Xeloda + Avastin Maintenance for NED people

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jp81
Posts: 27
Joined: Sun Jun 04, 2017 4:45 am

Xeloda + Avastin Maintenance for NED people

Postby jp81 » Sat Nov 10, 2018 1:57 am

My mom (who had mets) just had her second clean PET scan (the last one was in May). She was doing FOLFIRI + Avastin between March and early September.
Her CEA has dropped to 3.6, which is still borderline. Now, we've been given the option of doing Xeloda and Avastin indefinitely as maintenance every three weeks. Has anyone tried/researched this protocol?
CAPOX had earlier caused her blood counts to drop (in Dec 17), and we had to suspend the last cycle of Xeloda.

Btw, she's close to 60 now, and is in excellent health and spirit.

Links:
There's a previous thread here: viewtopic.php?f=1&t=30116&p=192484#p192484 in which vancouvereve talks about Xeloda+Avastin.
Dear Mom 58yrs, Stage 3 RC (T3CN2M0), CEA 9
MSS G12D
6.5cm from verge, 30mm in Mesorectal Fascia
Xeloda+Radiation 06/17
Surgery 08/17, CAPOX 5 rounds (plan 6, but blood counts low)
CEA 6, para-aortic node 01/18
CEA 5.6, PET 1 malign PALN 02/18
Pre-op CEA 4.8; Surgery (open) - 1.6cm Inferior Mesenteric Node - 26/02/18
FOLFIRI+Avastin from 03/18 to 09/18 (12 cyc)
Clean PET - 23/05/18
Xeloda+Avastin 18/11/18
CEA 3.6 06/11/18, 4.5 17/03/20, 3.6 26/01/19, 4.2 02/19, 5.1 11/04/19, 4.11 03/01/20, 3.17 04/11/21

jep
Posts: 260
Joined: Sun Jun 11, 2017 7:45 pm
Location: New England, USA

Re: Xeloda + Avastin Maintenance for NED people

Postby jep » Sat Nov 10, 2018 8:42 am

My husband's onc had talked about this exact maintenance regiment (as my husband is stage 4), but after 6 months of folfox, everything seemed good and he backed off the maintenance. I wanted my husband to do it anyway, but there didn't seem to be any reason to . . . now he has had a recurrence (nodes lit up on PET scan) and he's back on chemo . . . I can't help but wonder if the maintenance would have kept him NED . . .
jep
Stage IV CC 5/16/17
Loc: recto-sig
Type: Adenocarcinoma
Size: 7.4 cm
Grade: G3
TNM: T3N2M1
LNs: 8/20
BL CEA: .9
LVI: present
Perineural invasion: present
LAR margins: clear (w/in microns)
Folfox (8/17-1/18)
Scope 6/18 - CLEAR! - 2 polyps
PET 10/17/18: 3 pos LNs
Irino + Vecti (11/18)
CEA: 1.7 (2/19)
Xel + rad (5/19)
Surgery: 8/21/19 (aborted)
P1 Trial 10/19 - 12/19
Bypass 12/6/19
Folfox + vecti 1/2/19 - 4/3/20
Kid Fail 5/1/20
Folfiri + Avastin 5/20 - 6/20
bypass 6/29/20
Stivarga 7/18/20 -
Home 9/10/20

WarriorSpouse
Posts: 220
Joined: Tue Aug 16, 2016 9:02 pm

Re: Xeloda + Avastin Maintenance for NED people

Postby WarriorSpouse » Sat Nov 10, 2018 1:33 pm

I have been a big advocate for this maintenance treatment. I believe it has kept my wife NED so far. The plan was initially reviewed under the Cairo-3 study, and her treatment plan oncologist is from Dana Farber, Boston, MA.

There may be newer analysis out there. Please share it if you find one. Stay on offense and your defensive self will not have to work as hard... So far so good.

Best wishes as you move forward.
WS
D/H 47 years old, 10/2014, Stage IV M/CRC, nodes 12/15, para-aortic, 5 cm sigmoid resection, positive Virchow. KRAS mut, MSS, Highly Differentiated, Lynch Neg, 5FU/LV and Avastin 1 YR (Oxi for 5 months), Zeloda/Bev since 01/2016. 02/2019 recurrence para-nodes, back to 5FU/LV Oxy/Bev. It is working again. "...Perseverance is not a long race; it is many short races one after the other."-Walter Elliot

Achilles Torn
Posts: 141
Joined: Fri Dec 16, 2016 2:41 pm

Re: Xeloda + Avastin Maintenance for NED people

Postby Achilles Torn » Sat Nov 10, 2018 2:37 pm

I am on maintenance chemo. I did over a year of 5FU pump and Avastin. The pump started making me sick and I am now doing Xeloda (3200mg reduced from 4000mg due to sore feet) and Avastin. I'm on the third 3 week cycle and so far seems so good (knock on wood). Everything I've read leads me to believe I need to be on maintenance... but I am "No Evidence of Bulky Metastatic Disease" through chemo alone so we know it is still there. If one is NED through surgery then the consideration is substantially different.


I'm hoping that this regime is tolerable and gives me some more time with my kids.


