Chemo break

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Trying
Posts: 170
Joined: Sun May 13, 2018 10:11 pm

Chemo break

Postby Trying » Sat May 11, 2019 8:46 am

Have any of you had a chemo break. If do how long was it and did it effect the scan such as growth wise. My body is begging for a break.

Thanks

Nicole
38 yr old single mom of almost 2 yr old.
Colon cancer stage IV 10 liver mets and peri metApril 2018
Folfox as of June 2018
Down to 2 mets in liver dec 2018.

User avatar
ginabeewell
Posts: 243
Joined: Wed Oct 24, 2018 10:30 am

Re: Chemo break

Postby ginabeewell » Sat May 11, 2019 8:58 am

I had an infection that required me to take a 7 week break to heal after 5 cycles. I think it may have been a blessing in disguise as my weight was down to 90 lbs and I managed to gain back almost 30 during that period.

The scans showed that I had just a tiny bit of growth in some areas while others continued to shrink.

I did continue to take Chinese and other supplements during this time which helped me to feel like I was at least doing something, whether or not they actually helped!

I will say that after I took the break, chemo was not as hard for me as it had been initially. Not sure if that’s because it was actually the infection making me feel extra awful or if by the time I resumed I just had less active cancer in my body. I’m not sure I would have felt brave enough to CHOOSE a break, but in retrospect I think it’s what I needed at the time.
45 year old mom of twins (7) and lucky stepmom of 13 and 16 year olds
9/17/18 DX stage 4 CRC w inoperable liver mets (largest 11 cm)
9/20/18 CEA 931
10/1/18 FOLFOX + Vectibix planned 12 rounds
12/12/18 Routine scan showed typhlitis (7 days in hospital) but largest met down to 5 cm. Chemo holiday.
12/26/18 CEA 4.6
1/14/18 Resume chemo (#6-8)
3/27/19 Surgery: HAI pump placement / colon resection
4/8/19 Resume chemo (#9-12) FOLFOX (no OX) + Vectibix
5/20/19 CEA 1.3
7/19/18: 1st of 2 liver resections

Trying
Posts: 170
Joined: Sun May 13, 2018 10:11 pm

Re: Chemo break

Postby Trying » Sat May 11, 2019 9:18 am

Thank you!
38 yr old single mom of almost 2 yr old.
Colon cancer stage IV 10 liver mets and peri metApril 2018
Folfox as of June 2018
Down to 2 mets in liver dec 2018.

zephyr
Posts: 225
Joined: Thu Aug 18, 2016 7:31 am

Re: Chemo break

Postby zephyr » Sat May 11, 2019 11:48 am

Over my first two years, I had a few chemo breaks, two of which I chose. Both were for about a month. There was some growth but it's hard to know what caused it: was it the chemo break or was it chemo resistance? My body was SCREAMING for a break, and the time off gave me a chance to recover physically and mentally. I too found that chemo was not as hard for me when I resumed after the breaks. If I had to do it all over again, I wouldn't change a thing.
Last edited by zephyr on Sat May 11, 2019 11:52 am, edited 1 time in total.
Nov-2009 Early stage CRC found during routine colonoscopy
2010, 2011, 2014 Follow up colonoscopies, all clear
Jun-2016 CRC found during routine follow up colonoscopy, surgery, Stage 4, KRAS, MSS, inoperable lung mets
Aug-2016-May-2018 Folfox, 5FU & Avastin, 5FU, Folfiri & Cyramza
Aug/Sep-2018 YAG laser surgeries (Germany) on both lungs, 11 nodules (9 mets) removed
Nov-2018 clean CT scan
Mar-2019 New lung nodules
April-2019 Xeloda + Avastin
July-2019 ... add SBRT

Detox
Posts: 47
Joined: Fri Apr 28, 2017 5:27 pm

Re: Chemo break

Postby Detox » Sat May 11, 2019 11:49 am

I think if you can compensate in other areas it can be extremely beneficial.

In others words, trying to eat a lot of anti-cancer foods, vitamin D, vitamin C and other supplements can help you hold serve if you decide to take a break.

Trying
Posts: 170
Joined: Sun May 13, 2018 10:11 pm

Re: Chemo break

Postby Trying » Sat May 11, 2019 1:53 pm

Thank you guys
38 yr old single mom of almost 2 yr old.
Colon cancer stage IV 10 liver mets and peri metApril 2018
Folfox as of June 2018
Down to 2 mets in liver dec 2018.

Trying
Posts: 170
Joined: Sun May 13, 2018 10:11 pm

Re: Chemo break

Postby Trying » Sat May 11, 2019 1:56 pm

Did you guys who had growth during the break find chemo went back to working again afterwords.
38 yr old single mom of almost 2 yr old.
Colon cancer stage IV 10 liver mets and peri metApril 2018
Folfox as of June 2018
Down to 2 mets in liver dec 2018.

zephyr
Posts: 225
Joined: Thu Aug 18, 2016 7:31 am

Re: Chemo break

Postby zephyr » Sat May 11, 2019 2:25 pm

Trying wrote:Did you guys who had growth during the break find chemo went back to working again afterwords.


