Folfox v. Folfiri?

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mpbser
Posts: 953
Joined: Wed Apr 19, 2017 11:52 am

Folfox v. Folfiri?

Postby mpbser » Tue Jan 22, 2019 8:30 am

Dr. Kemeny had said at my husband's December 26th appointment that she will have him do Folfiri instead of Folox/Xelox. Xelox (oral 5FU for the "fol" part) worked extremely well for him pre-liver surgery last year, so I am just wondering why she made that recommendation. She was very rushed and we didn't have a moment to ask our many questions so I was wondering if anyone here might have an idea why the preference. Thoughts?
Wife 4/17 Dx age 45
5/17 LAR
Adenocarcinoma
low grade
1st primary T3 N2b M1a
Stage IVA
8/17 Sub-total colectomy
2nd primary 5.5 cm T1 N0
9 of 96 nodes
CEA: < 2.9
MSS
Lynch no; KRAS wild
Immunohistochemsistry Normal
Fall 2017 FOLFOX shrank the 1 met in liver
1/18 Liver left hepatectomy seg 4
5/18 CT clear
12/18 MRI 1 liver met
3/7/19 Resection & HAI
4/1/19 Folfiri & FUDR
5/13/19 HAI pump catheter dislodge, nearly bled to death
6-7 '19 5FU 4 cycles
NED

hiker
Posts: 139
Joined: Thu Aug 09, 2018 10:15 am

Re: Folfox v. Folfiri?

Postby hiker » Tue Jan 22, 2019 8:43 am

Dr. K tends to switch things up a bit. She wanted me to have folfox before my liver resection and folfiri after. Never asked her why...don't really care. She knows a whole lot more about it than I do.

hiker
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

e_enyedy
Posts: 29
Joined: Sat Nov 25, 2017 5:28 pm

Re: Folfox v. Folfiri?

Postby e_enyedy » Tue Jan 22, 2019 8:43 am

Both chemo regimens seem to have the same effectiveness for treating metastatic CRC.
As far as I could make it out, there are no direct comparisons of the two treatments. I guess most of us will meet both treatments in the c ourse of
our disease.

Cordially
E
77 yrs male (73 at Dx)
2/13 Dx Carcinoma, Sigmoid Colon
3/13 Sigmoid Colon Hemicolectomy,( 12"+)
3/13 Pathology Staging: T1N0M0; no follow-up chemo
5/15 Recurrence: in pre-sacral space -no other mets detected (Instantly became Stage IV)
5/15 Started 8 sessions of Folfox + Avastin
11/15 Finished chemo, PET/CT: NED
11/15 Started Xeloda+ Avastin every 3 weeks. Still Doing it.
Still NED -(Hope treatment keeps working)

User avatar
LPL
Posts: 651
Joined: Fri Apr 22, 2016 12:49 am
Location: Europe

Re: Folfox v. Folfiri?

Postby LPL » Tue Jan 22, 2019 1:26 pm

mpbser, I have read somewhere.. (sorry, can’t find it now) that most Oncs change the chemo for the 2nd line(?time). Like if folfox first folfiri would 2nd and vice versa. I hope someone else have read this and can comment. While trying to find a reference for that statement, I found this paper .. not syre it explain it but here it is https://scholar.google.se/scholar?q=rel ... 2QnPFpvr0J
DH @ 65 DX 4/11/16 CC recto-sigmoid junction
Adenocarcenoma 35x15x9mm G3(biopsi) G1(surgical)
Mets 3 Liver resectable
T4aN1bM1a IVa 2/9 LN
MSS, KRAS-mut G13D
CEA & CA19-9: 5/18 2.5 78 8/17 1.4 48 2/14/17 1.8 29
4 Folfox 6/15-7/30 (b4 liver surgery) 8 after
CT: 8/8 no change 3/27/17 NED->Jan-19 mets to lung NED again Oct-19 :)
:!: Steroid induced hyperglycemia dx after 3chemo
Surgeries 2016: 3/18 Emergency colostomy
5/23 Primary+gallbl+stoma reversal+port 9/1 Liver mets
RFA 2019: Feb & Oct lung mets

mpbser
Posts: 953
Joined: Wed Apr 19, 2017 11:52 am

Re: Folfox v. Folfiri?

