JJH wrote:Your mom could contact her oncologist on Monday to seek clarification on these two issues:
1. Why did the oncologist recommend Xeloda dosing at half the protocol-recommended level during neoadjuvant chemo/radiation? He should be able to explain his rationale for doing this. Normally the low 50% dose level is reserved for fragile patients who cannot tolerate full Xeloda dosing, such as patients who have renal insufficiency and are in danger of renal failure. Ask him to explain his reasons.
2. Why is the oncologist recommending a 6-week short course of neoadjuvant CapeOX in tandem with the 5 week neoadjuvant chemo/radiation course already completed? He should be able to explain why he wants to do this. This type of addition to the neoadjuvant chemo/radiation standard is not mentioned in the NCCN standard of care for rectal cancer.
Meanwhile, between now and Monday you could help your mom by drafting a checklist as well as a transcript of possible questions to ask in a teleconference with the oncologist.
Good luck!
On #2, agree definitely suggest asking the oncologist, however I’ll add that mine was very keen for me to fit in a couple of cycles of FOLFOX between radiation and Recital surgery as well (although not strictly within the NCCN guidelines). One of the big challenges with treating rectal cancer is the long delays between treatments, around long-course chemoradiation (particularly waiting for a full response before resecting which can take up to 8-10 weeks) and then after a ULAR (often with an ileostomy). This can result in several continuous months without full-dose systemic chemo, increasing the risk of progression while off treatment. This is particularly of concern in the metastatic setting (as my case was).
There is a growing movement toward “more, earlier” with regard to chemo for RC (as evidenced by the Total Neoadjuvant Therapy trials), and many practitioners here are encouraging a significant proportion of what would normally have been adjuvant chemo to be delivered either neoadjuvantly or perioperatively. 2 cycles seems to be the andecdotal “minimum” for effectiveness; while 3-4 would be ideal this would likely risk delaying surgery and also potentially deconditioning the patient excessively. Hopefully in time we get some more empirical data to support this approach.
Cheers
Rob