Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

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NHMike
Posts: 326
Joined: Fri Jul 21, 2017 3:43 am

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby NHMike » Tue Sep 05, 2017 1:06 pm

susie0915 wrote:I had reductions due to diarrhea and weight loss. Not sure of the % but my xeloda was reduced by 1000mg/day. Not sure about the oxi but that was reduced also. I did the same amount of infusions.


My Xeloda is 3,400 mg/day so 1,000 mg/day would be a pretty big reduction for me.
Mike in NH:
Rectal Bleeding biopsy June 23, 2017, Diagnosed Stage 3B rectal cancer late July 2017 via MRI.
T3, N1b, M0.
Chemo (Xeloda) and radiation from 07/31/17 to 09/08/17.
CEA before treatment: 2.7. CEA after 14 treatments 1.9 to 1.8 after treatment.
KRAS Mutant KRAS p.Gly12Asp

susie0915
Posts: 156
Joined: Wed Aug 02, 2017 8:17 am
Facebook Username: Susan DeGrazia Hostetter
Location: Michigan

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby susie0915 » Tue Sep 05, 2017 3:42 pm

Yes it was. Mine was 3500/day I believe. Three pills in the morning and four in the evening. I started at the same amount I was given during preadjuvant therapy. I really didn't have problems then, but after surgery did have diarrhea, plus had lost weight since surgery and my blockage. I also lost another 10 lbs pretty quickly after starting adjuvant therapy. I did have the reversal before treatment so may not have had the issues if I still had the ileo, which was the original plan. I know the doctor didn't want to reduce it anymore since I'm sure there is a therapeutic range that has to be followed.
57 yr old mother of 3
5/15 DX T3N0MO Stage 2A
6/15 5 wks of radiation/xeloda
7/15 sigmoidoscopy/scar tissue only
8/15 Pet scan NED
9/15 LAR
10/15 Bowel blockage. 3 1/2 weeks in hospital.
early ileo rev since
surgery to repair blockage. c-diff inf
12/15 6 rds of xelox
5/16 Clear CT lung scarring/inflammation
9/16 clear colonoscopy
4/17 CT 4mm lung nodule onc thinks scar tissue
7/17 no change lung nodule
Currently NED

prs
Posts: 103
Joined: Sat Dec 12, 2015 7:09 pm
Location: Central California

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby prs » Tue Sep 05, 2017 4:41 pm

Sreekanth, in my case it was the oxaliplatin infusions that caused all my blood counts to fall. Are you sure it's the 5FU causing your problem?

I took Xeloda pills instead of 5FU and for my weight and height the official Xeloda dose should have been 2,300 mg twice per day. In fact my oncologist started me at 1,500 mg twice per day, and quickly dropped it to 1,000 mg twice per day when I developed severe diarrhea. So in effect my dose was 43% of the manufacturers recommended dose. Also, for me, the dose reductions did not increase the number of cycles

It does seem that a reduction of 25% is within the norm.
Peter, age 65 at dx
DX 4 cm x 4 cm very low rectal adenocarcinoma into the sphincters 01/15
Stage III T3 N1 M0 with two suspicious lymph nodes
26 sessions IMRT radiation with 1,000 mg Xeloda twice per day 03/15 to 04/15
Complete clincal response to the chemoradiation...the tumor shrank completely away 06/15 :D
No surgery...Habr-Gama watch and wait protocol instead
Xelox chemotherapy 07/15-12/15
MRI and rectal exam every three months starting 07/15
MRI and rectal exam every six months starting 07/17
NED

susie0915
Posts: 156
Joined: Wed Aug 02, 2017 8:17 am
Facebook Username: Susan DeGrazia Hostetter
Location: Michigan

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby susie0915 » Tue Sep 05, 2017 5:06 pm

