NEWS from ongoing ASCO 2017: shorter chemo for stage III OK

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Maia
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Joined: Fri Aug 24, 2012 8:00 am

NEWS from ongoing ASCO 2017: shorter chemo for stage III OK

Postby Maia » Sun Jun 04, 2017 5:34 pm

Stage III: 3 months of FOLFOX was nearly as effective as 6 months


Shorter Chemo Duration for Colon Cancer May Spare Patients Toxicity

News | June 04, 2017 | ASCO, Colorectal Cancer

CHICAGO—Patients may be able to simplify their course of chemotherapy after surgery for stage III lymph node–positive colon cancer, according to a new analysis of six clinical trials (abstract LBA1). The data, presented at the 2017 American Society of Clinical Oncology (ASCO) Annual Meeting, held June 2–6, suggest that some patients may only need half of the longstanding standard course of chemotherapy.

The researchers examined data on 12,834 patients and found that 3 months of chemotherapy was nearly as effective as 6 months in patients with relatively lower recurrence risk. The findings suggest that this new schedule results in fewer side effects, particularly nerve damage.

“The side effects were dramatically lower and so this will change the standard of care,” said senior study author Axel Grothey, MD, an oncologist at the Mayo Clinic Cancer Center in Rochester, Minnesota.

Since 2004, the standard adjuvant therapy after surgery has been a combination of chemotherapies (FOLFOX or XELOX) given over a period of 6 months. The goal of this study, which pooled data from 6 studies conducted in North America, Europe, and Asia, was to determine if 3 months of chemotherapy was as effective as 6 months.

The analysis showed that a 3-month course of chemotherapy was associated with a lower chance of being colon cancer free at 3 years compared with the standard 6-month course (74.6% vs 75.5%). In patients considered low risk for cancer recurrence (60% of patients in the study), the difference was even smaller (83.1% in patients receiving a 3-month course vs 83.3% in patients receiving a 6-month course).

“It is very good news. It will decrease long-term side effects that would affect quality of life,” said Grothey. He noted that patients with higher-risk colon cancer should discuss these results with their clinicians to tailor a course of therapy optimal for them, taking into account their preference, age, and ability to tolerate chemotherapy.

Nerve damage was substantially less common in patients receiving a 3-month course of chemotherapy compared with a 6-month course (15% vs 45% with FOLFOX and 17% vs 48% with XELOX). For all patients combined, the rate of disease-free survival at 3 years was slightly lower with 3 months of chemotherapy vs 6 months of chemotherapy (74.6% vs 75.5%). The type of chemotherapy regimen selected affected the difference in 3-year disease-free survival between the 3-month and 6-month treatment durations (75.9% vs 74.8% with XELOX and 73.6% vs 76.0% with FOLFOX). Patients were followed for a median time of 39 months.


http://www.cancernetwork.com/asco/short ... s-toxicity

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chrissyrice
Posts: 1150
Joined: Thu Sep 23, 2010 8:44 am
Location: Atlanta, Georgia

Re: NEWS from ongoing ASCO 2017: shorter chemo for stage III OK

Postby chrissyrice » Sun Jun 04, 2017 6:54 pm

This is good news... when I was first treated back in 2010 my oncologist said that he believed base on the studies back then that patients like me Stage 3b at the time would only be doing 8 rounds of Folfox instead of the 12 rounds in the near future.

So 7 years later the data is providing better information and going with 6 rounds of Folfox...

HOWEVER!!! Back in 2010 I was never tested for genome makeup of my tumor or chemoresistance, MSS vs MSH... things have come a long way in 7 years. Especially me and the knowledge about cancer that is so easily available on sites like this and now even FB.

I can see where I would not choose to do less rounds unless I knew my genetic prognosis that is available today. Seeking out the best NCI center is as essential as the chances for better survival too.

Chrissy
Dx 10-31-09 Surgery 12-1-09 Sigmoid Colon Stage IIIb; Chemo Feb 2010-Aug 2010; 4 rounds Folfox; 8 rounds 5FU & Leucovorin;12-16-2010 PET/CT Scan Cancer Free;7-05-2012 CT Scan NED 2 years;10-13-2013 NED 3 yrs; 08-01-2014 NED 4 yrs; 06-30-2015 Stage 4 iliac lymph node(s) 08-11-2015 Surgery 3 cm tumor and iliac artery graft done. Positive margins in the abdominal aorta, No chemo. 03-16-2016 CT Scan Stable,06-16-2016 CT Scan Stable,09-21-2016 CT Scan Stable,12-2016 Stable,03-31-17 Stable,
Recurrence 6-30-17

Lee
Posts: 4974
Joined: Sun Apr 16, 2006 4:09 pm

Re: NEWS from ongoing ASCO 2017: shorter chemo for stage III OK

Postby Lee » Sun Jun 04, 2017 6:58 pm

Maia,

This is AWESOME news. I took the full 12 cycles. I was fortunate, while I do have some issues, I am aware others suffer far more. Yes reducing the cycles I believe is a step in the right direction.

