Vectibix - Distant LN spread

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clj12288
Posts: 7
Joined: Tue Dec 12, 2017 11:09 am

Vectibix - Distant LN spread

Postby clj12288 » Sat Sep 22, 2018 4:47 pm

Hi Everyone,

I have been a member for a while, read here and there, but never posted. I've done a little searching on the topic but thought it may be useful to start a new thread on this. As you can see from my signature, I have been through a lot of tx since being diagnosed in July of 14. I have only distant lymph node spread currently (in supraclavicular node, and a few para-aortic and common illiac node). Activity isn't really high (<5 for the para aortic and common illiac) but the supraclavicular is a new one, PET SUV of 5, so definitely considered progression. Therefore my oncologist suggested we change up the chemo to folfiri + vectibix.

Has anyone here been on vectibix & folfiri and did they see significant results? I am hesitant going on such an aggressive regimen, especially with the rash, but also want to keep things under control so that local treatments to these nodes could be a possibility in the future.

We have done a good job of controlling further spread thus far but the new node in the supraclavicular area indicates either resistance or the chemo wasn't 'working' as planned. The surgery/radiation to get rid of the para-aortic lymph nodes was not entirely successful. My oncologist has stressed that the longer we can keep these things under control, buy time, the more likely it is a new breakthrough treatment will come out to help all of us!

Any feedback would be appreciated, even if you are on vectibix for organ mets, not just lymph node mets.

Thanks!
clj, 30
dx '14, stage IIIc sigmoid cc
colectomy, 12 folfox
7/15, stage IV, met to liver, retroperitoneal/para aortic LNs
8/15 - 11/15: folfiri + liver resection
2/16: 14 5FU + avastin & 4 folfiri +avastin
12/16 -2/17 - PA LN removal (5/10 LNs +) & 25 tx radiation
12/17 - PET confirms metastasis to right common illiac node, uptake in PA LNs
14 folfiri + avastin
9/18: Pet progression, left supraclavicular node, biopsy + for mets
Begin folfiri + vectibix
CEA: not useful. 0.9 now
KRAS wild type, MSS

hiker
Posts: 89
Joined: Thu Aug 09, 2018 10:15 am

Re: Vectibix - Distant LN spread

Postby hiker » Sat Sep 22, 2018 7:35 pm

On February 28 this year, I completed my post-surgery mop up chemo that involved folfiri+vectibix. You can see my details in the signature line. I was on it after having all liver mets removed via surgery so I have no way of knowing if it would have worked to decrease solid tumors. The goal was to kill any remaining cells floating around.

Vectibix, as with all chemo, affects people differently. I had a few small, red bumps (similar to pimples) on my face, neck and chest - but nothing significant at all. The worst side effect I had from it was my bottom eyelashes fell completely out and the ones on top grew to ridiculous lengths (I had to trim them constantly).
Colonoscopy 2/17, 5cm tumor descending
Diagnosed stage iv, liver mets 3/17
Colon resection 3/17
Told surgery not an option, get my affairs in order
Meet w/MSK team 5/01/17
Folfox(3rds) 5/17-6/17
Liver resection/implant HAI pump 7/17
HAI pump chemo(5rds) 8/17-2/18
Folfiri+Vectibix(11rds) 8/17-2/18
Spot on chest CT 10/17
Lung biopsy (that was fun) 11/17
Nocardia bacterial infection w/spread to brain (this is serious) 11/17
IV antibiotics 12/17-2/18
Oral antibiotics 3/18-12/18
Clear of cancer since surgery

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GrouseMan
Posts: 774
Joined: Mon Aug 12, 2013 12:30 pm
Location: SE Michigan USA

Re: Vectibix - Distant LN spread

Postby GrouseMan » Sun Sep 23, 2018 12:03 am

My wife was on Irinotecan Avastin and Erbitux (an EGFR Inhibitor) which is similar to Vectibix (an ABL-EGFR Inhibitor). Of all the chemo she had been on - this one she said was a piece of cake. Mind you she always tolerated chemo very well, but she found the side effects of this combination to be easiest on her. Unfortunately after several months on this the tumors in her abdomen became tolerant of the combination. For her this was about the last chemo they could try. She was on a sort of super Avastin for a couple of months after that as a single agent trial but it didn't really do anything for her.

As for the rash - its actually quite manageable. My wife's rash would be the worst a couple days after the infusion. But by taking cephalexin daily the rash hardly was noticeable. I worked on several similar small molecule EGFR inhibitors resulting in Dacomitinib when I was doing anticancer drug discovery. The rash is an issue with all the drugs in this class. Another thing that has been learned is that often when these EGFr inhibitors stop working, a time off of them often makes the tumors susceptible to them again later.

Good Luck

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

mhf1986
Posts: 158
Joined: Sat Mar 11, 2017 8:30 pm
Location: near DC

Re: Vectibix - Distant LN spread

Postby mhf1986 » Sun Sep 23, 2018 12:45 pm

DH started on Vectibix in May + then added 66% Irinitican dose in June (no 5FU) every 2 weeks. The Vectibex rash showed up at the 2nd treatment but is very manageable: good face moisturizer morning and night, sunblock when he's outside, and Aveeno Oatmeal Lotion for chest and back rash. Prescription gel and antibiotics if needed. Do NOT pick at the bumps!!!