Hmmm... maybe. I don't really remember but I *think* in both cases I hit chemo resistance and my cocktail was changed, after which the chemo began working again. Sorry to be so vague.

I second what Detox wrote about compensating in other areas.
Nov-2009 Early stage CRC found during routine colonoscopy
2010, 2011, 2014 Follow up colonoscopies, all clear
Jun-2016 CRC found during routine follow up colonoscopy, surgery, Stage 4, KRAS, MSS, inoperable lung mets
Aug-2016-May-2018 Folfox, 5FU & Avastin, 5FU, Folfiri & Cyramza
Aug/Sep-2018 YAG laser surgeries (Germany) on both lungs, 11 nodules (9 mets) removed
Nov-2018 clean CT scan
Mar-2019 New lung nodules
April-2019 Xeloda + Avastin
July-2019 ... add SBRT

stu
Posts: 1141
Joined: Sat Aug 17, 2013 5:46 pm

Re: Chemo break

Postby stu » Sat May 11, 2019 3:21 pm

Hi ,
My mum had a six month break between her first and second cycle of chemotherapy. The tumours responded just as before . It did her the world of good . She did have growth when off chemo but they shrank again .

A different health care system and I suspect you won’t want so long a break but it lets you see the effect chemo can still have once it is recommenced.

Take care ,

Stu
supporter to my mum who lives a great life despite a difficult diagnosis
stage4 2009 significant spread to liver
2010 colon /liver resection
chemo following recurrence
73% of liver removed
enjoying life treatment free
2016 lung resection
Oct 2017 nice clear scan . Two lung nodules disappeared
Oct 2018. Another clear scan .

debb
Posts: 173
Joined: Sun Dec 21, 2008 9:03 pm
Location: NJ

Re: Chemo break

Postby debb » Sat May 11, 2019 7:46 pm

Hi...I think it is perfectly reasonable to request a break. I've been dealing with cancer for almost 11 years, and over the last 3-4 years have been on and off chemo. I don't think chemo will ever truly get rid of my cancer, but it is managing it. I went on Folfiri and Avastin for 12 cycles and then had a break for almost 18 months. The cancer in and out of my lung was controlled when I went off, and we watch with 3 month scans until my doc said It's time to go back on chemo. I did Folfiri & Avastin again for 12 cycles, everything shrunk and was controlled and got another 8 month break. I'm back on the same cocktail and it's working because I was in pain, but am painfree now so I'm hopeful my scan next week will be a good one. If I get a good scan, I will then have my 6 treatment this go-round and plan to ask my doc if i can just skip a week, just because I need a break.

I guess I'm lucky because my cancer keeps responding to Folfiri and Avastin after I take breaks. I'm hoping this continues.
Stage 3C, Dx at 42, mom of 4
Colon resection 7/08
Folfox 9/08-2/09
Met to right ovary, both ovaries removed 7/10
HIPEC 8/10
VATS 7/12, 2 nodes, right lung
10/14 3 lung nodes, Stivarga clinical trial
3/15-7/15 Folfiri & avastin for lung things
Break! One+ year of freedom
8/16 Folfiri & avastin..lung things again
Break! 10 months of freedom
1/18 rib mets, radiation, folfiri & avastin
1/19 rib mets again, radiation, folfiri & avastin

Caat55
Posts: 665
Joined: Sat Dec 23, 2017 6:01 pm

Re: Chemo break

Postby Caat55 » Sat May 11, 2019 9:25 pm

I went ten weeks between 2 and 3. It was great, got to enjoy time with kids. This was post chemo/radiation and surgery. I have had two clean scans.
S
55 y.o. Female
Dx 9/26/17 RC Stage 3
Completed 33 rad. tx, xeolda 12/8/17
MRI and PET 1/18 sign. regression
Surgery 1/31/18 Ileostomy, clean margins, no lymph node involved
Port 3/1/2018
Oxaliplatin and Xeloda start 3/22/18
Last Oxaliplatin 7/5/18, 5 rounds
CT NED 9/2018
PET NED 12/18
Clear Colonoscopy 2/19

Pyro70
Posts: 118
Joined: Mon Jan 21, 2019 4:25 pm

Re: Chemo break

Postby Pyro70 » Sat May 11, 2019 10:05 pm

I think it’s fair to say that there currently is a trend to see if “less is more” with chemo, especially with FOLFOX or FOLFOXFIRI. In addition to a chemo “break” one can consider de-intensifying chemo to a maintenance regime (typically 5fu/xeloda and avastin). I’ve heard oncologists say both are reasonable approaches and although they may impact PFS (progression free survival) its believed OS (overall survival) is not impacted.

