nzjez wrote:Hi Rob
Thanks for taking the time to reply.
I like the sound of curative intent.
I was just so deflated after the Dr's brief phone call, I felt like I had lost then and there. My world just came crashing down after such a big battle, and what felt like a short time recovering.
But I will now hold on to this chance in the meantime.
Cheers,
Jeremy
boxhill wrote:nzjez, what is your MSS/MSI, KRAS, BRAF, etc status?
bitchslapped wrote:Sometimes hope is all we have Jeremy. Hope changes throughout the cancer journey, sometimes if it's just for a better tomorrow.
You are young, so the challenges may be greater in that the cancer can seem more aggressive, but there is always hope. For colon cancer patients, spread to the peritoneal cavity can be more challenging than appendix cancer spread to the peritoneal w/the exception being high grade appendiceal cancer.
I believe the difference for those colon cancer patients undergoing CRS/HIPEC is adjuvant chemotherapy is recommended where not necessarily for low-grade appendiceal cancer.
Lymph node involvement will also be a complicating factor.
Colorectal peritoneal metastases: Optimal management review, July 2019:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6658395/
The role of HIPEC in relation to the PRODIGE 7 trial in this review:
The lack of consensus about the role of HIPEC may be due to several reasons: The marked heterogeneity of protocols, drugs, carrier solutions and methods of HIPEC administration (open, semi-open, closed techniques) and the discrepancy concerning patient eligibility and lack of randomized trials in the era of modern chemotherapy and targeted therapy.
The preliminary results of the PRODIGE 7 trial[76], presented at the American Society of Clinical Oncology (ASCO) meeting in 2018, questioned the widespread conviction of the beneficial effects of HIPEC. After complete cytoreduction of M1c CRC, 265 patients were randomized to standard treatment plus HIPEC with oxaliplatin or standard treatment alone. No significant difference in overall survival was found, with a median of 41.7 months in the HIPEC arm vs 41.2 mo in the non-HIPEC arm [Hazard ratio (HR) = 1.00, 95% confidence interval (CI): 0.73-1.37] and no significant difference in relapse-free survival (13.1 vs 11.1 mo, HR = 0.90, 95%CI: 0.69-1.90). However, a trend toward better disease-free survival was found on the Kaplan-Meier curves for the first 18 months after surgery, and a subgroup analysis for patients with a PCI between 11 and 15 showed significantly better overall and recurrence-free survival for the HIPEC group.
Regarding morbidity, the study reported a higher late, grade 3-5 morbidity (up to 60 d after surgery) in the HIPEC arm (24.1% vs 13.6%, P = 0.03). The unexpected results have encouraged the scientific community to continue searching for the role of HIPEC in PM, as its advantageous effects have been extensively reported in the biomedical literature for CRC and recently proven for other origins[77]. To our knowledge, high quality and complete cytoreduction has been confirmed once again as a pivotal pillar of treatment for peritoneal dissemination of CRC. Efforts are now focused on electing patients who would benefit the most from HIPEC because this trial remarks high PCI as an already known impaired factor.
Another goal is to ascertain the real morbidity (as most of the publications only report the 30-day morbidity-mortality and have widely been compared, similar to other major abdominal surgeries[78]) and reduce the side-effects of HIPEC[79]. This may be achieved by either minimizing drug doses (which has been one critic of the PRODIGE 7, considering previous experimental studies)[80], establishing the benefits of hyperthermia alone and combined with the chemotherapy agents, or trying different drugs or delivery systems. Additionally, the final results are published; to date, only one multicenter randomized trial studying the effects of HIPEC vs standard treatment for patients with established PM of CRC origin (NCT02179489). Therefore, the search is ongoing, and further trials are needed to determine what HIPEC can offer.
Bottom line you would need laparoscopic surgery to determine PCI (peritoneal cancer index). Of course less is best so PCI of <10 = highest rate of 5-year survival rates.
My best friend had discomfort similar to what you describe in a previous post...in the vicinity of her right ribcage. Several doctors & several months later her persistence paid off. It was discovered through laparoscopic surgery that her appendix was cancerous (rare) & removed. She had mucinous spread to her perotineal w/PCI index of 10. If you go ahead w/any procedures have them check that appendix too. She was able to travel to find a highly regarded, high volume CRS/HIPEC cancer center. I highly recommend you do the same if @ all possible.
Do check back in with what you have learned from your doctors.
Best Wishes
BS
tcross wrote:I’m in the same boat as you currently. Found out in August I have spread in the periometuem. I’m currently three rounds into FOLFOXFIRI and had a diagnostic laparoscopy conducted two weeks ago and given a PCI of 6. The plan is to perform 6-9 chemo sessions prior to CRS/HIPEC and then another 3-6 after and then take it from there.
Most insurance companies will fight paying for the HIPEC portion but CRS is typically covered. You can seek out information at insurancewarrior.com for how to appeal. The author appealed her HIPEC 14 years ago and won. She had appendixeal cancer but there are several with colon cancer that are survivors as well.
Find an NCI-designated hospital and they will have a surgeon that specializes in the procedure. https://www.cancer.gov/research/nci-rol ... nters/find
nzjez wrote:tcross wrote:I’m in the same boat as you currently. Found out in August I have spread in the periometuem. I’m currently three rounds into FOLFOXFIRI and had a diagnostic laparoscopy conducted two weeks ago and given a PCI of 6. The plan is to perform 6-9 chemo sessions prior to CRS/HIPEC and then another 3-6 after and then take it from there.
Most insurance companies will fight paying for the HIPEC portion but CRS is typically covered. You can seek out information at insurancewarrior.com for how to appeal. The author appealed her HIPEC 14 years ago and won. She had appendixeal cancer but there are several with colon cancer that are survivors as well.
Find an NCI-designated hospital and they will have a surgeon that specializes in the procedure. https://www.cancer.gov/research/nci-rol ... nters/find
Hi Tcross
Sorry to hear you've also found this
I'm really impressed your team has moved along with treatment so fast - I'm 3 weeks in and nothing has happened. First investigatory calls made yesterday during our follow up appt.
Don't know if I should be on Chemo now? Maybe CRS/HIPEC or Pelvic Exenteration ops if possible. I mention about laparoscopic surgery to find extent of spread- and he said not necessary as PET tells them all they need. Weird as I keep reading about the PCI scoring system for CRS feasibility?!
My surgeon is very well respected, but in my region they are extremely under resourced and worry this fact might effect my outcomes due to time delays.
What were your timeframes after discovery of peri meds? It sounds like things moved fast.
All the best with your treatment!
Cheers
Jeremy
DarknessEmbraced wrote:I'm sorry it wasn't better news and that you're dealing with this!*hugs*
Rock_Robster wrote:One other comment on the PRODIGE 7 trial results - this trial used oxaliplatin as the HIPEC drug. I’ve seen inconsistent results between this and mitomycin-C (MMC), some research suggests Oxaliplatin has the edge, but some more recent studies indicate significantly better results from MMC. Might also be a topic for discussion with whomever is planning the surgery.
Cheers
Rob
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