Clarification on response rate with Folfox as first line treatment

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hopefulandstrong
Posts: 8
Joined: Fri Apr 19, 2019 7:11 pm

Clarification on response rate with Folfox as first line treatment

Postby hopefulandstrong » Sun Apr 21, 2019 11:53 am

Greetings all --

This forum has been a great support and I navigate at Stage 4 diagnosis. Thank you to all who have been so generous sharing your stories

I am about to complete a 5th round of Folfox, with disease that is currently confined to liver. Pending scans on Thursday, I may be a candidate for regional hepatic therapy (via MSK) or re-section. CEA levels are still high (70 - 84), but I am told this is not a reliable marker, especially at this point in treatment. Can anyone share insight on the effectiveness of Folfox as a first line treatment? What are the stats? Are there variables that determine response?

Many thanks.
54, female
1/8/19 DS Stage 4 with Liver Mets
1/11/19 Successful Colon Resect -- 12 inches of transverse colon removed
2/9/19 PET scan with disease confined to liver
2/18/19 Started Folfox -- CEA 70
2/25/19 -- Scans to determine next steps -- HIA, Liver resect
5/1/19 -- Scans show progression -Switch to Folfiri
5/8/19 - BRAF mutation -- switch again to Triplet Therapy: Encorafenib, Binimetinib, Cetximab

russcott
Posts: 1
Joined: Sun Apr 21, 2019 3:14 pm
Facebook Username: Patty.dewhurst

Re: Clarification on response rate with Folfox as first line treatment

Postby russcott » Sun Apr 21, 2019 3:26 pm

My hubby is stage 4 with liver Mets. He commenced Folfox6 back in November 2018. His bowel tumour was 40mm and he had 8 liver tumours. Over a course of 9 Folfox6 without the Avastin ( in preparation for surgery as Avastin is detrimental to healing) his bowel tumour reduced to 19mm and some of his liver Mets were no longer visible. Two weeks ago he had a liver resection and surgeon advised that the removed tumours presented as 90% dead at biopsy so I’d say in his case, Folfox6 was very effective.
Hopefully whilst he is off chemo (due to his surgery) the tumours are still too bedazzled by Folfox6 to regroup. Fingers crossed!
We are still to find out if he will have to resume chemo before the bowel resection.

martd
Posts: 88
Joined: Tue Nov 21, 2017 3:48 pm
Location: Phoenix, Az

Re: Clarification on response rate with Folfox as first line treatment

Postby martd » Sun Apr 21, 2019 7:40 pm

My only treatment was folfox, I had a very good response. But everyone is different. It also depends on the genetics of the cancer.
49 y/o male dx 11/2017 crc
Stage 4 with 17 liver Mets, cea 490
RAS, BRAF WT
12 rounds folfox , avastin
5/18 cea 2.8 liver resection and pve
7/18 part 2 liver resection, remove right side of liver
Surgical site mrsa infection, wound vac
8/18 cea .9 cCR, rectal tumor is gone
Rectal surgery postponed, watch and wait
10/18 clear scan CEA .7
01/19 clear scan CEA .9
04/19 clear scan CEA .9

Rock_Robster
Posts: 69
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: Clarification on response rate with Folfox as first line treatment

Postby Rock_Robster » Mon Apr 22, 2019 2:16 am

For response rates, it’s a tricky question to answer, but Table 7 in the below provides an overview from a range of studies. There’s a few complicating factors, including what counts as a response (stable disease? Shrinkage?), and inclusion of targeted therapies (Bevacizumab, cetuximab). As a rough figure though I think you’d be reasonable to take a number in the order of about 60% (possibly higher if you include stable disease, and/or targeted therapies).

https://onlinelibrary.wiley.com/doi/ful ... ags3.12071

This study showed a wide range of response rates of 40% and almost 80%, again depending on measurement criteria used:

https://www.ajronline.org/doi/10.2214/AJR.11.7910

My situation was similar to yours - I was lucky to be resectable at diagnosis but still did 6 rounds of FOLFOX before liver resection; scans before surgery had good shrinkage, and pathology after surgery showed tumour necrosis ranging 40-80%.

I was also told that CEA taken during chemo is not particularly meaningful.

Best of luck.
Male 37 years; Melbourne, Australia
10/2018 Dx: 3.5 cm rectal adenocarcinoma, 10 cm from verge. Well/mod diff (G1-2), T3bN1bM1a.
3 enlarged local lymph nodes and 4 liver lesions.
MSS, MMR-proficient, mutated in NRAS (G13R).
CEA: Oct-18 = 12; Nov-18 = 14, Mar-19 = 2.4
11/18 - 6 rounds neoadjuvant FOLFOX
12/18 - DVT, started clexane
3/19 - Liver resection, R0
4-5/19 - Long-course pelvic chemoradiation (45 Gy w/ Xeloda)

hopefulandstrong
Posts: 8
Joined: Fri Apr 19, 2019 7:11 pm

Re: Clarification on response rate with Folfox as first line treatment

Postby hopefulandstrong » Mon Apr 22, 2019 2:28 pm

Thanks everyone! Just knowing you are here is so comforting.
54, female
1/8/19 DS Stage 4 with Liver Mets
1/11/19 Successful Colon Resect -- 12 inches of transverse colon removed
2/9/19 PET scan with disease confined to liver
2/18/19 Started Folfox -- CEA 70
2/25/19 -- Scans to determine next steps -- HIA, Liver resect
5/1/19 -- Scans show progression -Switch to Folfiri
5/8/19 - BRAF mutation -- switch again to Triplet Therapy: Encorafenib, Binimetinib, Cetximab