Thank you,

Lee
rectal cancer - April 2004
46 yrs old at diagnoses
stage III C - 6/13 lymph positive
radiation - 6 weeks
surgery - August 2004/hernia repair 2014
permanent colostomy
chemo - FOLFOX
NED - 10 years and counting!

benben
Posts: 119
Joined: Fri Apr 28, 2017 3:18 pm
Location: Washington State

Re: NEWS from ongoing ASCO 2017: shorter chemo for stage III OK

Postby benben » Sun Jun 04, 2017 9:47 pm

I'll be talking with my ONC about this Tuesday when I go in for treatment #2.
First one was pretty smooth, only had mild first bite syndrome for about 24 hours, tired day after disconnect - otherwise good to go.
When first discussing with my ONC he suggested I go at least 8 session as that seemed to be the magic number and each session beyond that would decrease chance of recurrence by about 1% each session.
Interesting this study suggests 6 sessions is only 1% more likely to have recurrence than 12 sessions. Definitely something to think about when considering life long Neuropathy.
----------------------
3/29/17 diagnosed CRC - 44 y/o Male
4/17/17 ULAR - Straight anastomosis - no ostomy.
Path: low grade T3n1m0 - moderate diff.
KRAS - NO, MLH1/PMS2/MSH6/MSH2 - Normal.
5/3 med port install
5/22 folfox - first treatment.
3rd treat, delayed - low ANC - reduced to 90% OXI
Granix given, Now Zarxio treatments every session.
Current - 6 treatments done, LOW WBC/ANC/Platelets.
Attempting to reach at least 8 sessions. Treat 7 most likely delayed

TXLiz
Posts: 179
Joined: Thu Sep 22, 2016 3:31 pm

Re: NEWS from ongoing ASCO 2017: shorter chemo for stage III OK

Postby TXLiz » Sun Jun 04, 2017 9:58 pm

I am of 2 minds about this.

3 months sounds great! Easy!

However, I picture microscopic cancer cells slinking about my body and want them dead. I want their families dead. I want their pets dead.
Vomiting and blockage 9/19/16 46 y F
R hemi colectomy 9/20/16
Stage 3 B CRC, located in cecum
3 out of 16 lymph nodes positive
perineural invasion/lymphovascular invasion
infiltrating, mod differentiated adenocarcinoma with a mucinous component
separate tumor nodules present in pericolonic adipose tissue
Baseline PET scan clear 9/16 CEA 0.5
FOLFOX 10/16- 3/17
April 16th, CT scan clear. CEA 1.1
Lynch "inconclusive"

Lee
Posts: 4974
Joined: Sun Apr 16, 2006 4:09 pm

Re: NEWS from ongoing ASCO 2017: shorter chemo for stage III OK

Postby Lee » Sun Jun 04, 2017 11:05 pm

TXLiz wrote:I am of 2 minds about this.

3 months sounds great! Easy!

However, I picture microscopic cancer cells slinking about my body and want them dead. I want their families dead. I want their pets dead.


I can not argue with this..., I want their pets dead. Makes sense to me . . .

Lee
rectal cancer - April 2004
46 yrs old at diagnoses
stage III C - 6/13 lymph positive
radiation - 6 weeks
surgery - August 2004/hernia repair 2014
permanent colostomy
chemo - FOLFOX
NED - 10 years and counting!

Basil
Posts: 108
Joined: Thu Mar 16, 2017 12:33 pm

Re: NEWS from ongoing ASCO 2017: shorter chemo for stage III OK

Postby Basil » Mon Jun 05, 2017 12:28 pm

I sent this study to my onc this morning to discuss next week. Hopefully, he will be aware of it without my having to bring it to his attention. I'm on round five and it's getting worse each time, including neuropathy. I can hack it for another round but another seven? Uhhhhh . . .
40 y/o male, kids 6&9
Dx 3/16/17, rectal cancer S3,t3,n1,m0
PROSPCT trial (FOLFOX in lieu of chemorad)
FOLFOX 4/5/17 - 6/26/17
LAR 7/31/17, temp ostomy
pathological complete response
NED
adjuvant chemo cancelled
reversal scheduled 9/25/17
(praying I don't have to add on from here)

TXLiz
Posts: 179
Joined: Thu Sep 22, 2016 3:31 pm

Re: NEWS from ongoing ASCO 2017: shorter chemo for stage III OK

Postby TXLiz » Mon Jun 05, 2017 6:24 pm

Lee wrote:
TXLiz wrote:I am of 2 minds about this.

3 months sounds great! Easy!

