methotrexate for nephrotic syndrome of the kidneys ( probably a result of levamisole). leucovorin did not make a bit of difference to the nausea and I eventually switched to cyclosporine which is a front line immunosuppressant and is surprisingly easy to tolerate ( until I grow another head). I guess what I am saying is I would not be worried about not having leucovorin. Ron.
dx 1/98
st 3 c 6 nodes
48 sessions 5Fu/levamisole
no recurrence cea <.5
numerous l/t side effects of chemo

Ontario Guy
Posts: 278
Joined: Fri Aug 03, 2012 7:55 am

Re: Chemo question - no leucovorin

Postby Ontario Guy » Thu Nov 19, 2015 7:26 am

plastikos wrote:Anyone familiar or undergoing the same regimen?


No, but thanks to you and Ron50 for the information. Very interesting.

Best,

OG

sjring
Posts: 181
Joined: Mon Jun 30, 2014 3:16 pm
Location: Philadelphia, PA

Re: Chemo question - no leucovorin

Postby sjring » Thu Nov 19, 2015 4:40 pm

I was doing FOLFOX but after a couple treatments we dropped the leucovorin and the 5FU bolus before the 46 hour infusion. Both were giving me some gastric issues. It didn't seem to make that much of a difference in my treatment.

As always your mileage may vary.
50 YO Husband & father of 2 teenagers.
DX 9/9/13 Stage 4 cc (at age 48)
16 Rounds FOLFOX + Avastin (Oct-13 to May-14)
Maintenance chemo - Avastin & 5-FU infusions (Jun-14 to Jul-15)
Jul-15: Mets to lymph nodes, resuming FOLFOX
Sep-15: MRI showed stability, back to maintenance chemo.

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exaussie
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Location: Silverton OR
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Re: Chemo question - no leucovorin

Postby exaussie » Thu Nov 19, 2015 4:58 pm

We were told leucovorin made chemo stay in the body longer but didn't offer that much of a difference for the bother. We dropped it after 6 rounds.
DS 26 yrs old diagnosed 6/13 T3N2aM1b
Resection 6/13
6 rounds chemo folfax
12/13 Fissure
hernia surgery 12/13
5 months break
Maintenance chemo 3/14
Crazy growth. Liver failing. Folfox and vectibex 7-29-14
Chemo failure Hospice 8/26
Left us 8/28

rp1954
Posts: 1523
Joined: Mon Jun 13, 2011 1:13 am

Re: Chemo question - no leucovorin

Postby rp1954 » Thu Nov 19, 2015 5:09 pm

In a Black (no LV) and White (huge LV, 75-90-200 mg/day for continuous 5FU) world, we're gray.

I've had my doubts they know what they are doing with leucovorin, for a while. Given the MTFHR mutations, alongside various individual metabolic divergences with 5FU, the amount of LV and 5,10 methylenetetrahydrofolate build-up might be a problem for many. Yet, part of the other "half" might really need a lot of LV to work.

That would account for some of the differences in 5FU-LV performance vs toxicity. For continuous 5FU, I wouldn't be surprised if 4 - 30 mg of LV per day had an optimum point, adequate for TS binding in up to half the population. This low dose LV issue was never properly addressed by trials in my eyes, but that's how I interpret what data there is. Don't quite have a view for biweekly MTD 5FU tx.

Because of the selective R,S enantiomer uptake, I also suspect that oral LV can be superior to IV LV, more than halfway to levo-leucovorin.
Last edited by rp1954 on Thu Nov 19, 2015 5:15 pm, edited 1 time in total.
watchful, active researcher and caregiver for stage IVb/c CC. surgeries 4/10 sigmoid etc & 5/11 para-aortic LN cluster; 8 yrs immuno-Chemo for mCRC; now no chemo
most of 2010 Life Extension recommendations and possibilities + more, some (much) higher, peaking ~2011-12, taper to almost nothing mid 2018, mostly IV C

JAZZToo
Posts: 509
Joined: Sun Oct 01, 2006 10:46 am
Location: New York City

Re: Chemo question - no leucovorin

Postby JAZZToo » Thu Nov 19, 2015 5:14 pm

When I was on Folfirinox for the last several treatments the Leucovorin and bolus 5FU were discontinued. When I asked why, I was told that it was found to be ineffective and not necessary, that the 48 hour 5FU was enough. Somewhere there must be a research study to back up this change in protocol, but I didn't think to ask.

