Regorafenib Trade Name: Stivarga bob.

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Gloriamazz
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Regorafenib Trade Name: Stivarga bob.

Postby Gloriamazz » Wed Dec 16, 2020 1:25 pm

[color=#800080][/colorl
I need some information about the drug Regorafenib

I was just taken off Irinotecan no longer working - only thing it did was on the first scan tumors did not grow. 2nd scan tumors grew a little 3 rd scan new cluster of tumors plus growth of old tumors.

After Xmas going on Regorafenib. I need to know the positive and negative. How was your reaction? Did it shrink the tumors, were you sick and fatigued.
Last edited by Gloriamazz on Sun Jan 10, 2021 2:36 am, edited 1 time in total.
June 2018 Colonoscopy
2.6 adenocarcinoma
8/8/18 APR
Colostomy
March 19 CT 2 lung nods
April 29, 2019 Pelvis leision 1.8 x 1.8 cm
7/22 - 7/29/ 2019 5 radi
no chemo 10 month
6-10-19 Folfox, Oxill
2nd Irinotecan , Folferi, FU5
12/14/20 Aborted Folferi
12/14/20 CT tumors grow and new ones
Resume chemo Jan/4/2021 Stivarga using pill
12/14/2020 Folferi not working lung tumors grew and have cluster of new ones
break going on pill drug Jan 2021

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Green Tea
Posts: 292
Joined: Mon Oct 24, 2016 10:48 am
Location: Nusa Tenggara

Re: Regorafenib Trade Name: Stivarga

Postby Green Tea » Wed Dec 16, 2020 2:09 pm

Gloriamazz wrote:....After Xmas going on Regorafenib. I need to know the positive and negative. How was your reaction? Did it shrink the tumors, were you sick and fatigued.

In the past, some people on this forum took Regorafenib. You can use the search function here to search past posts to see some of the reactions to Regorafenib / Stivarga. For example:

Stivarga side effects thread

Read this thread, too:
STIVARGA (Regorafenib) - ONGOING PATIENT EXPERIENCES

From the Stivarga package insert:
-------------------------ADVERSE REACTIONS -----------------------------
The most common adverse reactions (≥30%) are
- asthenia/fatigue,
- decreased appetite and food intake,
- hand-foot skin reaction (HFSR) [palmar-plantar erythrodysesthesia (PPE)],
- diarrhea,
- mucositis (mouth sores),
- weight loss,
- infection,
- hypertension,
- dysphonia (voice impairement, hoarseness)

Stivarga side effects (from drugs.com website)
https://www.drugs.com/sfx/stivarga-side-effects.html
Last edited by Green Tea on Thu Dec 17, 2020 7:45 am, edited 3 times in total.

Gloriamazz
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Re: Regorafenib Trade Name: Stivarga bob.

Postby Gloriamazz » Wed Dec 16, 2020 8:34 pm

Hi Green Tea,

I did read the post that I found under the brand name.
It was mostly caregivers telling the experience of some one else taking the drug,

Most comments from caregivrers were not positive with the drug. I would like first hand information about their results and about their side effects
And if tumors shrunk. Length of time on the drug. I would like contact with people who are dealing with this drug now not 5 or 10 yrs ago.

Where do I post to reach it to these people taking Regorafenib or is it not a drug that is not given much.with this drug are there other drugs I should inquire about.I joined this form for knowledge. I knownothing about cancer past the point I took 2 Chemos Oxilaplatin did not work.
June 2018 Colonoscopy
2.6 adenocarcinoma
8/8/18 APR
Colostomy
March 19 CT 2 lung nods
April 29, 2019 Pelvis leision 1.8 x 1.8 cm
7/22 - 7/29/ 2019 5 radi
no chemo 10 month
6-10-19 Folfox, Oxill
2nd Irinotecan , Folferi, FU5
12/14/20 Aborted Folferi
12/14/20 CT tumors grow and new ones
Resume chemo Jan/4/2021 Stivarga using pill
12/14/2020 Folferi not working lung tumors grew and have cluster of new ones
break going on pill drug Jan 2021

henny-crc
Posts: 11
Joined: Mon Sep 14, 2020 6:09 pm

Re: Regorafenib Trade Name: Stivarga bob.

