ASCO study on shorter chemo for stage3's

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juliej
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Joined: Thu Aug 05, 2010 12:59 pm

ASCO study on shorter chemo for stage3's

Postby juliej » Wed Aug 16, 2017 4:26 pm

A study of more than 12,800 patients with stage III colon cancer in 12 countries found that some people with colon cancer only need half of the 6-month standard course of chemo after surgery. Below is the news release.

It's interesting that CAPOX showed slightly better results at stopping recurrence since there are still oncs out there who are dubious about Xeloda! :roll:

For some with colon cancer, shorter chemotherapy is nearly as effective and has fewer side effects

A large international study has found that some people with colon cancer may only need to have half of the 6-month standard course of chemotherapy after surgery. The study found that there was only a 1% overall difference between people who had a cancer recurrence after 6 months and 3 months of chemotherapy. A recurrence means the cancer returned after the initial treatment period.

Chemotherapy lowers the chance of recurrence after colon cancer surgery, and this kind of treatment is called adjuvant chemotherapy. Since 2004, standard adjuvant chemotherapy has required 6 months of a combination of chemotherapies. There were 2 adjuvant chemotherapy combinations included in this analysis, called FOLFOX and CAPOX.

This study included data from more than 12,800 patients with stage III colon cancer in 6 different phase III clinical trials in 12 countries. Participants’ health was tracked for a median time of 39 months after treatment. The median is the midpoint, so half were followed for less than 39 months and the other half were followed for more than 39 months. For all patients combined, the rate of disease-free survival at 3 years was very similar for both 3 months and 6 months of chemotherapy (74.6% vs. 75.5%). Disease-free survival is the amount of time after treatment during which no sign of cancer is found.

For each chemotherapy combination, there were small differences in the 3-year disease-free survival rates for the 3-month and 6-month treatment periods. With the FOLFOX combination, the 3-month treatment was very close to the 6-month treatment at stopping recurrence (73.6% vs. 76.0%). If patients received CAPOX, the 3-month and 6-month treatments were nearly the same at stopping recurrence (75.9% vs. 74.8%).

People with lower risk colon cancer had almost the same rates of recurrence if they took 3 or 6 months of chemotherapy (83.1% vs 83.3%, respectively). Lower risk colon cancer was defined as cancer that had spread to 1 to 3 lymph nodes and not completely through the bowel wall.

The shorter course also resulted in fewer side effects. Both FOLFOX and CAPOX include oxaliplatin (Eloxatin). Oxaliplatin can cause nerve damage, which leads to permanent numbness, tingling, and pain. The longer someone receives oxaliplatin, the higher the risk of long-term nerve damage. Specifically, this study found that the shorter course of chemotherapy had substantially lower rates of severe nerve damage for both FOLFOX (15% vs. 45%) and CAPOX (17% vs. 48%).

What does this mean? For some people after colon cancer surgery, a 3-month course of combination chemotherapy could reduce the risk of recurrence and the chances of long-term side effects. This approach may offer a better quality of life.

Our findings could apply to about 400,000 colon cancer patients worldwide every year. For 60% of these patients, who have lower risk for cancer recurrence, 3 months of chemotherapy will likely become the new standard of care. Patients with higher risk colon cancer, however, should discuss these results with their doctor to see if a shorter course of therapy would be right for them.”

— senior study author Axel Grothey, MD
Mayo Clinic Cancer Center
Rochester, Minnesota
Stage IVb, liver/lung mets 8/4/2010
Xelox+Avastin 8/18/10 to 10/21/2011
LAR, liver resec, HAI pump 11/2011
Adjuvant Irinotecan + FUDR
Double lung surgery + ileo reversal 2/2012
Adjuvant FUDR + Xeloda
VATS rt. lung 12/2012 - benign granuloma!
VATS left lung 11/2013
NED 11/22/13 to 12/18/2019, CEA<1

benben
Posts: 324
Joined: Fri Apr 28, 2017 3:18 pm
Location: Washington State

Re: ASCO study on shorter chemo for stage3's

Postby benben » Wed Aug 16, 2017 9:10 pm

Yes there was another thread about this already.

