Cancer Center Recommendations

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csfl
Posts: 4
Joined: Mon Apr 06, 2020 3:48 pm

Cancer Center Recommendations

Postby csfl » Mon Apr 06, 2020 4:14 pm

I am looking for recommendations for my 45 year old sister who was diagnosed with colon cancer in Jan 2020. She had a right hemicolectomy in Feb due to pain from a partial blockage. They were in the process of determining stage 3 or 4 based on CT/MRI/PET but had to do surgery before chemo due to pain. They are starting Folfox this week (8 weeks after surgery.) Post surgical MRI and PET showed some liver nodules and pertioneal involvement. Based on this they are adding Avastin starting with her second chemo. I want to take her for a second opinion. I saw MSK and Dana Farber both have Young Onset Colorectal Cancer Centers. Would you recommend one over the other? Thanks!!

Rock_Robster
Posts: 1027
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: Cancer Center Recommendations

Postby Rock_Robster » Tue Apr 07, 2020 9:38 am

I think these are both strong choices. I’m not in the States but I got second opinions from both, and overall I preferred my experience with MSK. I think you’ll struggle to find many people with a negative thing to say about them.

One consideration with peritoneal mets - this is fairly specialised and you’ll probably also want to talk to a high volume peritoneal practice as well. You could get referred from your primary centre, or perhaps start making some contacts yourself. Dr Sardi in Baltimore and Dr Sugarbaker in DC come to mind as early ideas. Others here will probably have more.

Best of luck,
Rob
41M Australia
2018 Dx RC
G2 EMVI LVI, 4 liver mets
pT3N1aM1a Stage IVa MSS NRAS G13R
CEA 14>2>32>16>19>30>140>70
11/18 FOLFOX
3/19 Liver resection
5/19 Pelvic IMRT
7/19 ULAR
8/19 Liver met
8/19 FOLFOX, FOLFOXIRI, FOLFIRI
12/19 Liver resection
NED 2 years
11/21 Liver met, PALN, lung nodules
3/22 PVE, lymphadenectomy, liver SBRT
10/22 PALN SBRT
11/22 Liver mets, peri nodule. Xeloda+Bev
4/23 XELIRI+Bev
9/23 ATRIUM trial
12/23 Modified FOLFIRI+Bev
3/24 VAXINIA (CF33 + hNIS) trial

boxhill
Posts: 789
Joined: Fri Apr 06, 2018 11:40 am

Re: Cancer Center Recommendations

Postby boxhill » Wed Apr 08, 2020 11:05 am

My first question would be is her tumor MSI-H or MSS? If it is MSI-H, she may well be able to go directly to Keytruda rather than (potentially) wasting time on FOLFOX. Things have changed a lot in the last year.

I'd assume that D-F and MSK are probably equal good choices, unless she is interested in the HAI pump for liver mets, where MSK is the gold standard.
F, 64 at DX CRC Stage IV
3/17/18 blockage, r hemi
11 of 25 LN,5 mesentery nodes
5mm liver met
pT3 pN2b pM1
BRAF wild, KRAS G12D
dMMR, MSI-H
5/18 FOLFOX
7/18 and 11/18 CT NED
12/18 MRI 5mm liver mass, 2 LNs in porta hepatis
12/31/18 Keytruda
6/19 Multiphasic CT LNs normal, Liver stable
6/28/19 Pause Key, predisone for joint pain
7/31/19 Restart Key
9/19 CT stable
Pain: all fails but Celebrex
12/23/19 CT stable
5/20 MRI stable/NED
6/20 Stop Key
All MRIs NED

csfl
Posts: 4
Joined: Mon Apr 06, 2020 3:48 pm

Re: Cancer Center Recommendations

Postby csfl » Wed Apr 08, 2020 2:16 pm

It looks like she is MSS or MSI-L. Does that change treatment options at all? We are still waiting for the tumor marker testing results for KRas, Nras and Braf from her right hemicolectomy. Any idea how long those results usually take?

NHMike
Posts: 2555
Joined: Fri Jul 21, 2017 3:43 am

Re: Cancer Center Recommendations

Postby NHMike » Thu Apr 09, 2020 2:22 pm

csfl wrote:It looks like she is MSS or MSI-L. Does that change treatment options at all? We are still waiting for the tumor marker testing results for KRas, Nras and Braf from her right hemicolectomy. Any idea how long those results usually take?


They take a couple of days to do (sequencing, computer pipelines, verification from pathologist) but there are lots of things that can add time like sending it out to the lab and processing time. Some labs are also a bit backed up because they're doing COVID testing too.
6/17: ER rectal bleeding; Colonoscopy
7/17: 3B rectal. T3N1bM0. 5.2 4.5 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6, 5 x 5
7/17-9/17: Xeloda radiation
7/5: CEA 2.7; 8/16: 1.9; 11/30: 0.6; 12/20 1.4; 1/10 1.8; 1/31 2.2; 2/28 2.6; 4/10 2.8; 5/1 2.8; 5/29 3.2; 7/13 4.5; 8/9 2.8, 2/12 1.2
MSS, KRAS G12D
10/17: 2.7 2.2 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 (-75%), 5 x 3 (-40%). 5.1 CM from AV
10/17: LAR, Temp Ileostomy, Path Complete Response
CapeOx (8) 12/17-6/18
7/18: Reversal, Port Removal
2/19: Clean CT

NHMike
Posts: 2555
Joined: Fri Jul 21, 2017 3:43 am

Re: Cancer Center Recommendations

Postby NHMike » Thu Apr 09, 2020 2:25 pm

I'm a patient at Dana Farber and had surveillance appointments early February. My next appointment is scheduled for August but I'm pretty sure that it will be delayed. It's a bit scary going to either MSK or DFCI right now. I've received a number of emails on updated protocols for parking, visitors, etc. from DFCI and it sounds like things are just more challenging. I think that I'd prefer to drive to either of those places, from someplace where the numbers are really low, and with a full gas tank, a bottle of water and food so that I didn't have to stop anywhere for food, drink or fuel.
6/17: ER rectal bleeding; Colonoscopy
7/17: 3B rectal. T3N1bM0. 5.2 4.5 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6, 5 x 5
7/17-9/17: Xeloda radiation
7/5: CEA 2.7; 8/16: 1.9; 11/30: 0.6; 12/20 1.4; 1/10 1.8; 1/31 2.2; 2/28 2.6; 4/10 2.8; 5/1 2.8; 5/29 3.2; 7/13 4.5; 8/9 2.8, 2/12 1.2
MSS, KRAS G12D
10/17: 2.7 2.2 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 (-75%), 5 x 3 (-40%). 5.1 CM from AV
10/17: LAR, Temp Ileostomy, Path Complete Response
CapeOx (8) 12/17-6/18
7/18: Reversal, Port Removal
2/19: Clean CT


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