Postby henny-crc » Thu Dec 17, 2020 8:06 am

You were on irinotecan chemo before oxali? Because thats the usual second chemo line, much more effective than stivarga.
Dx 06/20
23 yo
Stage 3A
T1N2a

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Green Tea
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Re: Regorafenib Trade Name: Stivarga

Postby Green Tea » Thu Dec 17, 2020 2:14 pm

Gloriamazz wrote:Hi Green Tea, ...
Most comments from caregivers were not positive with the drug. I would like first hand information about their results and about their side effects and if tumors shrunk. Length of time on the drug. I would like contact with people who are dealing with this drug now not 5 or 10 yrs ago.

Where do I post to reach it to these people taking Regorafenib, or is it not a drug that is not given much. With this drug are there other drugs I should inquire about. I joined this form for knowledge. I know nothing about cancer past the point I took 2 Chemos Oxilaplatin did not work.

Hi Gloria,
So far this week you have not received any replies from Stivarga patients "who are dealing with this drug now." I think that this might be because this drug is not given much these days. Stivarga was approved in 2012 and there was a big flurry of patients who were put on the drug in the 2013-2015 time frame, since it was the newest Stage IV drug available on the market at the time. Now, in 2020, there are several other newer drugs that have been approved and I think that patients who qualify for these newer drugs are being placed on them instead of Stivarga.

On this message board I think that there is only one Stivarga patient currently active (maybe two) and this is probably why you haven't received any replies.

You may want to look into a couple of the other recently approved drugs to see if you qualify. Most new immunotherapies now require that certain genetic mutations must be present (or not present) in the tumor for the treatment to be successful. Thus, to see if you qualify for any of these new treatments you would probably have to have these tests done to check on your tumor's mutation profile. This would mean that your doctor would have to request that the resected specimen from your surgery be retrieved from long-term storage and sent to a lab for genomic testing -- unless these tests have already been done before.

The main test required is that of MSI status (Microsatellite Instability). If you look at the pathology report from your original surgery, you can check if there is any entry for MSI status, or dMMR status. You might also need to have BRAF/KRAS testing done -- it depends on what other drug you might be considering to replace Stivarga.

What do you think? Do you want to stay with Stivarga or do you want to look for someting else?

Gloriamazz
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Joined: Thu Jul 12, 2018 1:59 pm
Facebook Username: gloriamazz@ yahoo.com
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Re: Regorafenib Trade Name: Stivarga bob.

Postby Gloriamazz » Fri Dec 18, 2020 12:31 am

Hi Green Tea,

This Chemo drug Stivarga has nothing but bad reviews from people that were taking it. Hardly anyone was on it for long due to bad reactions.

I am very uncomfortable with Stivarga. I was on Irinotecan with FU5. and had a reaction and was taken off. I am not sure if it was the drug or panic attack.
I asked my oncologist yesterday about going back on it it yesterday and was told the fu5 did nothing with the Oxaliplatin

I am going to look up alternatives to Stivarga and check out my pathology report.

Are you a moderator?
Thank you for your help. You are a big help.
June 2018 Colonoscopy
2.6 adenocarcinoma
8/8/18 APR
Colostomy
March 19 CT 2 lung nods
April 29, 2019 Pelvis leision 1.8 x 1.8 cm
7/22 - 7/29/ 2019 5 radi
no chemo 10 month
6-10-19 Folfox, Oxill
2nd Irinotecan , Folferi, FU5
12/14/20 Aborted Folferi
12/14/20 CT tumors grow and new ones
Resume chemo Jan/4/2021 Stivarga using pill
12/14/2020 Folferi not working lung tumors grew and have cluster of new ones
break going on pill drug Jan 2021

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Green Tea
Posts: 292
Joined: Mon Oct 24, 2016 10:48 am
Location: Nusa Tenggara

Re: Regorafenib Trade Name: Stivarga

Postby Green Tea » Fri Dec 18, 2020 2:44 pm

Gloriamazz wrote:... I am going to look up alternatives to Stivarga .

Hi Gloria -

To help you in your search for alternatives to Stivarga, here is a list of FDA-approved drugs for rectal cancer ordered alphabetically by trade name. The conditions and restrictions (if any) are listed to the right of the drug name.