The Irinitican has been problemactic with the late-onset diarrhea. 2 Imodium every 4 hours (Dr. said the instructions on the package won't do it) is controlling it currently. Also probiotic morning and night along with modified diet. He may skip the Irinitican dose in October so we can take a short trip to Florida. Dr. is good about working with our travel schedule (Dr. not particularly good about long term dreams...).

So...the July CT scan showed the liver tumors had shrunk back to January size: just 4 treatments caused this! Next scan is October 5 so we are keeping our fingers crossed for more shrinkage as blood work (liver functions) is showing improvement.
Caregiver to DH, dx @ 50, mets to liver/lungs, MSS, wild
9/16 CEA 114, blockage, left hemi, perm. colostomy
11/16 port in, FOLFOX + Avastin
6/17 CEA 15, 5FU + A only due to neuropathy
11/17 CEA 38, CAPOX + A
1/18 CAPOX = hi bilirubin/bad hfs, back to FOLFOX + A
5/18 growth; Vectibex + 75% Irinotecan
7/18 CEA 23, shrinkage
10/18 CEA 28, growth of 2 liver tumors/shrinkage of few and lung nodes
11/18 Lonsurf, looking at spheres, proton, trials
11/19/18 Peace

clj12288
Posts: 7
Joined: Tue Dec 12, 2017 11:09 am

Re: Vectibix - Distant LN spread

Postby clj12288 » Sun Sep 23, 2018 8:53 pm

Thanks for the feedback!

Hiker, it sounds like you had good results since you've been clear since surgery. I'm hoping for something similar - mainly to mop up any micro-metastasis that's out there and then get to the point to locally treat the nodes we know of. I'm not expecting the nodes to completely resolve by any means, but they are generally very small and only picked up on PET based on activity. Based on some of my research, left sided KRAS wild-type cancer seem to have the best responses. I don't think I'll mind having some lengthing of my lashes to make up for the not-so-great rash and of course ahir thinning from folfiri.

Grouseman, I'm glad to hear you wife tolerated it well, and it worked for a time. I'm interested in how an onc chooses to try erbitux over vectibix (or vice-versa). Mine told me there was less of a chance of some sort of severe reaction that can occur with Erbitux, because it contains some mouse antibodies, whereas vectibix is a full human antibody (I may have some of the lingo incorrect but that was the gist).

mhf1986, fingers crossed for continued great response! I have lots of experience with Irinotecan, I think about 20 rounds - the diarrhea could be a problem, but I did something similar with Immodium if I needed. I actually found that with all the pre-meds from infusion sometimes I'd actually get plugged up! It's hard to find the balance. I did have an rx for lomotil in case the diarrhea got out of hand.

I'm relieved to hear that the rash is manageable. I have seen some pictures but I suppose most people that would post pictures maybe have more extreme reactions? Either way, it's worth it in the short term if I can get some good results.
clj, 30
dx '14, stage IIIc sigmoid cc
colectomy, 12 folfox
7/15, stage IV, met to liver, retroperitoneal/para aortic LNs
8/15 - 11/15: folfiri + liver resection
2/16: 14 5FU + avastin & 4 folfiri +avastin
12/16 -2/17 - PA LN removal (5/10 LNs +) & 25 tx radiation
12/17 - PET confirms metastasis to right common illiac node, uptake in PA LNs
14 folfiri + avastin
9/18: Pet progression, left supraclavicular node, biopsy + for mets
Begin folfiri + vectibix
CEA: not useful. 0.9 now
KRAS wild type, MSS

Eternal optimist
Posts: 16
Joined: Sun May 01, 2016 9:26 am

Re: Vectibix - Distant LN spread

Postby Eternal optimist » Mon Sep 24, 2018 1:22 am

I have been on Erbitux since my last recurrence a year ago, with irrinotican and 5fu for 15 cycles which got me to NED and with 5fu alone as a maintenance treatment since my operation in july. I find it completely tolerable, I don't get a significant rash or any other side effects except split skin on my fingers, and it seems to work for me.
Diagnosed age 34 in Feb 2015, sigmoid tumour & PALNs
CapOx Mar-Oct 15
Resection of colon and para aortic node Dec 15. Histology T3a N2 M1a
Capecetabine Apr- Nov 16
Dec 16 - PALN recurrence, Radiotherapy
Aug 17 - FDG uptake in para aortic and retro peritoneal nodes, peritoneum, ovary plus small nodues on lungs. Only enlarged Palns and small lung nodules visible on CT, but possible spine Mets seen.
Sept 17 Folfiri and Cetuximab
April 18 NED
July 18 - surgery to remove benign peritoneal inclusion cyst

User avatar
GrouseMan
Posts: 774
Joined: Mon Aug 12, 2013 12:30 pm
Location: SE Michigan USA

Re: Vectibix - Distant LN spread

Postby GrouseMan » Mon Sep 24, 2018 11:57 am

clj12288 wrote:Thanks for the feedback!

Grouseman, I'm interested in how an onc chooses to try erbitux over vectibix (or vice-versa). Mine told me there was less of a chance of some sort of severe reaction that can occur with Erbitux, because it contains some mouse antibodies, whereas vectibix is a full human antibody (I may have some of the lingo incorrect but that was the gist).



Well - The use of Erbitux was due to the fact that this was a small trial her oncologist practice was participating in. Had it been me I would have selected a small molecule Irreversible EGFr Inhibitor such as Dacomitinib, or now the newer Afatinib, and Osimertinib. But being a drug discovery chemist I am perhaps biased somewhat by small molecule drugs. Also I am not an Oncologist but I do happen to know a lot about this class of drugs.

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


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