Chemotherapy for Stage 2A

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demievent
Posts: 3
Joined: Sun Mar 28, 2021 12:52 am

Chemotherapy for Stage 2A

Postby demievent » Fri Apr 02, 2021 4:33 am

Hello All,

This is my first post in this forum, I have to say that it's very very informative and supportive. Thanks to all the users for making it so.

Some context on his journey so far:

My dad (67) has been diagnosed with Stage 2A colon cancer. It's been a rough few months.

We first started noticing weight loss and tiredness. Took a few blood tests which pointed towards anemia (low hemoglobin levels). Tried to improve the levels through meds for about a month, when that did not work. Our local doc ordered an occult fecal blood test which was positive. Took abdomen CT which showed wall thickening and regional enlarged nodes.

In he went for a colonoscopy which found a malignant adenocarcinoma in the ascending colon confirmed by biopsy. Next step was research to find the best surgical oncologist in the city with a DaVinci robot and we successfully found a great one. Took a few more scans which did not show metastasis. Surgeon performed a right hemi-colectomy with complete mesocolic excision. He's recovering well from the surgery.

Pathology came back as:

- 0/25 nodes positive
- negative margins
- no LVI, PVI
- T3 tumor
- no perforation of colon wall or spread to nearby organs
- no tumor deposits
- MSI stable
- intermediate tumor budding

Note: Pre Surgery CEA was 5.49

So staged at 2A (T3N0M0). The surgical oncologist did not want to interfere in the chemo decision since it's already a well known debated grey area for 2A. So we were referred to a medical oncologist.

Our conversation with the oncologist was straight forward, they said that since it is not MSI-H, there would be a response to chemo and hence we're going to do a 3 month CapOx regime.

My questions:


1. From what I've researched the standard case for low risk 2A is either surveillance or Xeloda for six months. While we're definitely willing to do chemo if needed, CapOx seems too aggressive for the above features. I'm not sure if there are a lot of high risk features hence I am assuming it is low risk, please do correct me if I am wrong in that assumption, if it is high risk - then perhaps CapOx is warranted.
2. My major concern is whether my dad would be able to handle the chemo. I know 3 months is better than 6 months for neuropathy but still worried a bit about the Oxy. Would love to see some experiences from someone who's had had 3 months of CapOx / Xelox

Beckster
Posts: 438
Joined: Thu Jan 12, 2017 3:01 pm
Location: New Jersey

Re: Chemotherapy for Stage 2A

Postby Beckster » Sat Apr 03, 2021 6:01 am

Welcome to the group!

I was diagnosed with stage 2A right sided colon cancer in 2016. During my first screening, they found the mass. I had no symptoms and my bloodwork was excellent and my CEA was 1.9. With that said, I had 2 high risk factors, which both are subjective....LVI and G3 tumor. Most right sided tumors have these risks. My oncologist is from a major cancer center, MD Anderson, and he recommended 6 months of Capeox and it was up to me whether I wanted to do chemo or not. I decided to take chemo to lower my risk of recurrence due to my age; however, I was allergic to the OXI in the first infusion and finished with 6 months of just Xeloda. Your dad had a 5.9 CEA and had a low blood count. What was the grade of the tumor and was pathology done at a major cancer center? My suggestion would be to have a second opinion with a major cancer center because there are stage II people on this forum who had their pathology change. You can also request a Signatera test, which is a molecular test for the detection of circulating tumor DNA (ctDNA) in the blood of patients previously diagnosed with cancer and it will guide your treatment decision. If you have any questions, feel free to contact me.
57/F
DX:(CC) 10/19/16
11/4/16- Lap right hemi(cecum)
CEA- Pre Op (1.9), Pre Chemo (2.5)
Type: Adenocarcinoma
Tumor size:3.5 cm x 2.5 x 0.7 cm
Grade: G3
TNM: T3N0M0/IIA
LN: 0/24
LVI present
Surgical margins: clear
MSS
12/27/2016 - Capeox, anaphylactic
1/2/17 to 6/9/17- Xeloda
6/17,12/17,6/18,12/18,6/19,12/19,12/20,12/21 CT Scan NED :D
CEA- 6/17- 3.6, 9/17- 2.8 12/17-2.8, 3/18-3.1, 6/18-3.0, 9/18 2.8, 12/18 2.5 3/19 3.1 6/19 3.1 9/19 2.6 12/19 2.8 6/20 3.0 12/20 2.7 6/21 2.9,[color=#000000]12/21 2.7[/color]
Clear Colonoscopy 10/17, 11/19,11/21 :D

