Good news on Triplet Therapy

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hopefulandstrong
Posts: 58
Joined: Fri Apr 19, 2019 7:11 pm

Good news on Triplet Therapy

Postby hopefulandstrong » Tue Aug 06, 2019 4:30 pm

For those of you with the BRAF mutation considering triplet therapy, I want to report that since starting this therapy in mid-May, my CEA dropped from 214 to 2.8, and all liver 4 mets have shrunk -- all are 3.5 cm or below now. Shrinkage at this point is about 30%. My side effects -- nausea, fatigue, rash -- have been completely manageable. I'm lucky that I work largely at home, so can nap when needed.

Headed to MSK tomorrow for another consult -- we'll see if pump is the next step. Curious to know if any of you have seen tumors continue to shrink on meds. Happy to answer further questions for those of you considering the Triplet.
54, female
1/8/19 DS Stage 4 with Liver Mets; Successful Colon Resect
2/18/19 Started Folfox -- CEA 70
5/8/19 - BRAF mutation -- switch to Triplet Therapy: Encorafenib, Binimetinib, Cetximab
6/13/19 - CEA dropped from 214 to 22
8/29 - CEA jump to 30-- scans reveal liver spread, though still confined. triplet therapy abandoned; some concern about PIC3 mutation interfering with BRAF treatment
9/1 - 10/4 -- no treatment
10/4 -- folfoxfiri to stem further progression; pump placement in January (hopefully)

fumaros
Posts: 273
Joined: Sat Jul 02, 2016 10:26 pm
Location: Syracuse, NY
Contact:

Re: Good news on Triplet Therapy

Postby fumaros » Tue Aug 06, 2019 8:23 pm

Thats some amazing developing and in such a short time. I haven't heard of triplet therapy before, is it confined to certain tumor characteristics?
Diagnosed 4/8/16, age 29
Colectomy 4/20/16
Stage III, T4bN1 Tumor 7x6.5x2. Muscinous Adenocarcinoma with SRC features
2/16 lymph nodes
Stage IV, Peri mets 5/2019
CEA 4/14/16 - 16.8
CEA 6/2/16 - 1.9
CEA 6/17/16 - 0.87, 7/16 - 1.33, 12/16 - 1.14, 4/17 - 0.6, 7/17 - 0.5, 10/17 - 0.9, 3/19 -5.8, 4/19 -10
FOLFOX began 6/24/16 - 11/25/16, FOLFIRI - 5/10/19
10 round FOLFOX, 2 round 5-FU & Leucovorin, 1 round FOLFIRI
MRI & CT 8/16 - NED, CT 12/16 - 10/17 - NED

User avatar
LeonW
Posts: 358
Joined: Sun May 03, 2015 4:59 pm
Location: Amsterdam, Netherlands

Re: Good news on Triplet Therapy

Postby LeonW » Wed Aug 07, 2019 7:45 am

Hi Hope

Congrats on your response - that your liver mets shrunk that much in 3 months time is really good news. Have a look at my sign below. FWIW, there are a few similarities that you may find encouraging: we both have/had a transverse colon resect immediately following Dx - ahead of attacking the liver mets that seem to respond so well to the meds. And your nice CEA readings seem to reflect what's happening in the liver. You may well be one of the lucky ones for whom CEA is a good indicator of cancer activity.

hopefulandstrong wrote:. . . Curious to know if any of you have seen tumors continue to shrink on meds.
My docs started out with CAPOX-Avastine right from the beginning, with shrinkage from week 10 which is quite comparable to your shrinkage of 30% at month 3.

I haven't heard of your EBC/triplet therapy, but it looks pretty effective, so far. Is it one of the new targeted treatments, may be?

I completed all the planned (8) rounds of CAPOX and may have been going into the liver surgery clean of cancer, as pathology couldn't find any living cancer cells in the piecesremoved. Have been NED with stable/low CEAs since (Oct 2013). I wish you to do similarly.

Regards, Leon
Dec 2012 - CC 2 unresect liver mets, CEA 41.8 (MM 65yrs)
Jan 2013 - colectomy @ spleen 2/26 nodes IVa T3N1bM1a
Feb-Aug - 1x Xelox-7x Xelox/Avastin (neo adjuv), shrinkage from #3
Sept - 2x PV embolization (both failed)
Oct 2013 - R liver resect, 28d hosp (liver failure/delirium, lung emboli, encephalopathy), cancer dead (pCR)
2014/15 - recovery, scopy: 2 polyps
2016 - new town, new life
June 2018 - 5 yr mark, scopy: 2 polyps
1.3-1.4 CEA/clean CTs: 4x2014, 6x2015-17, 2x2018-19 :D, next June 2020

hopefulandstrong
Posts: 58
Joined: Fri Apr 19, 2019 7:11 pm

Re: Good news on Triplet Therapy

Postby hopefulandstrong » Wed Aug 07, 2019 6:08 pm

Thanks friends -

Just came from MSK consult. Plan is to do a couple more months as is and then consider resection. An earlier scan suggested possible peri mets, but the latest contradicts -- saying what is seen is scar tissue from surgery. I think if my onc is convinced the disease is confined to liver, she will be more enthusiastic about surgery.

Leon, she also confirmed that finding necrotic tissue in the spaces that show up as lesions is more common than some think. I think CEA may be a good indicator for me.

The Triplet Therapy is new -- targeted especially for BRAF 7600 folks like me. Though, I'm also understanding that there are varieties of BRAF'ness. Crossing my fingers that my version may a teeny bit less virulent than some others. In any case, this response is such a relief as Folfox failed for me.
54, female
1/8/19 DS Stage 4 with Liver Mets; Successful Colon Resect
2/18/19 Started Folfox -- CEA 70
5/8/19 - BRAF mutation -- switch to Triplet Therapy: Encorafenib, Binimetinib, Cetximab
6/13/19 - CEA dropped from 214 to 22
8/29 - CEA jump to 30-- scans reveal liver spread, though still confined. triplet therapy abandoned; some concern about PIC3 mutation interfering with BRAF treatment
9/1 - 10/4 -- no treatment
10/4 -- folfoxfiri to stem further progression; pump placement in January (hopefully)

boxhill
Posts: 405
Joined: Fri Apr 06, 2018 11:40 am

Re: Good news on Triplet Therapy

Postby boxhill » Thu Aug 08, 2019 1:14 pm

Congratulations, that is excellent news!
F, 64 at DX CRC Stage IV
3/17/18 blockage, r hemi
11 of 25 nodes,5 mesentery nodes
5mm liver met out
pT3 pN2b pM1
BRAF wild, KRAS G12D
dMMR, MSI-H
5/4/18 FOLFOX
Neulasta 6/28
7/9/18 CT NED
11/20/18 CT NED. Enlarged spleen.
12/20/18 Liver MRI 5mm liver met? and 2 lymph nodes in porta hepatis
12/31/18 Keytruda
6/5/19 Triphasic CT LN and spleen normal, Liver node stable
6/28/19 Pause Keytruda, predisone for joint pain
7/31/19 Restart Keytruda
9/10/19 CT stable


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