MSI-high and Folfox

[Stewsbetty]

Hello all, I am wondering about other MSI-high patients and Folfox. I did the 12 rounds of Folfox (stage 3) and the one lymph node that was showing up on the scans didn't respond. I will be having surgery to remove it in a couple of months. I am just curious how Folfox worked for others MSI-high. This article seems to indicate that it isn't the best treatment for MSI.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4901118/

So just killing time trying to gather more information that is applicable to my situation.

Beth

[Maia]

Stewsbetty, the best treatment for MSI is immunotherapy, an anti PD-1 checkpoint inhbitor. One, Keytruda, has been approved for MSI-high cancers, including CRC, this past May in USA. It is probably a matter of months until is approved in Canada, but you probably could obtein that off label, now, or in a clinical trial.

I think you followed BeanMamma's posts. She's MSI-high. If you remember, she had Folfirinox plus Avastin, and was deemed a non-resectable, chemo-for-life patient. She started immunotherapy, the CEA dropped and keeps dropping and she just posted she'll have resection soon.

[TXLiz]

This is an area of interest to me as well. I am MSI high too.

I received folfox and finished in March 2017, and am NED.

Because I have so many poor prognosticators- perineural and lymphvascular invasion, a very large tumor that obstructed, right sided disease- I am indeed nervous.

Both my local onc and my onc at MDA said folfox was first line treatment, because I questioned them both about the study cited in this thread. They both said we'd cross that bridge when we got there, but said immunotherapy was a treatment that may help me.

I am wondering if at some point they will use immunotherapy as a first line treatment on MSI high tumors but I don't think they have enough "evidence" yet.

I underwent testing for Lynch and was told it was inconclusive because my tumor and presentation was that of Lynch but the test came back negative. The geneticist said she's still recommended that me and my kids get all the advanced screenings because there is a lot the medical community does not know about Lynch and tests are not definitive.

If I have any change in status or any further info from my oncs I'll be sure to report back. Good luck my friend.

[Stewsbetty]

Thanks Maia and TxLiz.

If I do have a recurrence I do plan to fight for immunotherapy! The folfox did virtually nothing on the infected lymph node that was left (it is out of the normal operating range). But I think I would rather have it surgically removed now. I guess I like the idea of getting rid of cancer in a few short hours. . plus I have been waiting awhile to hear NED!

[Maia]

Thanks Maia and TxLiz.
If I do have a recurrence I do plan to fight for immunotherapy! The folfox did virtually nothing on the infected lymph node that was left (it is out of the normal operating range). But I think I would rather have it surgically removed now. I guess I like the idea of getting rid of cancer in a few short hours. . plus I have been waiting awhile to hear NED!

Of course! If resectable... resect! Just keep in mind that you'll have immunotherapy approved IF --IF, I remark that-- you need, someday, some systemic, IV, treatment. The same for you, TxLiz --for you, in USA, it is already approved. But I'm hopeful neither of you both will need further treatment!!