Maintenance Chemo or No ?

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Achilles Torn
Posts: 68
Joined: Fri Dec 16, 2016 2:41 pm

Re: Maintenance Chemo or No ?

Postby Achilles Torn » Fri Aug 04, 2017 12:52 pm

Thanks to everyone who responded. I value all the thoughtful advice. (Including as WS mentioned those that went before)

I am officially back on Chemo and sitting in the chair today. 5FU Folinic Acid and Bev. I plan on staying with the 2 week infusion cycle for another 3 months. Depending on how I handle it and if I scan well at 90 days I will consider requesting a move to metronomic / ADAPT pill based chemo. (If scans are bad it's FOLFIRI).

will continue to push my Onc for more blood monitoring in the meantime.

Thanks again.
AT
40 yo Male. BC Canada Sigmoid Colectomy Dec. 2016
Pathology T3N2bM1 19 of 24 Nodes Positive + tumour deposits
PET scan - Para-Aortic and Iliac Lymph node spread. Stage VI.
Moderately differentiated. MSS. KRAS/BRAF Wild.
Mutations: TP53, ERBB4, MLL3, PDCD1LG2, PRKDC, SMAD3
FOLFOX Commenced Jan 9/2017 - Avastin(Bev) added after round 1.
June 2017 Dose Reduction on Round 11 due to Neuropathy.

rp1954
Posts: 1161
Joined: Mon Jun 13, 2011 1:13 am

Re: Maintenance Chemo or No ?

Postby rp1954 » Wed Aug 09, 2017 7:40 am

I am mostly off line this past week, sole ISP problems where we live. Was angry, then wife exchanging views with lineman on the pole, wife heard from someone else there, who has been offline since 7/15 :shock:

I am hurrying here. I have no experience with the CA15-3 marker, but looking for a potential personnel marker, I might repeat that marker several times over a year if not more frequently, depending on the chemo havoc aspect and your venture interest. There is a paper that suggests that CA15-3 value if undistorted is of CRC interest if the labs' reference intervals are similar. One winds up tracking down examples and papers to see how fast which markers recover from chemo over the following 3 -12 months.

The CRC literature I've seen would call your CA19-9, LDH relatively favorable with respect to mets and are statistically consistent with Kras wild patients that don't benefit from cimetidine or perhaps IV vitamin C (that serum reading wouldn't be conclusive by itself though, tissue staining is the definitive method). Those CEA values suggest a PSK-chemo benefit might be possible.

I'm not sure your MCV values had enough initial treatment time to buildup and react to chemo, vs whether the chemo was active. Once a full chemo activity buildup occurs with MCV, the MCV reaction times to chemo appear much faster, especially in a chemo failure mode. We have had a lot of favorable experience with MCV and chemo activity, where/when the CA199 and LDH are in a danger zone.

The doctor shutting you down on D-dimer is thinking that d-dimer is 98%-99% selective for embolisms. "Quantitative d-dimer" was the latest type in 2010-11 and was most suited for its CRC information content. What he doesn't know about is that high values for some mCRC patients about to get in catastrophic trouble might be 50-50% which potentially terminal process is happening and needs to paid careful attention in any case. I found several D-dimer-CRC papers because of several surprise endings here. I hate surprises and wanted a good, less specific marker not dependent on CEA. Also very low D-dimer is some slight reassurance in the dimer's lowest range that the coast (NED) is really clear.

We've been adding celecoxib to her daily maintenance chemo tx for about 5 years to help club the CEA and CA19-9 values down and into stasis. She takes natural blood thinners and low dose aspirin with varied regularity, depending on pill fatigue.
watchful, active caregiver for stage IVb CC since early 2010. immuno"Chemo forever," for mCRC

crazylife
Posts: 220
Joined: Wed Dec 30, 2015 11:29 am

Re: Maintenance Chemo or No ?

Postby crazylife » Thu Aug 10, 2017 5:14 pm

DH has been off chemo since June 2016. That's 14 months. Scans are showing a few tiny spots in lungs but they are still keeping him off chemo for now.
Wife to DH, 41 years old, diagnosed 11/15
Stage 4, Mod diff, 13/24 LN, 1 liver met
Colon/liver resection at MSK, 11/15
8mm lung met (not confirmed) and enlarged lymph nodes 1/16
12 rounds of folfox (9 with Oxi) 6/16
NED - July 2016
NED - October 2016
3 lung mets - March 2017
7 lung mets, May 2017
RFA to largest met, June 2017


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