The two drugs indicated in bold are the ones that do not have any restrictions and are recommended by NCCN** for your stage in treatment (i.e., for refractory tumors that have not responded to your particular first-line mCRC treatment). There are several other drugs on the recommended list that may apply, but only if your tumor has the right genetic profile with respect to MSI-status and KRAS/BRAF status.

So, the easiest option right now looks like a possible shift to Lonsurf if you do not have any contra-indications for this drug and if the side-effects profile suits you better.

    Drugs approved for Rectal Cancer, with their FDA approval dates

    2004 Avastin (Bevacizumab) - mCRC 1st line+
    2020 Braftovi (Encorafenib) - mCRC, BRAF V600E only
    2000 Camptosar (Irinotecan Hydrochloride) - no restrictions
    2014 Cyramza (Ramucirumab) - mCRC 2nd line
    2004 Eloxatin (Oxaliplatin) - no restrictions
    2004 Erbitux (Cetuximab) - mCRC 1st line+, KRAS wild type only
    1962 5-FU (Fluorouracil Injection) - no restrictions
    2012 Keytruda (Pembrolizumab) - mCRC 1st line, MSI-H only
    2015 Lonsurf (Trifluridine and Tipiracil Hydrochloride) - no restrictions
    2017 Opdivo (Nivolumab) - mCRC 1st line+, MSI-H only
    2012 Stivarga (Regorafenib) - no restrictions
    2006 Vectibix (Panitumumab) - mCRC 1st line+, KRAS wild type only
    1998 Xeloda (Capecitabine) - no restrictions
    2018 Yervoy (Ipilimumab) - mCRC 1st line+, MSI-H only
    2012 Zaltrap (Ziv-Aflibercept) - mCRC 2nd line,
    2019 Zirabev (Bevacizumab.alt) - mCRC 1st line+

**This information is from NCCN document entitled, "NCCN Guidelines Version 6.2020 Rectal Cancer ". The options for your particular situation are contained in the flowsheet displayed in Section "Rec-F" on page 43 of that document

henny-crc
Posts: 11
Joined: Mon Sep 14, 2020 6:09 pm

Re: Regorafenib Trade Name: Stivarga bob.

Postby henny-crc » Sat Dec 19, 2020 4:01 am

Gloriamazz wrote:Hi Green Tea,

This Chemo drug Stivarga has nothing but bad reviews from people that were taking it. Hardly anyone was on it for long due to bad reactions.

I am very uncomfortable with Stivarga. I was on Irinotecan with FU5. and had a reaction and was taken off. I am not sure if it was the drug or panic attack.
I asked my oncologist yesterday about going back on it it yesterday and was told the fu5 did nothing with the Oxaliplatin

I am going to look up alternatives to Stivarga and check out my pathology report.

Are you a moderator?
Thank you for your help. You are a big help.

Can you get a second opinion from another oncologist? Because thats not how it works. Irinotecan-containing regime is the standard second line, and second line is always prescribed when the first line is not working, like in your case. It has a synergy with 5fu , that makes it work better than 5fu alone. There were a number of people on this forum that failed early/were allergic to oxali and then FOLFIRI/XELIRI helped them.
Dx 06/20
23 yo
Stage 3A
T1N2a

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Green Tea
Posts: 292
Joined: Mon Oct 24, 2016 10:48 am
Location: Nusa Tenggara

Re: Regorafenib Trade Name: Stivarga

Postby Green Tea » Sat Dec 19, 2020 7:49 am

Hi Gloria -
To help clarify the full range of your current options, we need more detailed information from you on which regimens you have been on so far and how/why they failed. From your signature and your recent posts it's not quite clear which regimens you have had so far.

The possible regimens are arranged in a kind of flow chart that starts with 1st-line chemo options, then 2nd-line chemo options, then 3rd-line chemo options, and finally, 4th-line chemo options.

We need to know which regimen (i.e., which drugs) you were on for 1st-line chemo.

Then we need to know which regimen (i.e., which drugs) you switched to when you quit or failed the 1st-line regimen, and so on.

Please be specific. We need to know all of the chemo drugs that you have had, and in which order. This will help determine where your case fits in the flowchart and what the next options are. (There must be more options than just Stivarga(regorafenib) but we cannot tell what these options are without knowing what options you have already exhausted.)