Postby mpbser » Tue Jan 22, 2019 1:42 pm

Thanks!
Wife 4/17 Dx age 45
5/17 LAR
Adenocarcinoma
low grade
1st primary T3 N2b M1a
Stage IVA
8/17 Sub-total colectomy
2nd primary 5.5 cm T1 N0
9 of 96 nodes
CEA: < 2.9
MSS
Lynch no; KRAS wild
Immunohistochemsistry Normal
Fall 2017 FOLFOX shrank the 1 met in liver
1/18 Liver left hepatectomy seg 4
5/18 CT clear
12/18 MRI 1 liver met
3/7/19 Resection & HAI
4/1/19 Folfiri & FUDR
5/13/19 HAI pump catheter dislodge, nearly bled to death
6-7 '19 5FU 4 cycles
NED

cbsmith
Posts: 87
Joined: Sat Nov 28, 2015 11:45 am
Location: New Brunswick, Canada

Re: Folfox v. Folfiri?

Postby cbsmith » Tue Jan 22, 2019 1:46 pm

I did folfox first and the to change it up I did a lot of rounds of folfiri and avastin.
06/14-DX with FAP as 36yo Male
07/14-total colectomy, rectum removal, permanent ileostomy
08/14-DX Stage IIIC, KRAS mutant, MSS
09/14-04/15 - 12 rounds of FOLFOX
07/15-CT showed para-aortic lymph node, onc thght inflammation
10/15-DX Stage IV, CT lymph node tripled in size, 1 small lung met
11/15-FOLFIRI + Avastin
06/16-lymph node is stable, now have a 2nd lung met
01/16-lymph node is stable, lung mets grown 2mm. Still on FOLFIRI + Avastin
11/17 - no chemo since. Lung growth minimal, lymph node is stable

teri3
Posts: 405
Joined: Fri Jan 09, 2015 11:03 am

Re: Folfox v. Folfiri?

Postby teri3 » Wed Jan 23, 2019 2:39 am

I did folfox first then did folfiri + avistin. The folfiri avistin works well for me.
Teri
58 yrs old female
MSS KRAS mutation G12V
adenocarcinoma sigmoid colon dx 11-14
sigmoidectomy 11-14
Stage 3A
3 out of 20 lymph nodes involved
started FolFox 1-27-15
11 rounds FOLFOX last one 6-30-2015
7-29-2015 PET clear
5-14-2016 CT 2 nodules one in each lung
Confirmed pulmonary metastasis stage 4
FOLFIRi + Avistin started 8-16 11 rounds complete 12-16
CT 12-16 nodules shrunk chemo break wait and see :?
CT growth
VATS l lung 4 10 17
VATS r lung 4 24 17
CT 2 nodules r up and l low :(

Kbelo
Posts: 20
Joined: Tue Aug 07, 2018 8:19 am

Re: Folfox v. Folfiri?

Postby Kbelo » Wed Jan 23, 2019 7:53 am

Folfiri contains 5FU too, it just swaps Oxaliplatin for Irinotecan. Hope this treatment does its job for you!
Stage 3B CC - diagnosed at 40
Bowel resection May 2018
28 nodes removed 1 with cancer traces
FOLFIRINOX started July 2018 for 6 months, finished Jan 2019.
1/19 - CT Scan shows NED
2/19 - CT Scan shows NED
5/19 - CT Scan shows NED
8/19 - CT scan + MRI show NED
2/20 - CT Scan shows NED
8/20 - CT Scan shows NED

FightCRC
Posts: 56
Joined: Fri May 25, 2018 10:39 pm

Re: Folfox v. Folfiri?

Postby FightCRC » Wed Jan 23, 2019 12:03 pm

Semi-pro tip: Ask all your questions with Sandy. She's Dr. K's buffer, but more importantly, she knows best how to communicate those questions to her. Now, there's no guarantee you'll get an answer (let alone one that satisfies you), but we've found that this works more often than not.