Yes, I think my last three cycles were 1000mg twice a day, but the doctor did say he didn't want to reduce any more. So that is a 1500mg reduction. I think there was one reduction in the oxi also. I know my hemoglobin was always a problem. I did go in a couple times for hydration.
57 yr old mother of 3
5/15 DX T3N0MO Stage 2A
6/15 5 wks of radiation/xeloda
7/15 sigmoidoscopy/scar tissue only
8/15 Pet scan NED
9/15 LAR
10/15 Bowel blockage. 3 1/2 weeks in hospital.
early ileo rev since
surgery to repair blockage. c-diff inf
12/15 6 rds of xelox
5/16 Clear CT lung scarring/inflammation
9/16 clear colonoscopy
4/17 CT 4mm lung nodule onc thinks scar tissue
7/17 no change lung nodule
Currently NED

mozart13
Posts: 72
Joined: Fri Dec 09, 2016 7:38 pm
Location: Toronto

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby mozart13 » Wed Sep 06, 2017 12:41 pm

My oxilaplatin was reduced to 90% than 65%, after 3rd treatment, I had grade 2 neuropathy, my oncologist pulled guidlenes for folfox, that was recomendation for that grade, after dose reduction neuropathy was gonne.
So far I had 8 treatments and neuropathy is almost at the same point when I had grade 2, will be interesting to see what happen next week when I go for chemo.
My oncologist told me that I had excelent response on my 3rd treatment.
We all react diferentlly to meds.
I am usually very sensitive to meds, took once naproxen ,small dose, while back and almost fell asleep while driving, and that is just regullar pain medication over the counter.
55 year, male, never been seek in my life.
Diagnosed with T1,T2 N0 M0 rectal cancer, tumor 4.5cm,
Stage 1
CEA 2.0
Discovered by pure lack, after taking baby ASA, had blood in stool.
25 sessions of Xeloda 1750 twice a day and Radiation 50 gy finished end of January 2017
Tumor erased, CCR, negative mri, ct, scope, just scar left, no evidence of cancer
W&W approach 8)
April 2017, folfox 8 rounds plus 2 rounds of xeloda
Sept.2017 CT , MRI negative

mozart13
Posts: 72
Joined: Fri Dec 09, 2016 7:38 pm
Location: Toronto

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby mozart13 » Wed Sep 06, 2017 1:27 pm

Metformin?!

One of the earlier posts mentioned that Korea has highest incidence of colorectal cancer, so I did a bit research to see their findings.
There is interesting study on Metformin (diabetic pills) and rectal cancer:
" One meta-analysis showed that patients with colorectal cancer taking metformin had a 34% improvement in the overall survival compared to nonmetformin users "

Here is the link to the article:
https://www.e-crt.org/journal/view.php? ... t.2016.128
55 year, male, never been seek in my life.
Diagnosed with T1,T2 N0 M0 rectal cancer, tumor 4.5cm,
Stage 1
CEA 2.0
Discovered by pure lack, after taking baby ASA, had blood in stool.
25 sessions of Xeloda 1750 twice a day and Radiation 50 gy finished end of January 2017
Tumor erased, CCR, negative mri, ct, scope, just scar left, no evidence of cancer
W&W approach 8)
April 2017, folfox 8 rounds plus 2 rounds of xeloda
Sept.2017 CT , MRI negative

mozart13
Posts: 72
Joined: Fri Dec 09, 2016 7:38 pm
Location: Toronto

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby mozart13 » Mon Sep 11, 2017 4:21 pm

"Evaluation of Mesorectal Lymph Nodes with High-Resolution MRI"

this is interesting article about mesorectal nodes before and after chemorad.
" Patients with TRG 3-5 disease following neoadjuvant therapy will all proceed to further treatment regardless of their nodal status and therefore only patients with TRG 1-2 disease are likely to benefit from the increased diagnosis of lymph node metastases. However this group is small with only 3% of patients with TRG 1-2 developing local recurrence [21]."

http://austinpublishinggroup.com/cancer ... id1021.php
55 year, male, never been seek in my life.
Diagnosed with T1,T2 N0 M0 rectal cancer, tumor 4.5cm,
Stage 1
CEA 2.0
Discovered by pure lack, after taking baby ASA, had blood in stool.
25 sessions of Xeloda 1750 twice a day and Radiation 50 gy finished end of January 2017
Tumor erased, CCR, negative mri, ct, scope, just scar left, no evidence of cancer
W&W approach 8)
April 2017, folfox 8 rounds plus 2 rounds of xeloda
Sept.2017 CT , MRI negative

mozart13
Posts: 72
Joined: Fri Dec 09, 2016 7:38 pm
Location: Toronto

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby mozart13 » Tue Sep 12, 2017 7:17 pm

Just to update, beceause of neuropathy my oncologist switched me to xeloda pills twice a day, 2 weeks on , 1 week off, 2 rounds, my picc line is out, that part feels good.