https://www.onclive.com/onclive-tv/dr-mahipal-on-maintenance-therapy-in-crc

Additionally, maintenance chemotherapy can be given without negatively impacting overall survival. The first progression is probably sooner with the chemotherapy-free interval, says Mahipal. However, when the therapy is reinstituted and is followed by a second progression, patients tend to have the same outcomes whether maintenance therapy was given or if they were continued on the same aggressive regimen.
Dx Jan 2017 stage IVB w/ PC age 35
FOLFOX
SEP 17 HIPEC 1, anastamosis leak
XELODA
MAR 18 HIPEC 2
JUN 18, ileo reversal and 2nd anastamosis leak

Rock_Robster
Posts: 112
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: Chemo break

Postby Rock_Robster » Sun May 12, 2019 3:41 am

Thanks Pyro70, I agree there definitely seems to be a trend toward ‘less is more’, esp. when oxaliplatin is involved. My onc is suggesting I stop at 8-9 FOLFOX treatments, and no need for further adjuvant oxy if NED after last surgery (maybe a few rounds of 5FU). He believes the evidence for 12 full FOLFOX doses is pretty weak, as it is for adjuvant chemo - provided the chemo was done at some point (and the earlier the better).

Interestingly that article you linked suggests dose reduction is less detrimental to outcomes than complete breaks - seems consistent with a lot of the European work on metronomic chemo too.

One question - what do people interpret as “maintenance chemo” in this context? Is this just a lower-dose chemo designed to delay progression but not necessarily achieve shrinkage? Or is it only chemo given once NED to reduce recurrence risk?

Thanks, Rob
Male 37 years; Melbourne, Australia
10/2018 Dx: 3.5 cm rectal adenocarcinoma, 12cm from AV. 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 cycles neoadjuvant FOLFOX
12/18 - DVT, started clexane
3/19 - Liver resection, R0
4-5/19 - Long-course pelvic radiation w/ Xeloda; complete metabolic response
07/19 - ULAR w temp ileostomy placed

Pyro70
Posts: 118
Joined: Mon Jan 21, 2019 4:25 pm

Re: Chemo break

Postby Pyro70 » Sun May 12, 2019 4:00 am

Rock_Robster wrote:Thanks Pyro70, I agree there definitely seems to be a trend toward ‘less is more’, esp. when oxaliplatin is involved. My onc is suggesting I stop at 8-9 FOLFOX treatments, and no need for further adjuvant oxy if NED after last surgery (maybe a few rounds of 5FU). He believes the evidence for 12 full FOLFOX doses is pretty weak, as it is for adjuvant chemo - provided the chemo was done at some point (and the earlier the better).

Interestingly that article you linked suggests dose reduction is less detrimental to outcomes than complete breaks - seems consistent with a lot of the European work on metronomic chemo too.

One question - what do people interpret as “maintenance chemo” in this context? Is this just a lower-dose chemo designed to delay progression but not necessarily achieve shrinkage? Or is it only chemo given once NED to reduce recurrence risk?

Thanks, Rob


Maintenance chemo is “lower dose”. Technically not lower dose but a more tolerable regime. Maintenance chemo could be given with active tumors on scans, or when NED, but having a high likelihood of occult mets. “Chemo given once NED to reduce recurrence risk” is technically called adjuvant, but there is some debate if there is such a thing as stage IV adjuvant or if that’s always/mostly still the “metastatic” setting. Most data on adjuvant is for stage III disease. Several regimes/agents with proven efficacy in the metastatic setting do not have proven efficacy (or shown worse outcomes) in the adjuvant setting... Folfiri is a prime example.
Dx Jan 2017 stage IVB w/ PC age 35
FOLFOX
SEP 17 HIPEC 1, anastamosis leak
XELODA
MAR 18 HIPEC 2
JUN 18, ileo reversal and 2nd anastamosis leak

Pyro70
Posts: 118
Joined: Mon Jan 21, 2019 4:25 pm

Re: Chemo break

Postby Pyro70 » Sun May 12, 2019 1:23 pm

Btw to clarify, I think most people would say maintenance chemo is intended to delay “progression” not necessarily to shrink tumors (of course the later would be nice). My understanding is that if chemo shrinks tumors it is mostly likely to happen in the first few months. So I think by the time one gets to the maintenance regime, further shrinkage is unlikely. Also shrinkage is probably only really important if one wants to facility surgery or if the patient is symptomatic and the oncologist wants a response to relieve symptoms. If one has unresectable metastatic cancer, I’m not sure it matters much if a tumor that isn’t causing issues is bigger or smaller as long as the cancer isn’t progressing.

In full disclosure, I’m not at MD, and the above is more my opinion. I don’t have articles to back it up.
Dx Jan 2017 stage IVB w/ PC age 35
FOLFOX
SEP 17 HIPEC 1, anastamosis leak
XELODA
MAR 18 HIPEC 2
JUN 18, ileo reversal and 2nd anastamosis leak


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