Lonsurf + Avastin

[meatie]

At the most recent dr's appointment, the onc suggested that my mother will be getting avastin plus a different chemo drug, which was not specified but I assumed to be stivarga. It turned out the new combo will be avastin + LONSURF.

I did some searches on google, but found very little on lonsurf. Any members had experience with the combo lonsurf + avastin?

[GrouseMan]

Search instead for TAS-102. It has been discussed here and I believe some others have also used it. The following is from Wikipedia

https://en.wikipedia.org/wiki/Trifluridine/tipiracil

This is a treatment that I understand has been used for some time in Japan. The combination is likely to be similar, yet different enough from 5-Fluorouricil that it might be effect where 5-FU has failed. Some folks have had some success, but it isn't a cure by any means. The combination with Avastin is probably a good choice, baring a clinical trial.

GrouseMan

[midlifemom]

Search instead for TAS-102. It has been discussed here and I believe some others have also used it. The following is from Wikipedia

https://en.wikipedia.org/wiki/Trifluridine/tipiracil

This is a treatment that I understand has been used for some time in Japan. The combination is likely to be similar, yet different enough from 5-Fluorouricil that it might be effect where 5-FU has failed. Some folks have had some success, but it isn't a cure by any means. The combination with Avastin is probably a good choice, baring a clinical trial.

GrouseMan

Gman, why do you say ""it isnt a cure by any means"?

[GrouseMan]

Seldom in late stage cancer treatment are chemotherapy agents by themselves able to cure anything (ie never)! Meatie's mom is a stage IV patient that has already failed the first two standard lines of treatment. Those folks dealing with advance stages look to get to a point via chemotherapy were surgery to take it out might get them to NED. Immunotherapy - someday might offer something akin to a cure for late advanced stage cancers but that day is not here yet and might never be by itself. I have seen cures using chemo in only one setting - preclinical mouse studies, and more often than not that doesn't translate to humans very well, or only marginally at best. I worked on two "successful" anticancer drugs during my career in drug discovery - both of which looked very promising and are now marketed. One of the drugs was a first known example of a small molecule kinase inhibitor actually curing mice, including those at the lower dose ranges. In the study the mice died of old age, the tumors never returned. We were very excited. But when the drug went through human trials it didn't have anywhere near as dramatic effect in NSCLC. It helped prolong the lives of maybe a third of the people, but certainly did not cure them. The other drug is doing better, used primarily for late stage advanced breast cancer.

That said - my wife is running out of chemo options herself. She is currently in a trial exploring the use of Irrinotecan, Erbitux and Avastin. This combo seems for the moment to be keeping her "stable". Every extension of time is important because it might get one to NED or stable long enough to the next treatment option which in turn might get you further down the road. For Stage IV patients their hope is to make it to a time when CURE might actually become possible. But as we have seen time and again here by the lose of our friends on this forum, most recently Kenny, not all are going to make it to the finish line in this race against time. TAS-102/Avastin might help Meatie's Mom get closer to the finish line, but by itself - I don't see this as a curative chemo therapy.

GrouseMan

[midlifemom]

Thanks Gman,
I am in basically same situation as Meaties mom. I had a reaction to the oxaliplatin and over a year of folfiri totally wiped me out. Possibility exists i can go back to folfiri, reduced dose since I've now had a break from it ( during which time there was rapid progression.
My onc has also said that the last two options, Stivarga and Lonsurf, are not for a cure, just buying times for a small percentage and harsher side effects.

Best of luck to your wife and thanks for all you do.

[meatie]

@GrouseMan + Midlifemom

According to your signatures, Lonsurf was not tried. Did your oncologist ever suggest lonsurf?

[midlifemom]

Meatie,
My oncologist has mentioned it, but at the time i was already on folfox. He did not seem optimistic about it and stated it is not a drug for a cure, just that it might buy me some more time - a month or two.
Now that I've reacted to oxaliplatin, we need to have a discussion on next options. That will be at next weeks appointment.

How does your mom feel? How strong is she? How much more chemo does she want to do? Is she interested in clinical trials? Has hospice been discussed with her as an option?

Best of luck.

[meatie]

Meatie,
My oncologist has mentioned it, but at the time i was already on folfox. He did not seem optimistic about it and stated it is not a drug for a cure, just that it might buy me some more time - a month or two.
Now that I've reacted to oxaliplatin, we need to have a discussion on next options. That will be at next weeks appointment.

How does your mom feel? How strong is she? How much more chemo does she want to do? Is she interested in clinical trials? Has hospice been discussed with her as an option?

Best of luck.

My mother's most recent infusion was august, so she's been on break for a three weeks now and has more energy now. There are other forum members who started lonsurf earlier this year, but have not posted here lately. Do you know any of them well enough to ask them to post updates of their experience with lonsurf?

[midlifemom]

Meatie,
I remember reading there is a large facebook audience for Lonsurf. Perhaps you can gather extra info there.

[GrouseMan]

In my wife's case no, her oncologist has not suggested Lonsurf/TAS-102. I doubt that he knows much about it. Its not commonly used in the US yet. It seems to be much more common in Japan. Its just another cytotoxic drug that has broad systemic reactions effecting normal as well as cancerous cells. It just effects the cancer cells more because they need more raw materials to reproduce as rapidly as they do compared to normal cells. Its one of these chemical compounds that messes up the cell because it looks chemically speaking very much like Uracil a natural building block that all cells use. But since its slightly different when the cell trys to use 5-FU or the similar compounds found as part of TAS-102 drug - its messes up the synthesis of DNA and HOPEFULLY these messed up cancerous cells undergo apoptosis and are destroyed. Same thing happens in normal cells, but because they don't replicate/proliferate as rapidly sometime the damage to normal cells is lessened, but there still is damage to normal cells. We call this class of anticancer drugs Antimetabolites. So - I don't expect a big advantage switching from one Anti-metabolite drug to another, as likely the same mechanism that resulted in resistance to 5-FU will also quickly apply to Tipiracil (chemical name: 5-Chloro-6-[(2-imino-1-pyrrolidinyl)methyl]-2,4(1H,3H)-pyrimidinedione) and Trifluridine (Chemical Name: 1-[4-hydroxy-5-(hydroxymethyl)oxolan-2-yl]-5- (trifluoromethyl) pyrimidine-2,4-dione) which in combination make up TAS-102. 5-FU chemical name is: 5-Fluoro-1H,3H-pyrimidine-2,4-dione. Notice anything similar in the names? These chemical compounds have a lot in common and would be expected to be metabolized by cells very similarly.

Avastin, is a Monoclonal Anti-body that binds to VEGFA, a protein that is involved in signaling via the VEGFr receptor. By binding the protein it turns off this kinase signaling pathway. Again, normal cells interact some what with Avastin, but less so because they are NORMALLY not producing excess amounts of VEGF family of Proteins, like cancer cells do. Oxaliplatin and Irrinotecan are called DNA binders. The bind to DNA and mess up its ability to replicate. These binders usually result in a non viable cell as It can't now properly undergo replication. Though there are mechanisms by which cells can attempt to correct these situations during the replication cycle - again we hope the toxic cell killing property effects rapidly reproducing cells as opposed to normal ones again. But as you all know having taking these two drugs - there are bad side effects and that is because of their effects on normal cells, nit just the cancerous ones!

So should my wife's Oncolgist suggest TAS 102, I would want to know specifically what his rational for using it was. He would have to convince me of its merits over 5-FU.

GrouseMan