Leslie
Lynch syndrome
2014 Pancreatic Cancer FOLFIRINOX x 23, Gemzar/Abraxane x 5
2003 Colon Cancer Stage 3. Right hemicolectomy, 6 mos. Leucovorin & Bolus 5FU
1995 Endometrial Cancer Stage 1. TAHBSO No chemo

fwilkins
Posts: 12
Joined: Tue May 13, 2014 9:08 pm

Re: Chemo question - no leucovorin

Postby fwilkins » Thu Nov 19, 2015 6:17 pm

We went trough the same ambiguity about Leucovorin and 5FU at MDA. It was on the orders at each infusion, so for months we thought that's what we were getting. It comes out later, that yes, it was on the orders each time, but they always excluded it. There had been a shortage of Leucovorin, so I was always concerned about why it was not given. Never really understood why.

justin case
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Location: Katy, Texas

Re: Chemo question - no leucovorin

Postby justin case » Thu Nov 19, 2015 6:44 pm

Someone correct me if I'm wrong, but leucovoren is a folonic acid substitute, that helps keep chemo in your body for a little longer, not much longer. If you are doing Folfox, you probably had some or something similar, if you are doing Folfiri, you probably had some , or something similar. If you are on a pump for day's or weeks, you probably don't need it, butt I could be wrong :roll:
Michael
7/11 diagnosed Stage 2 colon and rectal cancer
chemo/rad
lar/temp ilio
Reversal & port removal
21 round of chemo Folfox 9tx, 5fu 12 tx
Last treatment July 2012

Ron50
Posts: 695
Joined: Fri Feb 10, 2006 7:04 pm

Re: Chemo question - no leucovorin

Postby Ron50 » Thu Nov 19, 2015 7:24 pm

You are not wrong Justin. When I was on methotrexate , I was originally given folic acid with the dose. As I progressed with the methotrexate my gi problems got worse. I progressed to self injecting methotrexate combined with folic acid tablets. My gi problems subsided for a short time then increased dramatically. They tried me then on leucovorin (follonic acid) in combination with the methotrexate. It did not help and I went off MTX altogeather. In reality the real cause of the problem was most likely bile salt malabsorption after my gall bladder was removed( one of the small black stones in my gall bladder blocked off my pancreatic duct and nearly killed me ). I finally solved the problem with cholestramine ( questran lite) which binds the bile salts and takes them thru the gi tract without causing problems. I think that is why it is called medical PRACTICE. I now take cyclosporine for my nephrotic syndrome. My first nephrologist mistook the kidney disease as minimal change disease and had me on 75mg daily of prednisone for nearly two years. I now have type two diabetes . More practice. Fortunately I have a good neph now . He has done two kidney biopsies and cannot identify the problem. I was losing over 7 grams of protein a day thru my urine before he put me on cyclosporine. I am down to .7 of a gram now and holding, for how long heaven only knows. Cheers Ron.
dx 1/98
st 3 c 6 nodes
48 sessions 5Fu/levamisole
no recurrence cea <.5
numerous l/t side effects of chemo

jhocno197
Posts: 817
Joined: Mon May 11, 2015 9:33 pm

Re: Chemo question - no leucovorin

Postby jhocno197 » Thu Nov 19, 2015 8:18 pm

After my husband started having severe gallbladder problems while on chemo, they dropped his leucovorin.
DH - dx Dec 2014, stage IV with bladder & peritoneal involvement - non-resectable
Colostomy
FOLFOX failed
FOLFIRI failed
Tumor actually distending pelvic skin
Not a candidate for last-ditch pelvic exenteration
Stivarga finally begun 2/19/16
Tumor growing/fungating
Lonsurf started 11/18/16
Died 3/10/17

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

Re: Chemo question - no leucovorin

Postby Nik Colon » Fri Nov 20, 2015 3:42 am

When I switched places and they cut my iri to 80% and no bolus 5fu they didn't do leucovorin then. Not sure if they meant cuz no bolus or cutting down the iri or what, but I didn't get any then. Idk
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

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

Re: Chemo question - no leucovorin

Postby plastikos » Sat Nov 21, 2015 8:30 pm

Thank you for all the replies. I was just worried that without leucovorin we would be veering off protocol. I've just had 1 infusion and so far, knock on wood, toxicity seems less. Hopefully response will also be good. According to my onc he used it on a patient with bone and lung mets and had a complete response, which is encouraging. In my case its adjuvant chemo post liver resection.
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


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