Pyro70 wrote:... and you won’t find it in any national guidelines (in the US or elsewhere)…. but never seems to provide advice on actual new developments in cancer care that are really revolutionizing how we treat patients (immunotherapy, targeted therapies, etc).
In addition to MSI testing I would insist on getting NGS molecular profiling of your cancer (this will likely include MSI). Getting NGS at diagnosis is really SOC now. In your case i might also consider getting a circulation tumor DNA blood test. The science on ctDNA isn’t settled. But if it comes back negative, it’s unclear what it means. But if you get a positive, I would definitely do chemo. Now if you’re going to do chemo anyways, probably no need for a test.
Sorry Jen43, I'm being repeatedly trolled by P70 worse than any pharma rep, or the most rabid onc I've met. He's wrong on a number of details, although we obviously have "less standard" tests, treatment, and advantages. CA199 is used in a number of countries, as well as some of the other therapeutics and tests. I am mildly supportive with comments of some advanced therapies here that we simply never needed, we did better at home. I believe most or all of the recent immunotherapies and targeted therapies that P70 refers to are for mCRC and stage 4 patients, and very expensive off trial.
In fact, there are a lot of stage 2s that suffered considerably more side effects after 4-6 months SOC treatment than my wife after 4 - 6 - 8 years every day
. This where my wife initially almost flunked 5FU without the heavy stuff with inadequate standard advice about folic acid and folates, not to mention actual survival at 8 years in good shape, better condition liver, hands and feet than many 2s and 3s.
I've supported initial genetic profiling before, for those who can arrange payment or insurance. I will point out some of the other countries' additional initial blood tests (e.g. CA199, AFP, LDH; ESR or hsCRP) cost us under $100 and aided us in comparing trials, papers and other patients results over the years, and turned to be more useful for us
, so far.
The board here doesn't know for absolute sure yet that you are appropriate for any 5FU based therapies, but 5FU based tx is usually the case.
My wife's 5FU treatment version probably has the lowest 5FU footprint on liver and general side effects but is typically reserved for fragile cases overseas. We just used it much more aggressively with mild and supportive adjuncts measured for her
I'm going to suggest that P70 take his differences, grievances and prejudices back to our previous general discussion at Immunotherapy in Switzerland
, without further burdens to Jen43.