If they started you off on one regimen before you had the recurrence then switched you to a different one when the recurrence occurred, we need the details on both the first and the second regimens. When you mention "oxaliplatin" we need to know which other drugs were in the combination, because oxaliplatin cannot be given alone. It has to be given along with one or two other chemo drugs, for example, as FOLFOX if with 5FU, or FOLFIRINOX if with irinotecan, etc.

Thank You.

==============================================
Hello again,

Here is a tentative overview of your treatment history so far, as best as I can reconstruct it from your signature and from your past posts.

Since August 2018 you have had three types of treatment for colorectal cancer: (1) surgery (APR), (2) post-surgery pelvic radiation, and (3) some chemotherapy. Please review this calendar and make additions and corrections where necessary. All phases of chemo need to be accounted for.

RECONSTRUCTED TIMELINE, DX TO PRESENT (DRAFT)
June 29, 2018, Colonoscopy
July 6, 2018 - DX Malignant Neoplasm of Anal Canal, 3cm adenocarcinoma, T2N0M0,
........................Initial staging: Stage 2A, no chemo or radiation recommended.
August 8, 2018 APR surgery (laparoscopic resection)
TX: No chemo for next 10 months, but antibiotics for infections, abscesses, etc., gall bladder surgery.
March 5, 2019. CT scan - 2 lung nodules noted: Possible remote recurrence in lungs
April 29, 2019 HyperDense Lesion 1.8 x 1.8 cm : Local recurrence in pelvic area, along sciatic nerve
May 25, 2019 Oncologist finally consulted
June 6, 2019 Port installed in preparation for chemo
<No chemo or radiation at all had been administered in the previous 10 months>
<Start FOLFOX regimen 6/10/2019 - first chemo started, 10 months after DX>
June 10, 2019 - Start FOLFOX, Round 1
July 8 , 2019 - Stopped FOLFOX after Round 2; change treatment now from chemo to pelvic radiation
< Start pelvic radiation regimen 7/22/2019>
July 22, 2019: 1st radiation of a total of 5 radiations
<Complete radiation regimen, when? mm/dd/2019 >
<Resume FOLFOX chemo regimen, when? mm/dd/2019 >
<Any change from FOLFOX to a different regimen? to FOLFIRI or FOLFIRINOX perhaps?
<how long on chemo since end of radiation until now? xx months.>
<Aborted FOLFOX regimen definitively on 12/14/2020: >
December 14, 2020 Oxaliplatin terminated after xx rounds. Not working, lung tumors grew and cluster of new ones appeared.
Taking break now over the holidays
<Resume chemo in January 2021 with change to a new, pill-based regimen: Stivarga, or Lonsurf >
January 2021 - ongoing chemo using pill drug

Your diagnosis was over two years ago. I found that the available information was pretty sparse for the past year or so. Some information is either missing or the tasks never done.

For example, what was done about KRAS/ BRAF testing and MSI status testing once Stage IV mCRC was established? What 1st-line mCRC chemo regimen was chosen once Stage IV mCRC was established? Were aggressive regimens like FOLFOX+Avastin, FOLFIRI or FOLFIRINOX ever considered? Were any of the targeted therapies ever considered? What did the tumor board have to say about the best treatment strategy for a local pelvic recurrence combined with mets to the lungs?

How many months of continuous chemo were actually done since FOLFOX chemo resumed over a year ago? Were there any gaps in the chemo regimen over the past year? How many months of chemo altogether?

My main, tentative conclusion right now is that there probably still remain several good 2nd-line and 3rd-line treatment options that could be used before having to turn to Stivarga as a last resort.

If I were faced with this situation, I think that my strategy would be:

First, before my infusion port is removed I would identify the 2nd-line and 3rd-line treatment options that require IV administration and that don't involve 5FU or oxaliplatin, and that don't require genetic testing of the tumor. Then I would discuss these options with the oncologist and come up with the best of these treatment options and request to start on that one in January.

I would leave the pill-only treatment options until after I had tried all of the promising, available IV options that applied to my situation. So, I would not want to use Stivarga or Lonsurf until I had exhausted all of the IV relevant options above.

However, this is just my own frame of mind and my own preference. Others may want to approach the situation differently.