However, I picture microscopic cancer cells slinking about my body and want them dead. I want their families dead. I want their pets dead.


I can not argue with this..., I want their pets dead. Makes sense to me . . .

Lee


Haha it's from Cheers. Since this place is our Cheers, I had to use it.
Vomiting and blockage 9/19/16 46 y F
R hemi colectomy 9/20/16
Stage 3 B CRC, located in cecum
3 out of 16 lymph nodes positive
perineural invasion/lymphovascular invasion
infiltrating, mod differentiated adenocarcinoma with a mucinous component
separate tumor nodules present in pericolonic adipose tissue
Baseline PET scan clear 9/16 CEA 0.5
FOLFOX 10/16- 3/17
April 16th, CT scan clear. CEA 1.1
Lynch "inconclusive"

Beckster
Posts: 107
Joined: Thu Jan 12, 2017 3:01 pm
Location: New Jersey

Re: NEWS from ongoing ASCO 2017: shorter chemo for stage III OK

Postby Beckster » Mon Jun 05, 2017 6:33 pm

This is awesome...I wonder if this will be used for Stage 2 colon cancer patients. Usually they follow Stage 3 protocol for Stage 2 that would benefit from chemo.
57/Female
DX:(CC) 10/19/16
11/4/16- Lap right hemi(cecum)
Tumor type: Adenocarcinoma
Tumor size: 3.5 cm x 2.5 x 0.7 cm
Tumor grade: G3 (surgical) G2 (biopsy from colonoscopy)
TNM: T3N0M0/IIA
Positive lymph nodes: 0 out of 24
Preoperative CEA- 1.9, Pre Chemo 2.5
Lymphovascular invasion
Surgical margins: clear
Lynch- Negative
12/27/2016 - Capeox, anaphylactic reaction to oxaliplatin on first infusion-discontinued
1/2/17 to 6/9/17- Xeloda monotherapy
6/26/17- CT scan and bloodwork (cea 3.6) NED :)

Lee
Posts: 4974
Joined: Sun Apr 16, 2006 4:09 pm

Re: NEWS from ongoing ASCO 2017: shorter chemo for stage III OK

Postby Lee » Mon Jun 05, 2017 8:46 pm

TXLiz wrote:
Haha it's from Cheers. Since this place is our Cheers, I had to use it.


Perfect. Loved that show.

Lee
rectal cancer - April 2004
46 yrs old at diagnoses
stage III C - 6/13 lymph positive
radiation - 6 weeks
surgery - August 2004/hernia repair 2014
permanent colostomy
chemo - FOLFOX
NED - 10 years and counting!

Tdubz
Posts: 74
Joined: Sun May 07, 2017 11:01 am

Re: NEWS from ongoing ASCO 2017: shorter chemo for stage III OK

Postby Tdubz » Mon Jun 05, 2017 9:32 pm

This is very interesting. It sure would be awesome to say I'm half way done instead of a quarter done. Is a lifetime of neuropathy worth a 1% difference? Especially for those of us on the younger side? Tough call. I get my genetic test back in 4 weeks. Maybe that would be a good time to discuss this further with my onc.

Edit to add:

At the bottom of the article, it says for folfox users, the difference was slightly larger, 73.6 vs 76.0%. That a 2.4% difference instead of the one percent mentioned at the top of the article. (If I'm understanding the article correctly)

I saw an elderly man today while getting my infusion who couldn't walk because of the neuropathy in his feet. Is that the life I see for myself at 37? No. But at the same time I want to be alive for as long as this old man was.

benben
Posts: 119
Joined: Fri Apr 28, 2017 3:18 pm
Location: Washington State

Re: NEWS from ongoing ASCO 2017: shorter chemo for stage III OK

Postby benben » Mon Jun 05, 2017 9:51 pm

Tdubz wrote:This is very interesting. It sure would be awesome to say I'm half way done instead of a quarter done. Is a lifetime of neuropathy worth a 1% difference? Especially for those of us on the younger side? Tough call. I get my genetic test back in 4 weeks. Maybe that would be a good time to discuss this further with my onc.

Edit to add:

At the bottom of the article, it says for folfox users, the difference was slightly larger, 73.6 vs 76.0%. That a 2.4% difference instead of the one percent mentioned at the top of the article. (If I'm understanding the article correctly)

I saw an elderly man today while getting my infusion who couldn't walk because of the neuropathy in his feet. Is that the life I see for myself at 37? No. But at the same time I want to be alive for as long as this old man was.