The study is quite extensive, however it is still just one study and will need a followup before it becomes standard of care. (At least this is what my Oncologist told me when I brought this up).
That said at my 6th treatment he said he would give me my blessing and put me on an extensive watch mode. He recommended I try to go at least 8 sessions as this was pretty widely accepted as the minimal number of treatments to be nearly fully effective.

Definitely the decreased number of treatments will help with neuropathy not being a long term or life long issue.
So that is an upside. But there is still a 2% increase of chance of reocurrence than the 12 treatments. Might be worth the increased risk if it means no 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
zarxio all treats
Treat 7 - 75% OXI
Treats 8-12 - NO OXI, Luke & 5FU
10/20/17 CT- NED
3/18 Scope - Clean
11/8 PORT OUT!
7/22 CT - NED (5 years!)

Basil
Posts: 275
Joined: Thu Mar 16, 2017 12:33 pm

Re: ASCO study on shorter chemo for stage3's

Postby Basil » Wed Aug 16, 2017 9:59 pm

I had stage iii and opted for six rounds of FOLFOX instead of chemorad. The plan was surgery and then six more rounds adjuvant chemo after surgery. However, I had a pathological complete response to the first six rounds of FOLFOX. My surgeon, who is very good (colorectal chief at MDAnderson), cancelled the post-surgery chemo citing the referenced study. Note - the complete response (and other factors) deemed me low risk for recurrence; I would have continued with adjuvant chemo if I'd had a lesser response.
40 y/o male (now 46), kids 11 & 14.
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 ileo
pathological complete response
Adjuvant chemo cancelled (IDEA Study)
Ileo reversed 9/25/17
NED
1 year scans - clear
2 year scans - clear
3 year scans - clear
4 year scans - clear
5 year scans - clear (considered cured)

mariane
Posts: 704
Joined: Sun Sep 13, 2015 6:16 pm

Re: ASCO study on shorter chemo for stage3's

Postby mariane » Wed Aug 16, 2017 10:33 pm

Thank you JulieJ!

Another interesting research. Even for me it provides some info.

I avoided chemoradiation because my surgeon decided, he could remove my tumor before starting chemo. My first oncologist thought that reducing tumor burden would buy me some time. Nobody believed that curative surgery is possible for me before I met Dr. K.
I received only 6 oxali treatments and avoided neuropathy. By chance I maybe went the optimal path for me...
mom of now 14 years old twins, dx @ 40 in 6/2015 with upper rectal cancer, 10+ liver mets, CEA 140
chemo: 8/2015 - 10/2016 - 4xFOLFIRINOX, 2xFOLFOX, 8xFOLFIRI, 10x5FU, HAI pump -12xFUDR
4 surgeries, complete pathological response
CEA<2 since 10/2015
NED since May 2016

I praise God for every day with my family!

Beckster
Posts: 438
Joined: Thu Jan 12, 2017 3:01 pm
Location: New Jersey

Re: ASCO study on shorter chemo for stage3's

Postby Beckster » Thu Aug 17, 2017 4:53 am

Basil wrote:I had stage iii and opted for six rounds of FOLFOX instead of chemorad. The plan was surgery and then six more rounds adjuvant chemo after surgery. However, I had a pathological complete response to the first six rounds of FOLFOX. My surgeon, who is very good (colorectal chief at MDAnderson), cancelled the post-surgery chemo citing the referenced study. Note - the complete response (and other factors) deemed me low risk for recurrence; I would have continued with adjuvant chemo if I'd had a lesser response.




Basil,

Just curious....which MD Anderson facility do you go to? I had the colorectal chef at the MD Anderson in NJ.
57/F
DX:(CC) 10/19/16
11/4/16- Lap right hemi(cecum)
CEA- Pre Op (1.9), Pre Chemo (2.5)
Type: Adenocarcinoma
Tumor size:3.5 cm x 2.5 x 0.7 cm
Grade: G3
TNM: T3N0M0/IIA
LN: 0/24
LVI present
Surgical margins: clear
MSS
12/27/2016 - Capeox, anaphylactic
1/2/17 to 6/9/17- Xeloda
6/17,12/17,6/18,12/18,6/19,12/19,12/20,12/21 CT Scan NED :D
CEA- 6/17- 3.6, 9/17- 2.8 12/17-2.8, 3/18-3.1, 6/18-3.0, 9/18 2.8, 12/18 2.5 3/19 3.1 6/19 3.1 9/19 2.6 12/19 2.8 6/20 3.0 12/20 2.7 6/21 2.9,[color=#000000]12/21 2.7[/color]
Clear Colonoscopy 10/17, 11/19,11/21 :D

