After Erbitux, what's next?

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musicluvr
Posts: 91
Joined: Fri Feb 21, 2014 8:07 pm
Location: Grand Rapids MI

After Erbitux, what's next?

Postby musicluvr » Wed Feb 07, 2018 6:37 pm

Just got CT results, lung mets are increasing In size. Been on Erbitux for roughly 2 years as single agent. Am I wrong in assuming this means the end of its effectiveness? What drug is normally given next? Trying not to freak out right now. TIA
58 yo female
Dx CRC 2/17/14
perm colostomy 3/14
12 rounds 5FU
Small bowel obstruction 8/14
Multiple nodules both lungs 6/15
FOLFIRI + ERBITUX started 8/11/15
Irinotecan reduced 40% , October
12/15 NED, holiday next 2 treatments, then 5FU only
Mets are back 3/16
Erbitux + Irinotecan only; dropping 5FU
CT Scan 6/16 shows mets still there
5/17 been on Erbitux only
chemo break for 3 months
5 mets now on CT Scan. Back to Erbitux
1/18 lung Mets all increased slightly
Adding Irinotecan back

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Shana
Posts: 401
Joined: Sun Jul 30, 2017 9:45 pm
Location: Sonoma, CA

Re: After Erbitux, what's next?

Postby Shana » Wed Feb 07, 2018 10:17 pm

Can you go back on Irinotecan? I've been on Irinotecan and Erbitux for about 7 months. I always worry about when it will stop working and what other options are out there. I had a bad reaction to Folfox twice so that's not an option.

I'm sure there must be other treatments available to you once you talk to your oncologist. Have you looked into clinical trials?

Good luck, will keep good thoughts and prayers for you!

All the best,

Shana
DX - 12/16
MSS - KRAS wild
Well-differentiated adenocarcinoma at splenic flexure
Stage IV CC with liver mets
5FU - Failed twice - 1/17 and 3/17
Irinotecan + Cetuximab: 8/17
Irinotecan and Erbitux ran it's course. CEA rising
Primary tumor invaded tail of pancreas and spleen. Liver mets major concern
Y-90 radioembolization on 9/17/18, liver enzyymes have dropped. 10 Radiation treatments to primary tumor completed too. CT scan Nov to assess overall situation...

Lee
Posts: 5678
Joined: Sun Apr 16, 2006 4:09 pm

Re: After Erbitux, what's next?

Postby Lee » Thu Feb 08, 2018 12:34 pm

Maybe Keytruda. It has been FDA approved for colon cancer in the past year.

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!

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juliej
Posts: 2859
Joined: Thu Aug 05, 2010 12:59 pm

Re: After Erbitux, what's next?

Postby juliej » Thu Feb 08, 2018 4:55 pm

Ask if your cancer center does molecular/genetic tumor testing. That will show your particular mutations and can help determine future treatments. I'm assuming you've already had your KRAS tested since you're on Erbitux. Other genetic tests you should have include: BRAF, MLH1, MSH2, APC, MSH6, PMS2, and MUTYH.

Additionally, testing for MSI or MRI status (MLH1, MSH2, MSH6, PMS2) lends information for the option to use pembrolizumab (Keytruda), a PD-1 inhibitor, and part of a new set of exciting immunotherapy drugs that are coming out right now. I'd also ask about Nivolumab (Opdivo), another immunotherapy drug, which is available for MSI-H or mismatch repair deficient (dMMR) patients. Again, the key is finding out your cancer genomics so you know which one is best for you.

I know it's hard not to freak out right now, but there are lots of new immunotherapy drugs coming out. Plus things like TIL immunotherapy at NCI, which our own Celine went through with great success. Hang in there! Stay strong and come up with a plan!

Juliej
Stage IV, liver/lung mets 8/4/2010
Xelox+Avastin 8/18/10 to 10/21/11
LAR, liver resec, HAI pump 11/11
Double lung surgery + ileo reversal 2/12
Adjuvant Xeloda 3-9/12
VATS rt. lung 12/21/12 - benign granuloma!
NED 3/17/12 to 7/13/2018, CEA<1

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GrouseMan
Posts: 754
Joined: Mon Aug 12, 2013 12:30 pm
Location: SE Michigan USA

Re: After Erbitux, what's next?