MRI and CT both came back negative, gonna see my surgeon next week.
55 year, male, never been seek in my life.
Diagnosed with T1,T2 N0 M0 rectal cancer, tumor 4.5cm,
Stage 1
CEA 2.0
Discovered by pure lack, after taking baby ASA, had blood in stool.
25 sessions of Xeloda 1750 twice a day and Radiation 50 gy finished end of January 2017
Tumor erased, CCR, negative mri, ct, scope, just scar left, no evidence of cancer
W&W approach 8)
April 2017, folfox 8 rounds plus 2 rounds of xeloda
Sept.2017 CT , MRI negative

mozart13
Posts: 72
Joined: Fri Dec 09, 2016 7:38 pm
Location: Toronto

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby mozart13 » Wed Sep 13, 2017 2:26 pm

Local inflamatory response
"After preoperative RCT, rectal cancer could undergo tumour regression by eradication of carcinoma cells and replacement by fibrous or fibroinflammatory tissues [123, 128, 129]. Nagtegaal et al. [130] and Shia et al. [123] found that patients with an extensive fibroinflammatory infiltrate around the tumour had lower recurrence rates. Two recent studies by Debucquoy et al. [128, 129] showed a better disease-free survival in rectal cancer patients whose TME specimens contained fibroinflammatory changes after RCT (Figure 1)"

https://www.hindawi.com/journals/bmri/2015/574540/
55 year, male, never been seek in my life.
Diagnosed with T1,T2 N0 M0 rectal cancer, tumor 4.5cm,
Stage 1
CEA 2.0
Discovered by pure lack, after taking baby ASA, had blood in stool.
25 sessions of Xeloda 1750 twice a day and Radiation 50 gy finished end of January 2017
Tumor erased, CCR, negative mri, ct, scope, just scar left, no evidence of cancer
W&W approach 8)
April 2017, folfox 8 rounds plus 2 rounds of xeloda
Sept.2017 CT , MRI negative

prs
Posts: 103
Joined: Sat Dec 12, 2015 7:09 pm
Location: Central California

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby prs » Sat Sep 16, 2017 12:14 am

mozart13 wrote:Just to update, beceause of neuropathy my oncologist switched me to xeloda pills twice a day, 2 weeks on , 1 week off, 2 rounds, my picc line is out, that part feels good.

MRI and CT both came back negative, gonna see my surgeon next week.

mozart, I hope this works for you as well as it did for me. My onc told me he thought the Xeloda pills contributed 80% to the overall effectiveness of the treatment. I don't know if there are any studies to support his view but, at the time, it sure made me feel good about skipping the last two oxi infusions!!!

Congrats on your clear scans, you should be all done well before Christmas. My three week delay really screwed up my Holiday schedule and I ended up taking my last pills on Jan 3rd. FWIW my neuropathy was a whole lot better after six months and, at eighteen months, was completely gone.
Peter, age 65 at dx
DX 4 cm x 4 cm very low rectal adenocarcinoma into the sphincters 01/15
Stage III T3 N1 M0 with two suspicious lymph nodes
26 sessions IMRT radiation with 1,000 mg Xeloda twice per day 03/15 to 04/15
Complete clincal response to the chemoradiation...the tumor shrank completely away 06/15 :D
No surgery...Habr-Gama watch and wait protocol instead
Xelox chemotherapy 07/15-12/15
MRI and rectal exam every three months starting 07/15
MRI and rectal exam every six months starting 07/17
NED

susie0915
Posts: 156
Joined: Wed Aug 02, 2017 8:17 am
Facebook Username: Susan DeGrazia Hostetter
Location: Michigan