Hope that helps

AT
Diagnosed as 40 yo Male. BC Canada. Sigmoid Colectomy Dec. 2016
Pathology T3N2bM1 19 of 24 Nodes Positive + tumour deposits
PET scan - Para-Aortic and Iliac Lymph node spread. Stage VI.
Moderately differentiated. MSS. KRAS/BRAF Wild.
Mutations: TP53, ERBB4, MLL3, PDCD1LG2, PRKDC, SMAD3
FOLFOX + Bevacizumab Commenced Jan 9/2017 PET Scan July 2017 - on maintenance 5FU/Bev every 2 weeks.
Progression after Covid19 induced break June 2020. Resume Maintenance chemo of Capecitabine and Bev

Mattie
Posts: 76
Joined: Fri Mar 07, 2014 1:06 am

Re: Xeloda + Avastin Maintenance for NED people

Postby Mattie » Sat Nov 10, 2018 3:19 pm

I went back to Xeloda+Avastin in March of 2016 when I had a recurrence in my abdomen. I was NED by Dec 2016. I kept on it until Sept of 2017 and then dropped the Xeloda. I'm still doing avastin only every three weeks without much trouble. I've been NED for almost 2 years. If it comes back, will probably add Xeloda again and see if that knocks it out again. My history below. Good luck!
4/10 debulk surgery, DX stage IVb, 49yo
5/10-11/11 Folfox, then Xeloda/Avastin
4/13 Resect liver met + pelvic node, 20+ Rad treatments
7/14 SBRT 15 mm Liver & node
12/14 SBRT 8 mm Liver met
3/16 4-5 pelvic nodes, Xeloda/Avastin again
12/16 NED, maintaining Xeloda/Avastin
8/17 NED Dropping Xeloda. Avastin only.
3/21 NED Avastin only
10/21 Pausing Avastin Proteinuria/BP complications
12/21 Resect 4.4 x 3.6 cm lower abdominal met

jp81
Posts: 27
Joined: Sun Jun 04, 2017 4:45 am

Re: Xeloda + Avastin Maintenance for NED people

Postby jp81 » Sun Nov 11, 2018 10:54 am

Thanks everyone. We'll discuss with our physician later this week, and I'll post the decision here once we know. My mom hates Xeloda, which gives her fatigue, low blood counts and makes food (waaay) less tasty. Based on your replies though, it certainly looks like we need to give Xeloda+Avastin a try.
Dear Mom 58yrs, Stage 3 RC (T3CN2M0), CEA 9
MSS G12D
6.5cm from verge, 30mm in Mesorectal Fascia
Xeloda+Radiation 06/17
Surgery 08/17, CAPOX 5 rounds (plan 6, but blood counts low)
CEA 6, para-aortic node 01/18
CEA 5.6, PET 1 malign PALN 02/18
Pre-op CEA 4.8; Surgery (open) - 1.6cm Inferior Mesenteric Node - 26/02/18
FOLFIRI+Avastin from 03/18 to 09/18 (12 cyc)
Clean PET - 23/05/18
Xeloda+Avastin 18/11/18
CEA 3.6 06/11/18, 4.5 17/03/20, 3.6 26/01/19, 4.2 02/19, 5.1 11/04/19, 4.11 03/01/20, 3.17 04/11/21

User avatar
Sophy
Posts: 261
Joined: Fri May 27, 2011 2:46 am
Location: New Zealand

Re: Xeloda + Avastin Maintenance for NED people

Postby Sophy » Mon Nov 12, 2018 4:12 pm

Not quite the same but I have been taking xeloda plus celecoxib (avastin isn't funded here in New Zealand) for over 4 years, currently on round 70 and still NED.

I have minimal side effects, some fatigue, sensitive hands (which may be from oxi 7 years ago) and my oncologist plans for me to stay on this indefinitely and I am fine with that. I take 1000mg xeloda twice daily for two weeks then a week off and I take the celecoxib 200mg twice every day.

All the best to your mother making her decision, great she has your support and research.
dx T3N1M0 Feb 2011 when children age 11, 7 and 2
Xeloda/rad March 11, LAR June 11 temp ileo
Xelox 6 rounds, NED
Lung mets Oct 13
Laser surgery Germany Jan 14. 3 mets left lung.
Laser surgery UK Jun and Aug 14 one met each lung, NED
Aug 14 Started Xeloda and Celebrex (ADAPT)
June 20 CT shows nodule, bronchoscopy confirms is scar tissue, still NED
Dec 20 stopping Xeloda continue celebrex, cimetedine
Aug 21,March 23 scans show still NED
March 2023 CURED - discharged from Oncology, no more scans or follow up

jp81
Posts: 27
Joined: Sun Jun 04, 2017 4:45 am

Re: Xeloda + Avastin Maintenance for NED people

Postby jp81 » Wed Nov 14, 2018 9:35 pm

Met the doctor yesterday. We're going to start capecitabine + avastin from Saturday. Avastin dosage as usual, 7.5mg/kg at three week cycles.
Thanks for the support and wishes.

Love.
Dear Mom 58yrs, Stage 3 RC (T3CN2M0), CEA 9
MSS G12D
6.5cm from verge, 30mm in Mesorectal Fascia
Xeloda+Radiation 06/17
Surgery 08/17, CAPOX 5 rounds (plan 6, but blood counts low)
CEA 6, para-aortic node 01/18
CEA 5.6, PET 1 malign PALN 02/18
Pre-op CEA 4.8; Surgery (open) - 1.6cm Inferior Mesenteric Node - 26/02/18
FOLFIRI+Avastin from 03/18 to 09/18 (12 cyc)
Clean PET - 23/05/18
Xeloda+Avastin 18/11/18
CEA 3.6 06/11/18, 4.5 17/03/20, 3.6 26/01/19, 4.2 02/19, 5.1 11/04/19, 4.11 03/01/20, 3.17 04/11/21


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