User avatar
ginabeewell
Posts: 177
Joined: Wed Oct 24, 2018 10:30 am

Re: Clarification on response rate with Folfox as first line treatment

Postby ginabeewell » Mon Apr 22, 2019 10:50 pm

I was not resectable when I started FOLFOX, and I don’t think anyone ever expected me to be. But I did 8 cycles and am now very close to liver resection. I did do a colon resection and the pathology suggested at least 80% effectiveness.

I do think that some of the Chinese supplements I was taking may have helped to make a difference but no way to know for sure if they were at play or I just had a good response to the chemo!

Now I will do a few more months of chemo with an HAI pump and hope to be ready for resection this summer.

Good luck!
45 year old mom of twins (7) and lucky stepmom of 13 and 15 year olds
9/11/18 colonoscopy
9/17/18 DX stage 4 CRC with inoperable liver metastasis (largest 11 cm)
9/20/18 CEA 931
10/1/18 FOLFOX + Vectibix planned 12 rounds
12/12/18 Routine scan picked up typhlitis - hospital stay for 7 days - but largest met down to 5 cm. Chemo holiday.
12/26/18 CEA 4.6!
1/14/18 Resume chemo (rounds 6-8)
3/27/19 Surgery: HAI pump placement / colon resection; liver resection to follow
CEA 2.6!!

Pyro
Posts: 196
Joined: Mon Oct 12, 2015 7:40 pm
Location: Tucson, AZ

Re: Clarification on response rate with Folfox as first line treatment

Postby Pyro » Sat Apr 27, 2019 9:30 am

hopefulandstrong wrote:Greetings all --

This forum has been a great support and I navigate at Stage 4 diagnosis. Thank you to all who have been so generous sharing your stories

I am about to complete a 5th round of Folfox, with disease that is currently confined to liver. Pending scans on Thursday, I may be a candidate for regional hepatic therapy (via MSK) or re-section. CEA levels are still high (70 - 84), but I am told this is not a reliable marker, especially at this point in treatment. Can anyone share insight on the effectiveness of Folfox as a first line treatment? What are the stats? Are there variables that determine response?

Many thanks.


It worked fairly well for me, shrank the 13 tumors in my liver, I was told surgery wasn’t an option before and after FOLFOX by local surgeons in Tucson, AZ. MD Anderson didn’t agree and cleared out my liver. I’ll never touch that crap again though, it’s the toughest chemo I’ve taken.
Aug 2015- Diag Stage 4 CC with mets to liver (38/m)
Sep 2015- Avastin/Folfox/Iron
Dec 2015-Not a surgery candidate for liver
Jan 2016- Erbitux/Folfiri, 2nd opinion at MDA in TX
Feb 2016 -MDA liver surgery, Dr. Vauthey
Mar 2016 -30% of left lobe rem, PVE
May 2016 - 70% of liver rem
Jun 2016-Rad
Jan 2017-perm colost @MDA
Jul 2017-Erb/FOLFURI
Nov 2017 -Lung & Liver ablations@MDA
Jan 2018 -Xeloda & Avastin mx
Jul 2018-Avast/FOLFURI
Sep 2018-Rad
Mar 2019 - Keytruda, CEA @30(3), shit still here

lindahudson
Posts: 1
Joined: Fri May 10, 2019 12:07 am

Re: Clarification on response rate with Folfox as first line treatment

Postby lindahudson » Fri May 10, 2019 12:18 am

Hello hopefulandstrong,

I hope you are in good health while reading this. Being anxious of the treatment is absolutely normal and there is no harm in predicting its outcome. I am sharing with you the details of a study and some statistics for Folfox, whose primary endpoint was disease-free survival. I will share the link of the study at the end so that you can go through it, if needed.

82 patients underwent potentially curative resection for stage high-risk colon cancer. They received FOLFOX 4 or modified FOLFOX6 for their treatment. During the follow up of 37 months, 14/82 patients experienced a relapse. The disease-free survival rate was 82-84% whereas 5 years survival rate varied from 74-90%. The hematological adverse effect includes neutropenia (40.2%), anaemia (2.4%) and thrombocytopenia (1.2%). Thus, it was concluded that FOLFOX is effective and tolerable in patients with high-risk of colon cancer.

So, now that you have some favorable statistics, you can relax. Believe in yourself, stay happy and confident. Do things that make you happy and don’t worry about your screening results. Just be positive and trust your doctor. You are in my thoughts. I hope you have a speedy recovery.

Here’s the link “Adjuvant Chemotherapy Using the FOLFOX Regimen in Colon Cancer”.


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