You are correct on the Folfox, stated at the bottom.
I'll go with the mindset of continuing on unless I start getting long lasting neuropathic side effects, but still will discuss with the Onc tomorrow.
Unfortunately it's a substitute ONC as mine is out, maybe he went to Chicago - but I'll talk with the fill in about it as well.
----------------------
3/29/17 diagnosed CRC - 44 y/o Male
4/17/17 ULAR - Straight anastomosis - no ostomy.
Path: low grade T3n1m0 - moderate diff.
KRAS - NO, MLH1/PMS2/MSH6/MSH2 - Normal.
5/3 med port install
5/22 folfox - first treatment.
3rd treat, delayed - low ANC - reduced to 90% OXI
Granix given, Now Zarxio treatments every session.
Current - 6 treatments done, LOW WBC/ANC/Platelets.
Attempting to reach at least 8 sessions. Treat 7 most likely delayed

Lee
Posts: 4974
Joined: Sun Apr 16, 2006 4:09 pm

Re: NEWS from ongoing ASCO 2017: shorter chemo for stage III OK

Postby Lee » Tue Jun 06, 2017 9:37 pm

Tdubz wrote:I saw an elderly man today while getting my infusion who couldn't walk because of the neuropathy in his feet. Is that the life I see for myself at 37? No. But at the same time I want to be alive for as long as this old man was.


I took the full 12 cycles at age 47. I have a few issues with neuropathy, mainly I have no problems as long as my feet are warm. Thus my days of going barefoot around house are pretty much over. Butt I do go barefoot in the ocean and sandy beaches. Love the feel of the sand between my toes.

Something I believe that has helped me, is power walking. Being doing it for 12ish years now. I truly believe is has kept a lot of potential problems/issues at bay. Not to mention, it suppose to help prevent a recurrence, and you feel good after ward. I walk 3-5 times weekly for about an hr.

Something to consider.

Lee
rectal cancer - April 2004
46 yrs old at diagnoses
stage III C - 6/13 lymph positive
radiation - 6 weeks
surgery - August 2004/hernia repair 2014
permanent colostomy
chemo - FOLFOX
NED - 10 years and counting!

benben
Posts: 119
Joined: Fri Apr 28, 2017 3:18 pm
Location: Washington State

Re: NEWS from ongoing ASCO 2017: shorter chemo for stage III OK

Postby benben » Tue Jun 06, 2017 9:57 pm

I talked with my assistant ONC today. She is actually my ONC's assistant. He wasn't out of office.
I asked and she said "oh no, he's here - just in the other room with another patient. We trade off sometimes."
I was a bit peaved as I was discussing low blood count with his assistant rather than him. I also brought up this study.
She smiled and said that she had indeed heard of it and had just met with one of the authors of the study yesterday.
Supposedly she said the studies are good mostly for stage II and Stage III with no lymph involvement. She said
they would still push aggressively for 12 treatments with stage IIIb and C.
----------------------
3/29/17 diagnosed CRC - 44 y/o Male
4/17/17 ULAR - Straight anastomosis - no ostomy.
Path: low grade T3n1m0 - moderate diff.
KRAS - NO, MLH1/PMS2/MSH6/MSH2 - Normal.
5/3 med port install
5/22 folfox - first treatment.
3rd treat, delayed - low ANC - reduced to 90% OXI
Granix given, Now Zarxio treatments every session.
Current - 6 treatments done, LOW WBC/ANC/Platelets.
Attempting to reach at least 8 sessions. Treat 7 most likely delayed

TXLiz
Posts: 179
Joined: Thu Sep 22, 2016 3:31 pm

Re: NEWS from ongoing ASCO 2017: shorter chemo for stage III OK

Postby TXLiz » Tue Jun 06, 2017 10:12 pm

benben wrote:I talked with my assistant ONC today. She is actually my ONC's assistant. He wasn't out of office.
I asked and she said "oh no, he's here - just in the other room with another patient. We trade off sometimes."
I was a bit peaved as I was discussing low blood count with his assistant rather than him. I also brought up this study.
She smiled and said that she had indeed heard of it and had just met with one of the authors of the study yesterday.
Supposedly she said the studies are good mostly for stage II and Stage III with no lymph involvement. She said
they would still push aggressively for 12 treatments with stage IIIb and C.


Interesting.

My neuropathy has lingered in my fingers quite a bit; sometimes I get "shocks" in my legs that my onc says is from chemo.

Since I finished 12 full courses of chemo with no reduction in oxy, the neuropathy has slowly been fading. I do notice it more when I am in a very cold room.
Vomiting and blockage 9/19/16 46 y F
R hemi colectomy 9/20/16
Stage 3 B CRC, located in cecum
3 out of 16 lymph nodes positive
perineural invasion/lymphovascular invasion
infiltrating, mod differentiated adenocarcinoma with a mucinous component
separate tumor nodules present in pericolonic adipose tissue
Baseline PET scan clear 9/16 CEA 0.5
FOLFOX 10/16- 3/17
April 16th, CT scan clear. CEA 1.1
Lynch "inconclusive"


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