More than anything, though, I have to once again stress that any Kemeny patient (as well as prospective patients) do their homework via this message board, as well as the many CRC groups on FB. There are some questions you are better off NOT asking, because you will almost certainly get an answer you won't like. Sometimes, better to leave well enough alone.

mpbser
Posts: 953
Joined: Wed Apr 19, 2017 11:52 am

Re: Folfox v. Folfiri?

Postby mpbser » Wed Jan 23, 2019 1:55 pm

Interesting. I'd love to know some of the questions that should not be asked. You've really piqued my curiosity!
Wife 4/17 Dx age 45
5/17 LAR
Adenocarcinoma
low grade
1st primary T3 N2b M1a
Stage IVA
8/17 Sub-total colectomy
2nd primary 5.5 cm T1 N0
9 of 96 nodes
CEA: < 2.9
MSS
Lynch no; KRAS wild
Immunohistochemsistry Normal
Fall 2017 FOLFOX shrank the 1 met in liver
1/18 Liver left hepatectomy seg 4
5/18 CT clear
12/18 MRI 1 liver met
3/7/19 Resection & HAI
4/1/19 Folfiri & FUDR
5/13/19 HAI pump catheter dislodge, nearly bled to death
6-7 '19 5FU 4 cycles
NED

User avatar
juliej
Posts: 3114
Joined: Thu Aug 05, 2010 12:59 pm

Re: Folfox v. Folfiri?

Postby juliej » Wed Jan 23, 2019 4:45 pm

mpbser wrote:Interesting. I'd love to know some of the questions that should not be asked. You've really piqued my curiosity!

Any question involving skipping a treatment because 1) you want to go on vacation, 2) you want to enjoy the holidays, 3) you're tired of chemo. Dr. K is a strong believer in aggressive treatment. Presumably that's why you're seeing her. That means not skipping a treatment unless there's a problem with your labs or a strong medical reason.

She also appreciates if you've done your homework and understand why something is the way it is. In other words, she doesn't suffer fools gladly! :D

FightCRC wrote:Semi-pro tip: Ask all your questions with Sandy. She's Dr. K's buffer, but more importantly, she knows best how to communicate those questions to her. Now, there's no guarantee you'll get an answer (let alone one that satisfies you), but we've found that this works more often than not.

This is good advice unless you're asking something highly technical. Sandy is good at jotting down patient's concerns so they get addressed when Dr. K is in the room. Remember she sees many patients (54 patients during one particularly grueling day when I was there), so she needs a heads-up about the patient's questions. I would save medically complex questions and ask her directly though.

mpbser wrote:Dr. Kemeny had said at my husband's December 26th appointment that she will have him do Folfiri instead of Folox/Xelox. Xelox (oral 5FU for the "fol" part) worked extremely well for him pre-liver surgery last year, so I am just wondering why she made that recommendation. She was very rushed and we didn't have a moment to ask our many questions so I was wondering if anyone here might have an idea why the preference. Thoughts?

She seems to have a preference for Irinotecan for pump patients. She is data-driven (and has access to tons of it due to Watson at MSK), so my guess is that Iri has consistently shown better results and less impact on the pump. However, I managed to talk her into Xeloda by saying that it was working to shrink my tumors prior to the liver resection/pump surgery (scans didn't show reduced efficacy), and it was easier for me to take because I go to work every day.

However, I did take Folfiri between my liver resection/pump surgery and my double-lung surgery. It wasn't fun but it was doable. I think she wanted to change things up between the two surgeries so there wouldn't be any chance of new growth. When you have multiple surgeries and active tumors it's often a race against mutating cancer cells (especially since surgery itself releases human growth hormones to speed up healing which theoretically could feed any remaining tumors).