Gloriamazz
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Facebook Username: gloriamazz@ yahoo.com
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Re: Regorafenib Trade Name: Stivarga bob.

Postby Gloriamazz » Mon Dec 21, 2020 5:33 pm

Hi Green Tea,

I have my Chemo drugs and dates

First Line: May 2019 was given Folfox, Oxaliplatin and 5FU ( taken off allergic reaction plus dry foot resulted into
Into ulcerated toe

Second Line: Feb 2020 Irinotecan, Folfiri and 5FU ( taken off Dec 14,2020 not working tumors growing and have new ones
According to CT.

Transcriped Dec 14, 2020
Multiple bilateral pulmonary nodules increased in size from prior CT
Exam Findings are compatible with Metastatic Disease

Multiple New satellite nodules opacities in the left lower lope
No evidense of Bulky intrathoracic lymphadenopathy
Last edited by Gloriamazz on Sun Jan 10, 2021 2:39 am, edited 1 time in total.
June 2018 Colonoscopy
2.6 adenocarcinoma
8/8/18 APR
Colostomy
March 19 CT 2 lung nods
April 29, 2019 Pelvis leision 1.8 x 1.8 cm
7/22 - 7/29/ 2019 5 radi
no chemo 10 month
6-10-19 Folfox, Oxill
2nd Irinotecan , Folferi, FU5
12/14/20 Aborted Folferi
12/14/20 CT tumors grow and new ones
Resume chemo Jan/4/2021 Stivarga using pill
12/14/2020 Folferi not working lung tumors grew and have cluster of new ones
break going on pill drug Jan 2021

Gloriamazz
Posts: 87
Joined: Thu Jul 12, 2018 1:59 pm
Facebook Username: gloriamazz@ yahoo.com
Location: Ohio
Contact:

Re: Regorafenib Trade Name: Stivarga bob.

Postby Gloriamazz » Mon Dec 21, 2020 6:12 pm

Hi Green Tea,

Have Radiation Dates:
July 22, July 24, July 26, July 29 and July 31

Resumed chemo: 8/12/20 Back on Chemo
I have the genetic testing report. This system won’t let me send you the genetic report it is too large to type.
June 2018 Colonoscopy
2.6 adenocarcinoma
8/8/18 APR
Colostomy
March 19 CT 2 lung nods
April 29, 2019 Pelvis leision 1.8 x 1.8 cm
7/22 - 7/29/ 2019 5 radi
no chemo 10 month
6-10-19 Folfox, Oxill
2nd Irinotecan , Folferi, FU5
12/14/20 Aborted Folferi
12/14/20 CT tumors grow and new ones
Resume chemo Jan/4/2021 Stivarga using pill
12/14/2020 Folferi not working lung tumors grew and have cluster of new ones
break going on pill drug Jan 2021

User avatar
Green Tea
Posts: 292
Joined: Mon Oct 24, 2016 10:48 am
Location: Nusa Tenggara

Re: Regorafenib Trade Name: Stivarga bob.

Postby Green Tea » Mon Dec 21, 2020 9:30 pm

Gloriamazz wrote:Hi Green Tea,

Have Radiation Dates:
July 22, July 24, July 26, July 29 and July 31

Resumed chemo: 8/12/20 Back on Chemo
I have the genetic testing report. This system won’t let me send you the genetic report it is too large to type.

Hi Gloria -

Thank you for filling in the missing chemo data. That will clarify a few things. For the genetic testing report, can you check if there is any reference to a MSI(microsatellite instability) test, or a dMMR test? Also, is there any reference to any KRAS mutations?

Many thanks and Merry Christmas! (It looks like it will be freezing cold on Friday/Saturday ... How are you and your family doing these days?)

Gloriamazz
Posts: 87
Joined: Thu Jul 12, 2018 1:59 pm
Facebook Username: gloriamazz@ yahoo.com
Location: Ohio
Contact:

Re: Regorafenib Trade Name: Stivarga bob.

Postby Gloriamazz » Tue Dec 22, 2020 1:29 am

Hi Green Tea,

Here’s what I found:

Immunostaining for MLH1, MSH2, PMS2 and MSH6 shows nuclear expression in the Neo plastic
and internal control tissue.