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby susie0915 » Sat Sep 16, 2017 8:22 am

How do the doctors know for sure that the cancer is totally gone? After chemoradiation, my surgeon did a sigmoidoscopy and said all that was left was scar tissue and I may not need chemo after surgery. I then had a pet scan and there was no sign of cancer especially in the distal rectal area. I was never offered the watch and wait strategy(which I may have seriously considered), but was quite happy that I may not need chemo after surgery. When I got the pathology report after surgery it did show minimal residual cancer in the specimen where tumor was removed. So I did still have some cancer cells, but the tests done after chemoradiation showed no cancer. I wonder if I was able to do watch and wait how long it would've taken for those cancer cells to grow or how I would know if they did not get into my blood stream.

Don't get me wrong, I think the watch and wait program has many benefits and can provide patients with such a better quality of life, but do you worry about there still being some cancer left in the tumor area? Is there another test that can pick up cancer cells other than pet scan or sigmoidoscopy I had. Would an endoscopic ultrasound be able to pick up residual cancer cell? This watch and wait program really intrigues me as I really feel I may have really chosen that route if offered. Hopefully, more doctors and cancer centers will be offering this option in the next few years.
57 yr old mother of 3
5/15 DX T3N0MO Stage 2A
6/15 5 wks of radiation/xeloda
7/15 sigmoidoscopy/scar tissue only
8/15 Pet scan NED
9/15 LAR
10/15 Bowel blockage. 3 1/2 weeks in hospital.
early ileo rev since
surgery to repair blockage. c-diff inf
12/15 6 rds of xelox
5/16 Clear CT lung scarring/inflammation
9/16 clear colonoscopy
4/17 CT 4mm lung nodule onc thinks scar tissue
7/17 no change lung nodule
Currently NED

mozart13
Posts: 72
Joined: Fri Dec 09, 2016 7:38 pm
Location: Toronto

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby mozart13 » Sat Sep 16, 2017 11:22 am

prs wrote: My onc told me he thought the Xeloda pills contributed 80% to the overall effectiveness of the treatment...FWIW my neuropathy was a whole lot better after six months and, at eighteen months, was completely gone.

prs, thats great, 80%, plus radiation is still active, xeloda and rad work together very well.
I think my surgeon will do scope after chemo, should all be finished before Christmas, actually all started before Christmas last year, treatment, so it will take about yearto finish it.
Xeloda is not bad, tolerable, oxy was brutal, and that is encouraging about neuropathy, my family doc put me on vit. b12injections as well, it should help with nerve damage.
Thx prs!
55 year, male, never been seek in my life.
Diagnosed with T1,T2 N0 M0 rectal cancer, tumor 4.5cm,
Stage 1
CEA 2.0
Discovered by pure lack, after taking baby ASA, had blood in stool.
25 sessions of Xeloda 1750 twice a day and Radiation 50 gy finished end of January 2017
Tumor erased, CCR, negative mri, ct, scope, just scar left, no evidence of cancer
W&W approach 8)
April 2017, folfox 8 rounds plus 2 rounds of xeloda
Sept.2017 CT , MRI negative

prs
Posts: 103
Joined: Sat Dec 12, 2015 7:09 pm
Location: Central California

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby prs » Sat Sep 16, 2017 12:35 pm

susie0915 wrote:How do the doctors know for sure that the cancer is totally gone? After chemoradiation, my surgeon did a sigmoidoscopy and said all that was left was scar tissue and I may not need chemo after surgery. I then had a pet scan and there was no sign of cancer especially in the distal rectal area. I was never offered the watch and wait strategy(which I may have seriously considered), but was quite happy that I may not need chemo after surgery. When I got the pathology report after surgery it did show minimal residual cancer in the specimen where tumor was removed. So I did still have some cancer cells, but the tests done after chemoradiation showed no cancer. I wonder if I was able to do watch and wait how long it would've taken for those cancer cells to grow or how I would know if they did not get into my blood stream.