Beckster
Posts: 438
Joined: Thu Jan 12, 2017 3:01 pm
Location: New Jersey

Re: Chemotherapy for Stage 2A

Postby Beckster » Sat Apr 03, 2021 6:13 am

Below is a link to a previous post that shows the importance of the pathology report...

viewtopic.php?f=1&t=62768&hilit=MSK+second+opinion
57/F
DX:(CC) 10/19/16
11/4/16- Lap right hemi(cecum)
CEA- Pre Op (1.9), Pre Chemo (2.5)
Type: Adenocarcinoma
Tumor size:3.5 cm x 2.5 x 0.7 cm
Grade: G3
TNM: T3N0M0/IIA
LN: 0/24
LVI present
Surgical margins: clear
MSS
12/27/2016 - Capeox, anaphylactic
1/2/17 to 6/9/17- Xeloda
6/17,12/17,6/18,12/18,6/19,12/19,12/20,12/21 CT Scan NED :D
CEA- 6/17- 3.6, 9/17- 2.8 12/17-2.8, 3/18-3.1, 6/18-3.0, 9/18 2.8, 12/18 2.5 3/19 3.1 6/19 3.1 9/19 2.6 12/19 2.8 6/20 3.0 12/20 2.7 6/21 2.9,[color=#000000]12/21 2.7[/color]
Clear Colonoscopy 10/17, 11/19,11/21 :D

demievent
Posts: 3
Joined: Sun Mar 28, 2021 12:52 am

Re: Chemotherapy for Stage 2A

Postby demievent » Sat Apr 03, 2021 7:46 am

Beckster wrote:Welcome to the group!

I was diagnosed with stage 2A right sided colon cancer in 2016. During my first screening, they found the mass. I had no symptoms and my bloodwork was excellent and my CEA was 1.9. With that said, I had 2 high risk factors, which both are subjective....LVI and G3 tumor. Most right sided tumors have these risks. My oncologist is from a major cancer center, MD Anderson, and he recommended 6 months of Capeox and it was up to me whether I wanted to do chemo or not. I decided to take chemo to lower my risk of recurrence due to my age; however, I was allergic to the OXI in the first infusion and finished with 6 months of just Xeloda. Your dad had a 5.9 CEA and had a low blood count. What was the grade of the tumor and was pathology done at a major cancer center? My suggestion would be to have a second opinion with a major cancer center because there are stage II people on this forum who had their pathology change. You can also request a Signatera test, which is a molecular test for the detection of circulating tumor DNA (ctDNA) in the blood of patients previously diagnosed with cancer and it will guide your treatment decision. If you have any questions, feel free to contact me.


Hey Beckster,

Thanks for your response!

We do not live in the US, but the path was done at a major cancer center in our country. It's pretty well known around here. The grade was moderately differentiated. Again, there was no LVI in my dad's case according to the path report.

I looked through the thread you've linked, great info. I will also ask about the Signatera test.

It's actually the Oxy I'm a bit scared about. I've heard folks say just the Xeloda was doable. That's why I'm thinking if 6-month Xeloda would be the way to go instead of 3 month CapOx (assuming chemo is needed - which is also debatable here I guess? But definitely can agree to taking the chemo to reduce recurrence).

User avatar
JJH
Posts: 408
Joined: Mon Apr 24, 2017 7:26 am

Re: Chemotherapy for Stage 2A

Postby JJH » Sun Apr 04, 2021 12:30 am

demievent wrote: ...
2. My major concern is whether my dad would be able to handle the chemo. I know 3 months is better than 6 months for neuropathy but still worried a bit about the Oxy. Would love to see some experiences from someone who's had had 3 months of CapOx / Xelox

I was on Xelox for just short of 3 months. I was supposed to have 6 rounds of Xelox, but the doctor stopped all chemo when I ended up on life support in the Intensive Care Unit (ICU) at the beginning of my 4th round (i.e., after only 2.5 months on chemo). The doctor didn't say whether the problem was due to oxaliplatin or due to Xeloda. He just said that I was not fit enough to have any more chemo of any kind. I was about the same age as your father when I was diagnosed, and I had multiple comorbidities -- hypertension, overweight, hypothyroidism, high cholesterol, etc. ... Maybe you should ask your father whether he has any comorbidities that might be exacerbated by a powerful chemo regimen.
"The darkest hour is just before the dawn" - Thomas Fuller (1650)
●●●

Rock_Robster
Posts: 1021
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: Chemotherapy for Stage 2A

Postby Rock_Robster » Sun Apr 04, 2021 9:05 am

I’m sorry about your news, but glad you found this group.