love3
Posts: 12
Joined: Tue Aug 01, 2017 1:06 pm

Re: ASCO study on shorter chemo for stage3's

Postby love3 » Thu Aug 17, 2017 8:10 am

My oncologist put me on this new treatment plan of 4 rounds of Capox (xelox). I started yesterday.
51 female
4/2017 - Routine Colonoscopy-No symptoms
CEA before polyp removal 1.7, CT scans clear
5/2017 - Another Colonoscopy to remove a flat lesion type polyp that could not be removed during original colonoscopy
6/2017 - Colon Resection due to abnormal cells found on polyp. 3/32 lymph nodes positive for cancer
New Diagnosis - IIIa (or possibly b)
11/2017 -Chemo complete-4 rounds of xelox. Full oxi each round, last 2 rounds of xeloda reduced
11/2017-Port Removed
12/2017-CT Scan clear, CEA 1.8 NED

Kobe
Posts: 27
Joined: Wed Mar 01, 2017 10:29 am

Re: ASCO study on shorter chemo for stage3's

Postby Kobe » Thu Aug 17, 2017 8:38 am

Just Capox - no Oxi? I just finished 8 round of 5-FU and I think I'm done. I'm curious what your oncologist told you about this choice of treatment.

Beckster
Posts: 438
Joined: Thu Jan 12, 2017 3:01 pm
Location: New Jersey

Re: ASCO study on shorter chemo for stage3's

Postby Beckster » Thu Aug 17, 2017 9:17 am

Kobe wrote:Just Capox - no Oxi? I just finished 8 round of 5-FU and I think I'm done. I'm curious what your oncologist told you about this choice of treatment.


Capox is Xeloda with Oxi for 8 cycles or now, due to new protocol, 4 cycles
57/F
DX:(CC) 10/19/16
11/4/16- Lap right hemi(cecum)
CEA- Pre Op (1.9), Pre Chemo (2.5)
Type: Adenocarcinoma
Tumor size:3.5 cm x 2.5 x 0.7 cm
Grade: G3
TNM: T3N0M0/IIA
LN: 0/24
LVI present
Surgical margins: clear
MSS
12/27/2016 - Capeox, anaphylactic
1/2/17 to 6/9/17- Xeloda
6/17,12/17,6/18,12/18,6/19,12/19,12/20,12/21 CT Scan NED :D
CEA- 6/17- 3.6, 9/17- 2.8 12/17-2.8, 3/18-3.1, 6/18-3.0, 9/18 2.8, 12/18 2.5 3/19 3.1 6/19 3.1 9/19 2.6 12/19 2.8 6/20 3.0 12/20 2.7 6/21 2.9,[color=#000000]12/21 2.7[/color]
Clear Colonoscopy 10/17, 11/19,11/21 :D

love3
Posts: 12
Joined: Tue Aug 01, 2017 1:06 pm

Re: ASCO study on shorter chemo for stage3's

Postby love3 » Thu Aug 17, 2017 2:01 pm

Capox and Xelox are the same treatment. I always called it Xelox but oncologist calls it Capox. Anyway, Yes, I did the Oxi yesterday and also started the Xeloda yesterday (14 days of pills and then 3rd week of nothing before starting over again). One Oxi done, 3 to go! woohoo! not too bad so far. Some neuropathy in my hands which is extremely annoying. Hoping it doesn't hang on too long. Also first bite syndrome....so weird. They had originally told me I could drive myself to and from treatments. I felt a little off after completing the Oxi so glad my daughter was with me to drive home.
My oncologist talked about the new study and determined that the nature of my cancer warranted just the 4 cycles. Of course he explained that if I felt more comfortable going with more I could absolutely do that. BUT he came flat out and said if it was him he would do only the 4. That choice was then a no brainer to me.
I really think 4 is manageable. Both physically and mentally.
I did decide on the port even with only 4 cycles. I just didn't want the stress of using the vein. Port was very easy. Hurts like heck for about a week after installation but all good after that.
51 female
4/2017 - Routine Colonoscopy-No symptoms
CEA before polyp removal 1.7, CT scans clear
5/2017 - Another Colonoscopy to remove a flat lesion type polyp that could not be removed during original colonoscopy
6/2017 - Colon Resection due to abnormal cells found on polyp. 3/32 lymph nodes positive for cancer
New Diagnosis - IIIa (or possibly b)
11/2017 -Chemo complete-4 rounds of xelox. Full oxi each round, last 2 rounds of xeloda reduced
11/2017-Port Removed
12/2017-CT Scan clear, CEA 1.8 NED

