The Colon Club

Hi,
I am posting this question as a new topic because my search in existing topics did not yield answers. My signature tells my story. After a solitary lung met and its removal by VATS, is adjuvant chemotherapy recommended?

NCCN guidelines for 2018 does not give clear recommendations. All it says is 'some experts say more chemotherapy is not recommended if chemotherapy was already delivered as part of original treatment'. I received recommendation from Mayo to get more chemo. No strong push for it from my oncologist at University of Minnesota but he may have been influenced by my reluctance to get more chemo. Given that Folfox treatment was already done (6 rounds) and it could not prevent this recurrence, I do not know how helpful it would be if I did the same treatment again.

-Is there any experience from anyone here on this topic?
- What does MD Anderson recommend?
- What does MSK recommend?

Thanks,
skb

I have no idea what various institutions recommend, but I do know that FOLFOX is unlikely to work for some of us, depending on tumor genetics. So the questions might be 1) is adjuvant chemo desirable in your situation, and 2) if so, what should that chemo be?

Do you have information about your tumor genetics to add to your sig?

Thank you boxhill for the prompt response.

1) CEA: My CEA has never been elevated.

2) Gene sequencing information-
Detected Alterations of Known or Potential Pathogenicity: None
Detected Alterations of Uncertain Significance: None
Genes with No Detected Alterations of the Amino Acid Sequence: BRAF, KRAS,
NRAS, PIK3CA, PTEN

3) Lymph node spread: Never detected
Nearby lymph nodes were also removed during VATS surgery and were negative

I had a solitary lung met removed via VATS in 2009. I decided to do Xeloda and Avastin. I decided that if I had a recurrence and hadn't done some chemo to stave it off, then I couldn't live with myself. It's a personal decision, but I'm glad I made the decision I did, My 2 cents.

Take care,

I think the question is more why did you have a recurrence? If it is due to some cancer cells that seeded in your and started a slow growing lung met then chemo is probably not going to assist a lot as the VATS would have dealt with the cancer. Are they any more cancer cells floating that could also be active? Who knows.

That is what Betsydoglover is referring to when she says she could not live with herself if she didn't do it. I too, had no idea. I'd hate to be proven wrong by not having chemo and then having more recurrences so in my situation, just like Betsy, I asked my oncologist what he would be in my position (he said he'd take chemo) so I went for 12 rounds of FOLFOX. Not fun, but did the trick in her case, and in mine.

I could be wrong but if you have already done folfox, they would likely give you a different chemo regime.

My wife has gone back to her original treatment after a few years of maintenance chemo, and it has appeared to work in some regard. She has also used SBRT to attack two specific para-aortic nodes. We will know more if the SBRT has worked after the holidays and her next PET scan.
Everyone is different, but by staying proactive, you do keep new growth suppressed. Maintenance chemo and six month scans have kept my wife's quality of life as manageable for over 5 years now. All the best in your decisions moving forward.
WS

Given that our situations are nearly identical, albeit 10 years apart, I have replied into your prior quotes for reference.

skb wrote: After a solitary lung met and its removal by VATS, is adjuvant chemotherapy recommended?
NCCN guidelines for 2018 does not give clear recommendations.
In 2010 with my single VATS removed lung met, this was controversial and called "pseudo-adjuvant" chemo which I did take

Given that Folfox treatment was already done (6 rounds) and it could not prevent this recurrence, I do not know how helpful it would be if I did the same treatment again.
I had full resection and elected Xeloda for neoadjuvant chemoradiation and post surgery adjuvant chemo.
When I had the lung met recurrence 3 years later, I chose to do 12 cycles FOLFOX as I had not had it previously and was determined to throw the book at the cancer !

skb wrote:1) CEA: My CEA has never been elevated. ...SAME = never elevated anytime so far since 2007 diagnosis
2) Gene sequencing information- ...in 2007 not done routinely as it may be now, so no info
3) Lymph node spread: Never detected ...SAME = never detected with MRI, CT, PET, or in surgery pathology samples post resection

skb wrote:Is there any experience from anyone here on this topic?

We are the poster kids for "Watch and Wait" versus "Cut and Chemo"
Different protocols, 10 years apart... BUTT ... with a commonality of low rectal primary tumors,
a period of NED, then a single metachronous lung met.

You had cCR and I had pCR with regards to determining if the tumor was gone.
We both had neoadjuvant chemoradiation and an "adjuvant" chemo after primary tumor resolution.
We both got recurrent lung mets.
You did not have surgery for the primary, but had it for the met.
I had surgery for the primary and the met.

You are deciding at the post VATS stage, 2 months out.
I am giving some input 9 years out from last chemo for my lung met.

My take :
explore other chemo / immuno therapies which could be targeted based on your genetics testing, with my preference being to do SOMETHING

Enact an AGGRESSIVE monitoring program with as many modalities and experts as you can muster to the cause.

JMO my friend
BTDT and still here to talk about it

In Harmony on the Journey
CRguy

I want to thank boxhill, betsydoglover, kiwiinoz, Tdubz, WarriorSpouse and CRguy for the responses.

CRGuy, you have been on a very similar journey and your detailed advice is very much appreciated.

Hi! I also had VATS for a solitary lung metastasis and did not do any chemo after that. The oncologist said it is not the protocol anymore here and it would have been different if it was in the liver.
The metastasis was sincrone and detected at diagnosis.

All the best

Claudia

Claudia,
Could you please say where you were getting your treatment?

From the format of dates in your signature, it appears that you are not in the United States.

In the United States, there is no clear protocol for this situation and the patient is asked to make a decision. Different cancer centers in the US have different recommendations. There is very limited online research data available for this and so it was very stressful for me to make a decision

Thank you,
skb

Hi. I had a lung nodule removed by VATS in May. I am finishing up 6 months of Xeloda. It was recommended by my oncologist and I agreed.

skb wrote:Claudia,
Could you please say where you were getting your treatment?

From the format of dates in your signature, it appears that you are not in the United States.

In the United States, there is no clear protocol for this situation and the patient is asked to make a decision. Different cancer centers in the US have different recommendations. There is very limited online research data available for this and so it was very stressful for me to make a decision

Thank you,
skb

Hi! I live in Norway, I come from Italy.

I think it is a very difficult decision, but it was their decision, they waited some months from diagnosis before removing the lung metastasis and made sure there were not many others coming out. I can still do chemo if I get new metastasis, while I might have done that unecessarly and get more side effects.

All the best

Claudia

Thank you, Claudia.

The United States lags behind Europe in adopting newer therapy protocols. They wait to see how things are working out in Europe before adopting a care protocol. Even newer medical devices built in the US are first launched in Asia and Europe. Which means US residents are often delayed in getting the newest medical care.

Thank you again.