This is such a tough call. I must say that my first impression based on what you describe was that CAPOX feels like overkill. This is a clear 2A with no additional high risk factors (except perhaps a slightly bulkier T3 tumour). The post-surgery cure rate from this diagnosis is very good, and chemo is not without risks in itself, and many of the side effects are long-term and irreversible - particularly anything involving oxaliplatin. These risks are amplified in an older gent, of course. Just as an example I had a pretty severe reaction to my 8th oxaliplatin dose and ended up being hospitalised - it was a scary night for everyone involved and a rough recovery (I dropped weight like crazy - almost 10kg in 2 weeks), and I was an otherwise-fit 36 year old guy.

My personal leaning would be toward capecitabine monotherapy, or no chemo - but I’m not a doctor of course. Perhaps you could ask your doctor to describe the overall survival benefit he expects from CAPOX in cases like your dad’s, over say the Xeloda or no adjuvant chemo?

Best of luck,
Rob

PS: I know you’re not in the US, but you might find pages 40-41 of the NCCN Guidelines quite relevant to this situation, including the risk factors: https://www.nccn.org/patients/guideline ... atient.pdf
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

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

Re: Chemotherapy for Stage 2A

Postby boxhill » Mon Apr 05, 2021 10:15 am

I think my question here is why Capox, not Folfox. Capox includes Xeloda, which is more likely to cause hand/foot symptoms than 5FU, and, if I am not mistaken, more rapid and intense infusions of oxaliplatin that may be more likely to cause a reaction than the 2-hour infusions of Folfox.

Yes, Capox may be more powerful, but does your father need it, given that his need for adjuvant chemo is marginal? Folfox is standard of care, so it is not a lesser regimen.

It is comparatively unlikely that your father would develop any long term side effects from the oxy in a short course of 3, or perhaps 4, rounds of folfox.

Unless your father has other really significant medical issues, there's no reason why his age should be an issue. I was diagnosed just a couple weeks before my 65th birthday, and tolerated my 12 rounds of folfox well. Yes, the intense fatigue and cold sensitivity of week one was unpleasant every time. The wear and tear tends to be cumulative, so 3 or 4 rounds is a far cry from 8 or more. Chemo is not fun. But for most of us it is doable.

What is your father's POV?
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

Beckster
Posts: 438
Joined: Thu Jan 12, 2017 3:01 pm
Location: New Jersey

Re: Chemotherapy for Stage 2A

Postby Beckster » Mon Apr 05, 2021 11:35 am

Stage 2 is a grey area. I was offered Capeox, Folfox or no chemo. Because I did not want a port, I opted for Capeox. Again, I had two high risk factors. If I was low risk, my onc would not have put me on chemo. I guess I am having a hard time understanding why the Oncologist is recommending a chemo that includes Oxy. If he is low risk with no factors, I do not understand why he can not do just Xeloda for 6 months or not do chemo at all. I did Xeloda and it was doable...yes hand and foot is common, but they can adjust the dosage. As stated, I had stage 2 and we tend to be the forgotten child. They are still doing research to find if adjunct chemo lowers the recurrence rate.
57/F
DX:(CC) 10/19/16
11/4/16- Lap right hemi(cecum)
CEA- Pre Op (1.9), Pre Chemo (2.5)
Type: Adenocarcinoma
Tumor size:3.5 cm x 2.5 x 0.7 cm
Grade: G3
TNM: T3N0M0/IIA
LN: 0/24
LVI present
Surgical margins: clear
MSS
12/27/2016 - Capeox, anaphylactic
1/2/17 to 6/9/17- Xeloda
6/17,12/17,6/18,12/18,6/19,12/19,12/20,12/21 CT Scan NED :D
CEA- 6/17- 3.6, 9/17- 2.8 12/17-2.8, 3/18-3.1, 6/18-3.0, 9/18 2.8, 12/18 2.5 3/19 3.1 6/19 3.1 9/19 2.6 12/19 2.8 6/20 3.0 12/20 2.7 6/21 2.9,[color=#000000]12/21 2.7[/color]
Clear Colonoscopy 10/17, 11/19,11/21 :D


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