The doctors don't know for sure, that's why the watch and wait protocol includes six months of mop-up Xelox or Folfox so that any stray cancer cells are killed before they can take hold.
Peter, age 65 at dx
DX 4 cm x 4 cm very low rectal adenocarcinoma into the sphincters 01/15
Stage III T3 N1 M0 with two suspicious lymph nodes
26 sessions IMRT radiation with 1,000 mg Xeloda twice per day 03/15 to 04/15
Complete clincal response to the chemoradiation...the tumor shrank completely away 06/15 :D
No surgery...Habr-Gama watch and wait protocol instead
Xelox chemotherapy 07/15-12/15
MRI and rectal exam every three months starting 07/15
MRI and rectal exam every six months starting 07/17
NED

susie0915
Posts: 156
Joined: Wed Aug 02, 2017 8:17 am
Facebook Username: Susan DeGrazia Hostetter
Location: Michigan

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby susie0915 » Sat Sep 16, 2017 12:47 pm

Ah. I see. Thank you for the information. I remember telling my husband that since chemo/radiation worked so well I wonder why they would have to do surgery? And actually mentioning couldn't they monitor me to see if it returns? Maybe I should've done some more research. Oh well, it doesn't matter for me now, but this is good information for future patients knowing that this is a possibility. It's kind of a game changer I think.
57 yr old mother of 3
5/15 DX T3N0MO Stage 2A
6/15 5 wks of radiation/xeloda
7/15 sigmoidoscopy/scar tissue only
8/15 Pet scan NED
9/15 LAR
10/15 Bowel blockage. 3 1/2 weeks in hospital.
early ileo rev since
surgery to repair blockage. c-diff inf
12/15 6 rds of xelox
5/16 Clear CT lung scarring/inflammation
9/16 clear colonoscopy
4/17 CT 4mm lung nodule onc thinks scar tissue
7/17 no change lung nodule
Currently NED

mozart13
Posts: 72
Joined: Fri Dec 09, 2016 7:38 pm
Location: Toronto

Re: Rectal Cancer: Habr-Gama Watch and Wait Strategy to Avoid Surgery

Postby mozart13 » Sat Sep 16, 2017 1:02 pm

susie0915 wrote:I wonder if I was able to do watch and wait how long it would've taken for those cancer cells to grow or how I would know if they did not get into my blood stream.

Don't get me wrong, I think the watch and wait program has many benefits and can provide patients with such a better quality of life, but do you worry about there still being some cancer left in the tumor area? Is there another test that can pick up cancer cells other than pet scan or sigmoidoscopy I had. Would an endoscopic ultrasound be able to pick up residual cancer cell?

Susie you got valid point.
Curentlly there is no test that will pick up microcells left after chemo/rad. Thats why extra chemo is given after chemo/rad, to wipe out anything left behind, and than close follow up for years.
Surgery or no surgery, there is no quaranty, with surgery, technique is very important, to get every thing out in one piece, not to make wholes in sample, and to obtain clear edges, so I was told by my surgeon.
There has been debate going on for years about cancer cells spreading when touched or cut through.

pCR (pathological complete response) result is the only sure thing, in my opinion,every thing else is up in the air, but that requires surgery to prove it. Lymph nodes involment play major role as prognostic factor.
Even some people that had pCR, still get chemo, all depends on who is taking care of you.

There was study, I posted link earlier where with just 3 extra folfox treatments, cCR went from 25% to 50%, thats huge difference, so probablly down the road the whole approach in treating rectal cancer will change.

Old approach, W&W, was chemo/rad only, new one chemo/rad followed by chemo.
This new approach is part of big trial currently taking place, and by looking at above result, looks very reassuring.
55 year, male, never been seek in my life.
Diagnosed with T1,T2 N0 M0 rectal cancer, tumor 4.5cm,
Stage 1
CEA 2.0
Discovered by pure lack, after taking baby ASA, had blood in stool.
25 sessions of Xeloda 1750 twice a day and Radiation 50 gy finished end of January 2017
Tumor erased, CCR, negative mri, ct, scope, just scar left, no evidence of cancer
W&W approach 8)
April 2017, folfox 8 rounds plus 2 rounds of xeloda
Sept.2017 CT , MRI negative


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