The Colon Club

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

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

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

Lee

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

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

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.

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

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