Hope this helps!
Juliej
Stage IVb, liver/lung mets 8/4/2010
Xelox+Avastin 8/18/10 to 10/21/2011
LAR, liver resec, HAI pump 11/2011
Adjuvant Irinotecan + FUDR
Double lung surgery + ileo reversal 2/2012
Adjuvant FUDR + Xeloda
VATS rt. lung 12/2012 - benign granuloma!
VATS left lung 11/2013
NED 11/22/13 to 12/18/2019, CEA<1

mpbser
Posts: 953
Joined: Wed Apr 19, 2017 11:52 am

Re: Folfox v. Folfiri?

Postby mpbser » Wed Jan 23, 2019 5:02 pm

Thanks, julie! This is all very helpful!

My husband's IQ is over 165 and mine isn't too shabby, either, so we also don't suffer fools gladly. That's actually one of my husband's favorite sayings.

Xelox worked extremely well for my husband but I don't know of any way to differentiate the effects of Xeloda or the Ox in that case. He also works six days a week.

Waiting to hear from them about confirming March 7th for resection and pump placement. We were offered February 14th but that day is too soon for us to get our affairs in order. Dr. D'Angelica's nurse called 27 hours ago and we haven't heard back yet. Hopefully, the plan will be solidified soon. Sure would be good to hear what the treatment plan is first, as well. :/
Wife 4/17 Dx age 45
5/17 LAR
Adenocarcinoma
low grade
1st primary T3 N2b M1a
Stage IVA
8/17 Sub-total colectomy
2nd primary 5.5 cm T1 N0
9 of 96 nodes
CEA: < 2.9
MSS
Lynch no; KRAS wild
Immunohistochemsistry Normal
Fall 2017 FOLFOX shrank the 1 met in liver
1/18 Liver left hepatectomy seg 4
5/18 CT clear
12/18 MRI 1 liver met
3/7/19 Resection & HAI
4/1/19 Folfiri & FUDR
5/13/19 HAI pump catheter dislodge, nearly bled to death
6-7 '19 5FU 4 cycles
NED

User avatar
juliej
Posts: 3114
Joined: Thu Aug 05, 2010 12:59 pm

Re: Folfox v. Folfiri?

Postby juliej » Wed Jan 23, 2019 5:33 pm

mpbser wrote:Thanks, julie! This is all very helpful!

My husband's IQ is over 165 and mine isn't too shabby, either, so we also don't suffer fools gladly. That's actually one of my husband's favorite sayings.

Xelox worked extremely well for my husband but I don't know of any way to differentiate the effects of Xeloda or the Ox in that case. He also works six days a week.

Waiting to hear from them about confirming March 7th for resection and pump placement. We were offered February 14th but that day is too soon for us to get our affairs in order. Dr. D'Angelica's nurse called 27 hours ago and we haven't heard back yet. Hopefully, the plan will be solidified soon. Sure would be good to hear what the treatment plan is first, as well. :/

Yikes! Feb 14 is very soon unless you live close to NYC. March 7 sounds less frantic. Wednesday is one of Dr. D'A's clinic days so it's hard to tell if you'll hear back today. They are constantly adjusting and readjusting his surgery schedule. I agree it would be nice to know the treatment plan ahead of time. You sound like me: I want to know everything as soon as possible! :D

How many cycles of Oxi has he had? Does he have any neuropathy? I started having neuropathy after about 6 cycles of Oxi so I dropped it and was just taking Xeloda and Avastin before I went to MSK. Because of that, I could convince her the Xeloda was working so it was fine to continue it during my pump treatment. In actuality, 5FU does more of the work in Xelox treatment anyway. 5FU is an antimetabolite, which means it interferes with cell division. Oxaliplatin is an alkylating agent, which means it's most active in the resting phase of the cell. One hits when it's trying to divide, the other hits when it's resting - sort of a one-two punch to cancer! But the heavy lifting is done by 5FU.