This result excludes 90 percent of Lynch Syndrome. These test are an imperfect screen because some mutations may not produce loss of immunohistochemical expression.
Further Genetic Testing Maybe Helpful

MSL Functional Testing of the repair Capacity of mismatch repair gene. May be helpful to detect alterations not identified by immunoties to chemical staining alone.

In phase 2 of patients with metastatic carcinoma, reported that clinical benefit of Pembrolicunab, an anti programmed death 1 (PD1) immune check point inhibitor was predicted by the mismatch repair state.

Mismatch repair deficient (DMMR) tumors are more responsible to PD1 blockade than mismatch repair proficient tumors.

Pembrrolizunab is FDA approved for treatment of adult and pediatric patients with unresectionable metastatic solid tumors that display micro satellite instability high (MSI.-H)
Or dmmr by immunohistochemistry)


that clinical benefit of Pembrolicunab, an anti programmed death 1 (PD1) immune checkpoint inhibitor, was predicted by the mismatch repair state.

Mismatch Repair Protein Immunohisto Chemistry Results
MLH1: Norm
MSH2: Normal
MSH3: Normal
PMS2: Normal

Synoptic Report of Key Pathological Findings:

Sigmoid Colon, Rectum, Anus, Colon and Rectum resection
Including Transanal Disk Exicison of RectAl Neoplasms
Tumor Location
Below Anterior Reflection
Greatest Dimension 2.6 CM
Histologic Type -Adenocarcinoma
Histologic grade: G2 Moderately differentiated
Tumor Extension: InvadesthroughMuscolaris propria
Small vessel vascular invasion
Tumor -Budding
O nodes involved
21 nodes tested
Distant Metetasis -not confirmed
Last edited by Gloriamazz on Tue Dec 22, 2020 1:54 am, edited 1 time in total.
June 2018 Colonoscopy
2.6 adenocarcinoma
8/8/18 APR
Colostomy
March 19 CT 2 lung nods
April 29, 2019 Pelvis leision 1.8 x 1.8 cm
7/22 - 7/29/ 2019 5 radi
no chemo 10 month
6-10-19 Folfox, Oxill
2nd Irinotecan , Folferi, FU5
12/14/20 Aborted Folferi
12/14/20 CT tumors grow and new ones
Resume chemo Jan/4/2021 Stivarga using pill
12/14/2020 Folferi not working lung tumors grew and have cluster of new ones
break going on pill drug Jan 2021

Gloriamazz
Posts: 87
Joined: Thu Jul 12, 2018 1:59 pm
Facebook Username: gloriamazz@ yahoo.com
Location: Ohio
Contact:

Re: Regorafenib Trade Name: Stivarga bob.

Postby Gloriamazz » Tue Dec 22, 2020 1:51 am

Hi Green Tea,

Here’s what I found:

Immunostaining for MLH1, MSH2, PMS2 and MSH6 shows nuclear expression in the Neo plastic
and internal control tissue.

This result excludes 90 percent of Lynch Syndrome. These test are an imperfect screen because some mutations may not produce loss of immunohistochemical expression.
Further Genetic Testing Maybe Helpful

MSL Functional Testing of the repair Capacity of mismatch repair gene. May be helpful to detect alterations not identified by immunoties to chemical staining alone.

In phase 2 of patients with metastatic carcinoma, reported that clinical benefit of Pembrolicunab, an anti programmed death 1 (PD1) immune check point inhibitor was predicted by the mismatch repair state.

Mismatch repair deficient (DMMR) tumors are more responsible to PD1 blockade than mismatch repair proficient tumors.

Pembrrolizunab is FDA approved for treatment of adult and pediatric patients with unresectionable metastatic solid tumors that display micro satellite instability high (MSI.-H)
Or dmmr by immunohistochemistry)


that clinical benefit of Pembrolicunab, an anti programmed death 1 (PD1) immune checkpoint inhibitor, was predicted by the mismatch repair state.

