What to expect from neoadj CAPOX ?

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Scilla
Posts: 24
Joined: Tue Apr 11, 2017 4:09 am

What to expect from neoadj CAPOX ?

Postby Scilla » Sat Apr 22, 2017 11:26 am

So my mom is too weak for chemo right now, she's having diarrhea on and off and has lost a lot of weight. She's in bed most of the time and has quickly become quite weak. Hopefully, a minor miracle will happen one of these days, so she'll be able to get out of her bed, stand on her legs and make it to the hospital. Because - the plan is to start chemo (CAPOX) in a couple of weeks, oxaliplatin IV on day 1 and capecitabine twice daily for two weeks.

My questions are: what can realistically be expected from this treatment? Can CAPOX make the tumors shrink? They were 5 and 9 cms a month ago. How long or how many rounds of CAPOX would it take to shrink tumors enough to make surgery possible? How fast do rectal and colon tumors grow, while she's not getting any treatment? I know that noone can answer these questions with any degree of certainty, but I'd like to hear your thoughts on this. I don't know whether there's still hope that she may get better or if I should consider this "treatment" more of a palliative approach and prepare myself mentally that time is running out.

I know that many of you will say "be optimistic", "keep fighting", "don't ever give up" and so on. I haven't let my mom in on these thoughts, obviously, on the contrary I try to be very optimistic and encourage her to fight, but when I'm alone I worry a lot and I'd like to know what I can realistically expect. Hope this makes sense.

And thanks for any input.
Supporter of mom 68 yr
Dx RC CRC 03/17
Rectal tumor 5cm, colon tumor 9cm
Two small liver mets,
04-05/2017 CAPOX Started twice, stopped due to side effects.
05/2017 One week of radiation to rectal tumor.
06-08/2017 Irinotecan+Bevacizumab
08/2017 Treatment stopped due to frail health
Mom is in Gods hands

PainInTheAss
Posts: 673
Joined: Tue Jul 02, 2013 3:08 am

Re: What to expect from neoadj CAPOX ?

Postby PainInTheAss » Sun Apr 23, 2017 5:50 am

Cancer cells range in their response to treatment depending on how they are programmed for cell death. Cells that are programmed for cell death will die when exposed to chemo. Cells that are not programmed for cell death can actually grow during chemo and or radiation. A tumor can be a combination of cells. So, her tumors could shrink but not completely die, they could grow, or they could completely die (a complete response). There is no way for anyone to predict this. Even statistics won't tell what will actually happen for your mom.

No, this is not palliative. There is a very real possibility that her cancer could respond dramatically. I had a 5cm rectal tumor that almost completely died during chemo-radiation. All that was left were trace cancer cells and scar tissue.

Chemo is very difficult. You really have to believe that it could save your life to get through it. My ex was given three to six. Inths to live last summer for stage IV medullary thyroid cancer that was not expected to respond to chemo. After he started chemo, all of his many bone spots disappeared. His doctors were amazed. His remaining lung spots are currently stable and there is no new growth. He could live for many years now and even possibly become a surgical candidate for the primary tumor.

I don't think you really "fight" cancer as much as you treat it and hope for the best. So, yes, she should treat it and see what happens. My pain diminished significantly after two weeks of chemo-radiation, so she may start feeling better even after the first infusion if she is in a lot of pain.
47yo single mom of 4 (24, 21, 18, 16) at Dx
6/13 - RC T4b IIIc 5LNs on PET CEA 5.4
8/13 - Finish chemorad
10/13 - APR/hyst+ovaries/perm colostomy 2/12 nodes+
6/14 - Finish Xelox 6 rds
1/15 - CT clear CEA 0.2
10/15 - CT/MRI clear CEA 0.7
4/16 - CT clear
10/16 - CT/MRI clear CEA 0.6
5/17 - PET clear? Follow up MRI to verify inflammation

Scilla
Posts: 24
Joined: Tue Apr 11, 2017 4:09 am

Re: What to expect from neoadj CAPOX ?

Postby Scilla » Sun Apr 23, 2017 8:06 am

Thanks for your reply, I really appreciate it. It made me more optimistic. I'll keep encouraging her and do my best to support her.
Supporter of mom 68 yr
Dx RC CRC 03/17
Rectal tumor 5cm, colon tumor 9cm
Two small liver mets,
04-05/2017 CAPOX Started twice, stopped due to side effects.
05/2017 One week of radiation to rectal tumor.
06-08/2017 Irinotecan+Bevacizumab
08/2017 Treatment stopped due to frail health
Mom is in Gods hands

KElizabeth
Posts: 400
Joined: Sat Oct 31, 2015 12:41 pm
Facebook Username: KElizabeth
Location: Omaha

Re: What to expect from neoadj CAPOX ?

Postby KElizabeth » Sun Apr 23, 2017 10:49 am

Oxaliplatin may well help your mom's cancer shrink, and after that there is always Iriotecan. You still have options so don't give up. If the Xeloda is too hard to handle with the oxaliplatin you could just do 5FU. Xeloda can be pretty toxic, but some people really prefer it to the 5fu pump.
Hang in there with us!

Elizabeth
Female age 39- ,2 teens.
Colon Cancer - DX March 2013
Age 34 at DX - Stage III B
Resection surgery -May 2013
FOLFOX - June, 2013 to Sept, 2013
5FU plus leukavorin Sept, 2013 to Dec, 2013
METs liver and lungs discovered Sept, 2015
KRAS - MSS
FOLFIRI plus Avastin - Sept, 2015 - July 2017
Durvalumab and Cediranib Sept 2017 Dec 17
FOLFOX with desensitization protocol - current

PainInTheAss
Posts: 673
Joined: Tue Jul 02, 2013 3:08 am

Re: What to expect from neoadj CAPOX ?

Postby PainInTheAss » Sun Apr 23, 2017 3:15 pm

Scilla wrote:Thanks for your reply, I really appreciate it. It made me more optimistic. I'll keep encouraging her and do my best to support her.


I'm glad that helped. I know this is all so difficult to wrap your mind around. I got very depressed after I found out I did not get a complete response until my Oncologist explained that a very good response is still a very positive prognostic indicator. Once I started believing I could be cured, I was sooooooo much happier. That's when I realized that belief is really a choice. I decided from then on to choose to believe I would be cured until a scan or test told me otherwise. It really helped me get through chemo, and it helped me to enjoy the time I know for sure that I have right now. I've created a lot of really great memories that I was able to really enjoy the last four years without that cloud of fear hanging over every moment. It's a bit of mental discipline to choose to believe, but you can do it. You can help your mom do this, too, and it will help her as well. Picture the doctor telling you both that the tumors shrank all the way and hang on to that image when doubts and fears try to creep in. This isn't just wishful thinking when it's a real possibility. The fear of worst case scenarios can be paralyzing.

By the way, I had a lymph node light up on my PET scan near my spine that was out of the surgical area. I had to get through treatment hoping the radiation and chemo alone would wipe out any cancer cells there. I had read on here that surgery was the only guaranteed curative approach. It was a continuous mental battle to bat away creeping fears. But the treatment seems to have worked. So far so good.
47yo single mom of 4 (24, 21, 18, 16) at Dx
6/13 - RC T4b IIIc 5LNs on PET CEA 5.4
8/13 - Finish chemorad
10/13 - APR/hyst+ovaries/perm colostomy 2/12 nodes+
6/14 - Finish Xelox 6 rds
1/15 - CT clear CEA 0.2
10/15 - CT/MRI clear CEA 0.7
4/16 - CT clear
10/16 - CT/MRI clear CEA 0.6
5/17 - PET clear? Follow up MRI to verify inflammation


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