Basil
Posts: 275
Joined: Thu Mar 16, 2017 12:33 pm

Re: ASCO study on shorter chemo for stage3's

Postby Basil » Thu Aug 17, 2017 2:40 pm

I'm at MDA in Houston.
40 y/o male (now 46), kids 11 & 14.
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 ileo
pathological complete response
Adjuvant chemo cancelled (IDEA Study)
Ileo reversed 9/25/17
NED
1 year scans - clear
2 year scans - clear
3 year scans - clear
4 year scans - clear
5 year scans - clear (considered cured)

Prop321
Posts: 4
Joined: Thu Aug 03, 2017 9:44 am
Facebook Username: N.a

Re: ASCO study on shorter chemo for stage3's

Postby Prop321 » Thu Aug 17, 2017 11:02 pm

Hi, my wife was diagnosed with rectal cancer in March. From the MRI, it was stage 3 with suspected T3/T4 and N1/ N2, M0.
She has completed the standard neoadjuvant xeloda/radiotherapry and had APR surgery.
Pathology after surgery was ypT2 N0 Mx (which is considered yp stage 1).

My wife started Capox this week. The oncologist still advised to go for 6 months adjuvant chemo.
His reason is although post surgery pathology result was ok, the staging during diagnosis (stage 3 with T4/4, N1/2) was more important criteria for followup treatment.

Anyone has experience with high stage rectal cancer during diagnosis and subsequent 'downstage' after neoadjuvant+surgery, what was your oncologist advice?
Many thanks.

weisssoccermom
Posts: 5988
Joined: Thu May 10, 2007 2:32 pm
Location: Pacific NW

Re: ASCO study on shorter chemo for stage3's

Postby weisssoccermom » Fri Aug 18, 2017 12:49 am

Prop321...what your oncologist is saying is the correct answer. First of all, no one is ever 'downstaged'.....unless something was incorrect in the original diagnosis. The 'yp' on the pathology report is there to clarify that the pathology report is AFTER some sort of treatment....be it radiation, chemo, chemorad, etc. You WANT the neoadjuvant treatment to work....that IS the objective...so yes, it is normal to expect that the tumor will shrink or even go away and that after surgery, there may very well be no positive nodes...That is what YOU WANT to happen. However, just because the yp pathology report indicates a T2N0M0....it does NOT mean that the patient is somehow now a stage I. Think about this. Your wife's tumor shrunk....yep, that's a good thing. The neoadjuvant report (presumably based on the results of a rectal ultrasound)showed some local nodes affected.....it was the determination that cancer had gotten into the nodal system. Of course, your wife (and others like her) would be treated in the adjuvant setting as a stage III....why wouldn't they? Cancer is an insidious little beast....your wife may very well have some stray cancer cells floating around in her lymphatic system that are travelling around, waiting to set up a new home somewhere else. They already had pretty definitive proof that there were cancer cells in her lymphatic system....and considering that the lymphatic system runs throughout the entire body....WHY wouldn't you want to do 'mop up' chemo to make sure that the even ONE stray cell that may have escaped isn't obliterated?

I realize that it is tempting to say that your wife is now a stage I....but no, she isn't. What the surgical pathology report simply indicates is that the chemoradiation did a good job in shrinking the tumor and killing off the cancer local lymph nodes....nothing more. Follow the advice of the oncologist and don't second guess this. Stage III is curable....don't take chances with it. Your wife is a stage III and always will be considered to be a stage III....that doesn't change.
Dx 6/22/2006 IIA rectal cancer
6 wks rad/Xeloda -finished 9/06
1st attempt transanal excision 11/06
11/17/06 XELOX 1 cycle
5 months Xeloda only Dec '06 - April '07
10+ blood clots, 1 DVT 1/07
transanal excision 4/20/07 path-NO CANCER CELLS!
NED now and forever!
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User avatar
juliej
Posts: 3114
Joined: Thu Aug 05, 2010 12:59 pm

Re: ASCO study on shorter chemo for stage3's

Postby juliej » Fri Aug 18, 2017 4:28 pm

mariane wrote:Thank you JulieJ!