Postby GrouseMan » Fri Feb 09, 2018 3:16 pm

I have to second JulieJ's answer. Unfortunately everyone eventually runs into Erbitux no longer being effective. There 4 kinases in the Erbb family. Erbitux primarily acts against EGFr (Erbb1) unfortunately tumors after a while kick up production of Erbb3 and Erbb4 and these keep the signaling pathways going.... There are a few additional drugs that work against EGFr and sometimes other Erbbs and mutant EGFr, but they haven't been approved for CRC. These might be a possibility (dacomitinib one example) . Also its been found that sometimes if you lay off an EGFr inhibitor for a while - the tumor reverts back to its old EGFr pathway and Erbitux or similar treatment become effective again.

The genetic tests can be very important - though if at all possible I would try and have it done on a biopsied MET rather than the primary that was removed. Mets genetics are often very different than the primary. But these tests can often lead to very important insights to treatment. Also are you MSS or MSI as the later might make it possible that Keytruda could be a possibility. After Erbitux plus Irinotecan plus Avastin failed my wife - we tried a clinical trial of a sort of super avastin. Didn't help her though.

Good Luck on your continued journey.

GrouseMan
DW 53 dx Jun 2013
CT mets Liver Spleen lung. IVb CEA~110
Jul 2013 Sig Resct
8/13 FolFox,Avastin 12Tx mild sfx, Ongoing 5-FU Avastin every 3 wks.
CEA: good marker
7/7/14 CT Can't see the spleen Mets.
8/16/15 CEA Up, CT new abdominal mets. Iri, 5-FU, Avastin every 2 wks.
1/16 Iri, Erbitux and likely Avastin (Trial) CEA going >.
1/17 CEA up again dropped from Trial, Mets growth 4-6 mm in abdomen
5/2/17 Failed second trial, Hospitalized 15 days 5/11. Home Hospice 5/26, at peace 6/4/2017

musicluvr
Posts: 91
Joined: Fri Feb 21, 2014 8:07 pm
Location: Grand Rapids MI

Re: After Erbitux, what's next?

Postby musicluvr » Tue Feb 13, 2018 10:18 am

Adding Irinotecan back in. Says it should kick Erbitux back to effective? MSS Stable so he said not a candidate for immunotherapy. Mixed feelings right now. He also said Avastin is nasty stuff, and doesn't want to go there yet.
58 yo female
Dx CRC 2/17/14
perm colostomy 3/14
12 rounds 5FU
Small bowel obstruction 8/14
Multiple nodules both lungs 6/15
FOLFIRI + ERBITUX started 8/11/15
Irinotecan reduced 40% , October
12/15 NED, holiday next 2 treatments, then 5FU only
Mets are back 3/16
Erbitux + Irinotecan only; dropping 5FU
CT Scan 6/16 shows mets still there
5/17 been on Erbitux only
chemo break for 3 months
5 mets now on CT Scan. Back to Erbitux
1/18 lung Mets all increased slightly
Adding Irinotecan back

User avatar
GrouseMan
Posts: 754
Joined: Mon Aug 12, 2013 12:30 pm
Location: SE Michigan USA

Re: After Erbitux, what's next?

Postby GrouseMan » Tue Feb 13, 2018 1:25 pm

My wife was on Avastin for a very long time and the worse side effect she had from it was very slight BP elevation from it and some blood when she blew her nose in the morning. She thought the combination of Erbitux and Avastin where a piece of cake compared to the FOLFOX, and she didn't have all that much trouble with that. My wife's oncologist was a firm believer in the use of Avastin in CRC. Added it right away as soon as he could after her initial resection. I think its gotten a bad rap myself. Initially a lot of people on these forums that was getting it complained of terrible headaches etc and I think that was because the high BP it often induced and that wasn't treated until after the fact if at all. My wife's oncologist started her right away on a low dose of an ACE inhibitor. Her BP was low to begin with so when the avastin made it go up, it wasn't very much with the low does ACE inhibitor. She never had bleeding except briefly in the morning when she went to blow her nose, nor did she ever get the headaches. I haven't heard in quite some time anyone else complaining about avastin on these forums so those that are getting it now I think are being managed correctly on it.

