Avastin yes, Avastin NO!

[jep]

Hey everyone. So, my husband goes for his 4th treatment tomorrow (folfox). He's been tolerating the treatments pretty well, but my question is about Avastin. Hubby still has a fistula and surgical drain. His oncologist had him start with the Avastin for round 1, but then my husband's incision opened up and started leaking . . . oncologist met with surgeon and they agreed that they should hit PAUSE on the Avastin. So, my question is, how effective will the Folfox be without the Avastin? I'm assuming they won't try it again until the fistula heals (question we will ask tomorrow), but how will this fistula ever heal while undergoing 12 rounds of chemo? I'm just worried that maybe my man's not getting all the perks of the folfox/avastin regimen. He's stage 4, but the surgeon got all cancer out, and his post surgery scan was clear! I'm just praying that the folfox will be enough to knock out any cells that might be lingering around. Any thoughts or advice? I haven't posted in a while, but I have been reading a lot and learning so much from everyone. Thank you!
jep

[Achilles Torn]

Actually where I am BC Cancer Agency protocol for fully resected patients undergoing adjuvant chemotherapy (for Stage III or fully resected 4) is FOLFOX without Avastin (aka Bevacizumab). Avastin prevents the rapid forming of new blood vessels (angiogenesis) that are needed to grow a tumor.... so is thought to be more effective when there is some "bulky" or measurable mets still present....that being said many people have reported good success while NED and staying on Avastin as part of a maintenance therapy perhaps because it prevents even tiny cancer cells from taking hold and building a blood supply. There isn't much reliable information out there that I can find on this. I also question if one ever truly 'fails' avastin as presumably it may continue to slow tumor growth if there is progression and there is no way of knowing if it would have grown faster without Avastin present...

Sorry I went off topic...I think if you have all visible Cancer removed then FolFox is thought to be effective as adjuvant therapy...and you can always add Avastin once it is safe to do so.

Hope that helps
AT

[juliej]

Avastin is a good anti-angiogenic (tumor-starving) therapy, but it's just an add-on that's usually given to patients with inoperable tumors or to shrink tumors prior to surgery.

Avastin and fistulas don't go together so it would be much safer for him to have just the Folfox right now, which is doing the real work anyway. It's not impossible for the fistula to heal on chemo - is just takes a lot longer. Make sure he's eating enough protein (the body needs protein to heal) and keep an eye on the area to make sure it doesn't get infected.

In the long run, this is a bump in the road, although I know it feels like a road block right now! The important thing is that he's tolerating Folfox and staying on his treatment so it can kill any residual cancer cells left after the surgery.

Hugs to you!
Juliej

[jep]

Thank you AT and Juliej for your replies! My husband's situation is strange (in a good way!). He's technically a stage 4 because of spread to 1 rogue lymph node (as well as 7 local nodes), but as my oncologist friend put it, stage 4 with an asterisk . . . no spread elsewhere, so we're just taking it one day at a time with the treatments and slow recovery from open surgery (in May). I'm glad to hear your thoughts on Folfox! And yes, protein, protein, protein! Since my hubby is still on the GI diet, protein is his main staple. Treatment #4 tomorrow! Thank you to everyone on this forum for all of your knowledge and support. I can't believe it's been more than 4 months since diagnosis and surgery (the very next day). It's still so surreal . . . . I'll let you know what hubby's ONC says regarding the Avastin.
jep

[rp1954]

We've always used extra nutrients for GI wound healing after surgery or chemo, with quick recovery. Things like glutamine, glucosamine, vitamin C - oral and IV, zinc gluconate or carnosine, magnesium chelates, vitamin K2, niacinamide, the non minerals in amounts "well above RDA". Oral components were mixed in a milk whey protein shake for the hospital stay, and long after.

Cancer, surgery, wounds, chemo toxicity - all tend to reveal vitamin C depletion and to greatly deplete vitamin C, with problems of wound healing, sepsis and allergic reactions as clues. Kras mutant cells, are often associated with CA19-9 values above 22, anaerobic sugar metabolism, HIF-1a, and LDH in the 200s and higher. Ascorbate's metabolite(s), dehydroascorbate, inhibits cancer cells' glucose transport, HIF-1a and VEGF-A formation; as well as help initiate various forms of cancer cell death depending on various adjuncts and circumstances. We've never needed Avastin for a deadly set of markers.

Some people have successfully done IV vitamin C following Folfiri + Avastin on a long term basis, with at least one Folfox patient mentioning it on the boards. Some patients reach agreement with their drs to do supplements outside of a zone of about 12 - 48 hours around chemo administration. We apply supplements and mild generic drugs to oral chemo on a full time basis to make the 5FU work.