Another interesting research. Even for me it provides some info.

I avoided chemoradiation because my surgeon decided, he could remove my tumor before starting chemo. My first oncologist thought that reducing tumor burden would buy me some time. Nobody believed that curative surgery is possible for me before I met Dr. K.
I received only 6 oxali treatments and avoided neuropathy. By chance I maybe went the optimal path for me...

Mariane, I also didn't have radiation. But it was because my local cancer center said I was "inoperable" so there was no point in doing anything but "chemo for life." :roll:

When I switched to MSK (where, like you, they believed in a curative approach for me), they did the surgery immediately (along with implanting an HAI pump and resecting my liver), so I bypassed the radiation again. I believe I've had better post-surgery bowel function (bowel urgency, food tolerance, etc.) than most rectal cancer patients because of the lack of radiation. The surgeon said radiated tissue is often thin and brittle so it's functionality is compromised. My GI surgeon (Dr. Weiser at MSK) started a trial to evaluate whether or not there's a need for radiation in all rectal cancer patients.

Still hope to meet you at 53rd one day!!! :D

Hugs to you!
Julie
Stage IVb, liver/lung mets 8/4/2010
Xelox+Avastin 8/18/10 to 10/21/2011
LAR, liver resec, HAI pump 11/2011
Adjuvant Irinotecan + FUDR
Double lung surgery + ileo reversal 2/2012
Adjuvant FUDR + Xeloda
VATS rt. lung 12/2012 - benign granuloma!
VATS left lung 11/2013
NED 11/22/13 to 12/18/2019, CEA<1

mariane
Posts: 704
Joined: Sun Sep 13, 2015 6:16 pm

Re: ASCO study on shorter chemo for stage3's

Postby mariane » Tue Aug 22, 2017 9:10 pm

Mariane, I also didn't have radiation. But it was because my local cancer center said I was "inoperable" so there was no point in doing anything but "chemo for life." :roll:

When I switched to MSK (where, like you, they believed in a curative approach for me), they did the surgery immediately (along with implanting an HAI pump and resecting my liver), so I bypassed the radiation again. I believe I've had better post-surgery bowel function (bowel urgency, food tolerance, etc.) than most rectal cancer patients because of the lack of radiation. The surgeon said radiated tissue is often thin and brittle so it's functionality is compromised. My GI surgeon (Dr. Weiser at MSK) started a trial to evaluate whether or not there's a need for radiation in all rectal cancer patients.

Still hope to meet you at 53rd one day!!! :D

Hugs to you!
Julie

Julie,
I look forward to meeting you. I will be in NY on October 15 and 16 again. Maybe this fall?
I also live relatively normal life. I have some frequency from time to time. I have to watch what I eat sometimes. It is not even too bothersome. Interestingly I cannot take the whole dose of Curcumin - it increases my frequency. I do not tolerate too much Aspirin and antibiotics. Rice cakes can help me a lot so I keep them handy.
I was able to hike in Zion and Grand Canyon for the whole day. It was a great healing experience. I came back to my old life I considered lost forever. I feel really well. Mentally I have ups and downs. I live from scan to scan, from doctor's visit to doctor's visit. There are labs and even more labs. There are constant expenses. The stress is still overwhelming. I try to keep myself as busy as possible so I have no time to think. There is no complete return to old pre-cancer body and mind but I can tell that at times I am close. I keep living ...
Julie J, I will be forever grateful to you. You did so much for me in my darkest times.
Thank you again,
mom of now 14 years old twins, dx @ 40 in 6/2015 with upper rectal cancer, 10+ liver mets, CEA 140
chemo: 8/2015 - 10/2016 - 4xFOLFIRINOX, 2xFOLFOX, 8xFOLFIRI, 10x5FU, HAI pump -12xFUDR
4 surgeries, complete pathological response
CEA<2 since 10/2015
NED since May 2016

I praise God for every day with my family!


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