Rock_Robster wrote:Hey Alex, great that you heard back from MSK! Indeed under the circumstances I think these results are both good and probably largely unsurprising.
When I got my opinion from them they were also very hesitant to say any on the HAI pump without seeing me in person, and also assessing my response to 4 cycles of FOLFOX. My doc here also wouldn’t talk about much else until I’d done 4 x FOLFOX. It seems FOLFOX is pretty standard first line in both the US and Australia, whereas FOLFIRI is more common in Europe.
I guess then the only things I’d say would be:
1. It makes sense to me to not see MSK right now, given they’d just tell him to go do FOLFOX and come back in 8 weeks for scans. However I agree with other views that you would want to get the MSK appointment booked beforehand, as you wouldn’t won’t to be off treatment too long for travel, scans, waiting for appts, etc.
2. I guess it’s just worth being aware that this is changing his treatment plan in order to get a consult with MSK. I don’t see any huge downside with this - FOLFOX is on average at least as effective as FOLFIRI, and given he hasn’t progressed on FOLFIRI there shouldn’t be anything preventing him going back to it if he maxes out on FOLFOX. My question would be the Vectibix - would this continue? FOLFOX/FOLFIRI + an EGFR inhibitor is basically gold-standard first line for a RAS-wild patient and he seems to have done well on it so far. I guess this is something your onc in Denmark would have an opinion on.
Best wishes again!
Hi Rob, good to hear from you!
1.I agree, it seems way smarter to go ahead (since we already got their recommendations for now) and go back after some FOLFOX. Then we can fly over and see them in person and see what they say without further delaying treatment.
2. Actually this doesn't change his treatment plan at all! MSK agreed with the recommendations our hospital gave. I was kind of wondering why they were putting him on second line chemo since FOLFIRI + Vectibix worked so well. I think it's because he's had a break so there's a chance it won't work as well and his cancer has had a chance to become resistant. His oncologist said that we can definitely go back to FOLFIRI later on, since as you say, he didn't progress on it. I think maybe they are switching the Vectibix out with Avastin because of his severe toxicity after 12 rounds of it, I'm not sure. Either way Jesper is thrilled to have a break from it.
His nausea was the worst side effect from FOLFIRI. I hope FOLFOX isn't as bad in that regard. I've heard mixed "reviews" from people, so we'll see what Jesper thinks!
Interesting on the HAI pump! I wonder why, seems like you'd be the perfect candidate!