Mismatch Repair Protein Immunohisto Chemistry Results
MLH1: Norm
MSH2: Normal
MSH3: Normal
PMS2: Normal

Synoptic Report of Key Pathological Findings:

Sigmoid Colon, Rectum, Anus, Colon and Rectum resection
Including Transanal Disk Exicison of RectAl Neoplasms
Tumor Location
Below Anterior Reflection
Greatest Dimension 2.6 CM
Histologic Type -Adenocarcinoma
Histologic grade: G2 Moderately differentiated
Tumor Extension: InvadesthroughMuscolaris propria
Small vessel vascular invasion
Tumor -Budding
O nodes involved
21 nodes tested
Distant Metetasis -not confirmed

Hi Green Tea,

I live in Ohio and it is freezing. I don’t go out much because of Covid19. Although my daughter caught the Covid, she works in a hospital as ER secretary. She is still off work.

Last year my husband past away although I decorated I am a Grinch. He was sick for 5 yrs

I appreciate your help I didn't know what was going on with me. My daughter goes to the meetings with my Oncologist with me and I am hard of hearing with the shields and mask
wear, I miss a lot of conversation.

There is a member who had nodules and his Dr. gave him Avastan and Folfox and the nodules disappeared.

I didnt know I had a few months to live and was going on a last resort drug that was a big surprise.

The doctors in general are optimistic. If last days on earth they are all smiles.


Have a very Merry Christmas! Ho Ho Ho
June 2018 Colonoscopy
2.6 adenocarcinoma
8/8/18 APR
Colostomy
March 19 CT 2 lung nods
April 29, 2019 Pelvis leision 1.8 x 1.8 cm
7/22 - 7/29/ 2019 5 radi
no chemo 10 month
6-10-19 Folfox, Oxill
2nd Irinotecan , Folferi, FU5
12/14/20 Aborted Folferi
12/14/20 CT tumors grow and new ones
Resume chemo Jan/4/2021 Stivarga using pill
12/14/2020 Folferi not working lung tumors grew and have cluster of new ones
break going on pill drug Jan 2021

User avatar
Green Tea
Posts: 292
Joined: Mon Oct 24, 2016 10:48 am
Location: Nusa Tenggara

Re: Regorafenib Trade Name: Stivarga

Postby Green Tea » Tue Dec 22, 2020 7:54 am

Hi Gloria -
Thanks for the reply and for the extra info. I'm so sorry to hear about the loss of your husband. You have been through so many hard times these past few years.

I have a new, tentative, revision of your treatment history, but I won't be able to do much background research on this right now because of the Christmas holiday. What it looks like is the following:

Your 1st-line chemo regimen was standard FOLFOX, but it was cut short because of intolerance to oxaliplatin.

Your 2nd-line mCRC regimen was FOLFIRINOX, which lasted until about a week or so ago, when it stopped working.

Now you are being proposed a 3rd-line regimen of Stivarga (regorafenib), or maybe Lonsurf (trifluridine/tipiracil).

You were not offered FOLFOX+Avastin or FOLFIRI+Avastin, probably because Avastin is not recommended when there are wound-healing problems or abscesses. Avastin retards wound healing.

For probably the same reason you were not offered Zaltrap or Cyramza -- these regimens, too, are incompatible with good wound healing.

You were not offered Keytruda (pembrolizumab) most probably because your dMMR immuochemistry test suggested that your tumor was not MSI-High; rather, all 4 relevant proteins expressed as normal, so your tumor could not be MSI-High which is required for administering Ketruda successfully.  It's the same for Opdivo and Yervoy.  These regimens, too, require MSI-High in order to be successful.

This leaves Erbitux and Vectibix as possibilities, but they require KRAS-normal status.  It is not clear why they did not offer either of these two targeted therapies.  Maybe they did a KRAS test and found out that the tumor was KRAS-mutant. If that were the case, theni they couldn't use either of the two because they both require KRAS-normal status in order to work. Do you have any information about your BRAF/KRAS mutation status?

If the above assumptions are correct, then you are left only with Stirvaga or Lonsurf as possibilities.  I don't think that the new drug Braftovi (encorafenib) would be a possibility because it requires BRAF V600E mutation, and I don't know if your tumor was ever tested for that.

So, that is my tentative summary about your treatment history and the possible reasons why certain promising drugs were never used.

Please note that I am not an oncologist and I don't ordinarily do research on Stage IV treatment options, so what I have said should be taken with a grain of salt.Your oncologist would be a better resource for a definitive opinion.

Take care, keep warm, and keep safe!


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