Hope you get the surgery date locked down soon!
Juliej
Stage IVb, liver/lung mets 8/4/2010
Xelox+Avastin 8/18/10 to 10/21/2011
LAR, liver resec, HAI pump 11/2011
Adjuvant Irinotecan + FUDR
Double lung surgery + ileo reversal 2/2012
Adjuvant FUDR + Xeloda
VATS rt. lung 12/2012 - benign granuloma!
VATS left lung 11/2013
NED 11/22/13 to 12/18/2019, CEA<1

mpbser
Posts: 953
Joined: Wed Apr 19, 2017 11:52 am

Re: Folfox v. Folfiri?

Postby mpbser » Thu Jan 24, 2019 10:31 am

>>>>Yikes! Feb 14 is very soon unless you live close to NYC. March 7 sounds less frantic. Wednesday is one of Dr. D'A's clinic days so it's hard to tell if you'll hear back today. They are constantly adjusting and readjusting his surgery schedule. I agree it would be nice to know the treatment plan ahead of time. You sound like me: I want to know everything as soon as possible! :D

We still have not heard from Dr. D's's office. My husband is COO for a company that has eight stores and other facilities. He needs to make arrangements with his employees, some of whom are brand new as of this week, and facilitate some interim measures so that the company does not fall apart. I have similar professional responsibilities to take care of. Plus, there are the arrangements to be made, e.g., where to stay, which affects many people's lives including a friend who has a coop near the UN we may stay with, my aunt who will be coming up from Delaware, and other family who want to be there, some who are local to the NYC area and some from farther away. I also have to change plans with our friend in CT who expects me/us to stay with him as I am most likely going to chose to stay near the UN.

>>>How many cycles of Oxi has he had? Does he have any neuropathy? I started having neuropathy after about 6 cycles of Oxi so I dropped it and was just taking Xeloda and Avastin before I went to MSK. Because of that, I could convince her the Xeloda was working so it was fine to continue it during my pump treatment. In actuality, 5FU does more of the work in Xelox treatment anyway. 5FU is an antimetabolite, which means it interferes with cell division. Oxaliplatin is an alkylating agent, which means it's most active in the resting phase of the cell. One hits when it's trying to divide, the other hits when it's resting - sort of a one-two punch to cancer! But the heavy lifting is done by 5FU.

He had four infusions of Ox. He had a tiny neuropathy that was fleeting after the third infusion and a bit more after the fourth. This is really helpful, concise information about Xeloda/5FU and Ox. Thanks! I am wondering about the Avastin. There is a possibility that she may add that. How was it?
Wife 4/17 Dx age 45
5/17 LAR
Adenocarcinoma
low grade
1st primary T3 N2b M1a
Stage IVA
8/17 Sub-total colectomy
2nd primary 5.5 cm T1 N0
9 of 96 nodes
CEA: < 2.9
MSS
Lynch no; KRAS wild
Immunohistochemsistry Normal
Fall 2017 FOLFOX shrank the 1 met in liver
1/18 Liver left hepatectomy seg 4
5/18 CT clear
12/18 MRI 1 liver met
3/7/19 Resection & HAI
4/1/19 Folfiri & FUDR
5/13/19 HAI pump catheter dislodge, nearly bled to death
6-7 '19 5FU 4 cycles
NED

mpbser
Posts: 953
Joined: Wed Apr 19, 2017 11:52 am

Re: Folfox v. Folfiri?

Postby mpbser » Thu Jan 24, 2019 3:50 pm

48 hours and still no word. Starting to get a tad annoyed.
Wife 4/17 Dx age 45
5/17 LAR
Adenocarcinoma
low grade
1st primary T3 N2b M1a
Stage IVA
8/17 Sub-total colectomy
2nd primary 5.5 cm T1 N0
9 of 96 nodes
CEA: < 2.9
MSS
Lynch no; KRAS wild
Immunohistochemsistry Normal
Fall 2017 FOLFOX shrank the 1 met in liver
1/18 Liver left hepatectomy seg 4
5/18 CT clear
12/18 MRI 1 liver met
3/7/19 Resection & HAI
4/1/19 Folfiri & FUDR
5/13/19 HAI pump catheter dislodge, nearly bled to death
6-7 '19 5FU 4 cycles
NED


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