Still good luck with the new treatment program your oncologist is putting you through. Being a former anticancer drug researcher that helped develop one of the first small molecule irreversible EGFr inhibitors I had never read anything about Irrinotecan reversing the resistance to Erbitux and I try and stay as up to date on EGFr inhibitors as I can. I'd be interested in any literature or clinical trial info on that subject.

Regards,

GrouseMan
DW 53 dx Jun 2013
CT mets Liver Spleen lung. IVb CEA~110
Jul 2013 Sig Resct
8/13 FolFox,Avastin 12Tx mild sfx, Ongoing 5-FU Avastin every 3 wks.
CEA: good marker
7/7/14 CT Can't see the spleen Mets.
8/16/15 CEA Up, CT new abdominal mets. Iri, 5-FU, Avastin every 2 wks.
1/16 Iri, Erbitux and likely Avastin (Trial) CEA going >.
1/17 CEA up again dropped from Trial, Mets growth 4-6 mm in abdomen
5/2/17 Failed second trial, Hospitalized 15 days 5/11. Home Hospice 5/26, at peace 6/4/2017

User avatar
Shana
Posts: 401
Joined: Sun Jul 30, 2017 9:45 pm
Location: Sonoma, CA

Re: After Erbitux, what's next?

Postby Shana » Tue Feb 13, 2018 1:36 pm

GrouseMan wrote:My wife was on Avastin for a very long time and the worse side effect she had from it was very slight BP elevation from it and some blood when she blew her nose in the morning. She thought the combination of Erbitux and Avastin where a piece of cake compared to the FOLFOX, and she didn't have all that much trouble with that. My wife's oncologist was a firm believer in the use of Avastin in CRC. Added it right away as soon as he could after her initial resection. I think its gotten a bad rap myself. Initially a lot of people on these forums that was getting it complained of terrible headaches etc and I think that was because the high BP it often induced and that wasn't treated until after the fact if at all. My wife's oncologist started her right away on a low dose of an ACE inhibitor. Her BP was low to begin with so when the avastin made it go up, it wasn't very much with the low does ACE inhibitor. She never had bleeding except briefly in the morning when she went to blow her nose, nor did she ever get the headaches. I haven't heard in quite some time anyone else complaining about avastin on these forums so those that are getting it now I think are being managed correctly on it.

Still good luck with the new treatment program your oncologist is putting you through. Being a former anticancer drug researcher that helped develop one of the first small molecule irreversible EGFr inhibitors I had never read anything about Irrinotecan reversing the resistance to Erbitux and I try and stay as up to date on EGFr inhibitors as I can. I'd be interested in any literature or clinical trial info on that subject.

Regards,

GrouseMan


Hello GrouseMan,

Thank your for sharing your wife's treatment history with us. I also had no idea of your professional connection to cancer research, thank you so much for your contributions!

I'm so very sorry that your wife is no longer with us, damn disease has a life of it's own. :( I know we all appreciate your continued presence on this forum, thank you again!

All the best,
Shana
DX - 12/16
MSS - KRAS wild
Well-differentiated adenocarcinoma at splenic flexure
Stage IV CC with liver mets
5FU - Failed twice - 1/17 and 3/17
Irinotecan + Cetuximab: 8/17
Irinotecan and Erbitux ran it's course. CEA rising
Primary tumor invaded tail of pancreas and spleen. Liver mets major concern
Y-90 radioembolization on 9/17/18, liver enzyymes have dropped. 10 Radiation treatments to primary tumor completed too. CT scan Nov to assess overall situation...


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