Erbitux vs. Avastin

[ketel]

Hi gang,

I am recently dx'd Stage III and looking down the long barrel of chemo. (surgery was a few weeks back.) Docs I have all met with are all recommending the standard FULFOX protocol.

However, I am trying to better understand the value/feasibility of complementing the FULFOX with another compound -- either Avastin or Erbitux. Some onc docs I am speaking with are big fans of one or the other and are interested in prescribing one of these in addition to the FULFOX. My orientation is to go for it given the advanced stage of my condition.

Has anyone used either or both of these in combo with their chemo. If so, please reply. The more feedback the better -- good, bad or indifferent. This is a big decision for me. I am reluctant to only do the standard FULFOX protocol if there are other compounds available that can improve my chances.

Thanks in advance.

ketel

[MissKim]

I am stage IV and I did FOLFOX6 with Avastin. My CEA tumor marker dropped like a rock while I was on this regime. Avastin had no nasty side effects for me. I have also done Camptosar with Erbitux. The Erbitux really dried out my skin and cause some problems with my toenails. I have done alot of chemo (3 reoccurrences) but I am determined to keep fighting. Good luck with your decision.

Miss Kim

[Christine]

I'm stage IV and did FOLFOX with Avastin. I had an excellent reaction to it and it shrunk the tumors in my liver to the point that they were resectable. Now I have no evidence of disease remaining.

I concur with Miss Kim that Avastin really doesn't have noticeable side effects. I've actually been receiving it alone for the last couple of months (due to low platelets, I cannot have any chemo drugs right now).

[skier03]

Hi Ketel,

I was diagnosed at Stage III c 2 years ago. I had rectal cancer, so radiation and chemo are the norm. However, given my age and gender (22 yo female), the effects of radiation were unacceptable for me and my family. Needless to say, we sought other options, and settled on FOLFOX & Erbitux. After surgery, we found that it was in 5 of 17 nodes, so we added Avastin to the mix. So I had FOLFOX + Erbitux + Avastin.

Erbitux at the time, was considered the new "miracle drug". It works similarly to Avastin in that it cuts off the blood supply to the tumor. The side effects are a rash - which it is believe that the worse the rash, the better the drug is working - and very dry skin. It is uncomfortable, but bearable.

Avastin also cuts off the blood supply to the tumor. It is generally a Stage IV drug, although it seems that more and more doctors and patients are using it to fight Stage III. There are no visible side effects, but it does effect your blood. The risks are blood clots, stroke, heart attack, bleeding, etc. Not to freak you out - the doctors told me that the chances of these things happening are only slightly higher than any other chemo regimine. But I did get bloody noses, and the doctors just like to keep close tabs on any other bleeding.

I have recently been diagnosed with mets, so I am on FOLFIRI + Avastin this time around.

My personal opinion is that if you have the option of receiving either or both of these drugs, you definitely should! They have both done wonders for me and for so many others (especially the Erbitux). Good luck with your decision, and if you have any other questions, please let me know.

Stay strong!

Skier03

[ketel]

Hi Skier03 -

Thanks SO much for your reply. I have been just a wreck lately debating what regime to go on and your comments really help. I need to make a decision pretty fast.

Here's where I am: I am stage III c also. I had 8 nodes positive (of 22 taken out). So...we are pretty close in stage. I had an extensive right hemicolectomy 4 weeks ago and now ready to start chemo.

I have met two onc docs here in SF. Both are considered top notch, but both have been reluctant to go beyond FOLFOX. Given my stage I REALLY want more than just the standard FOLFOX protocol. What also complicates my case is that I have what is called signet cell type cancer, which is considered especially aggressive. Finally, like you, I am relatively young (41) so I am more inclined to be as aggressive as possible now and not wait until my condition gets more serious. Sometimes I feel the docs are too conservative for me.

So, I have 3 questions for you:

1. Where are you being treated and how is it that you have found docs so willing to get you both Erbitux and Avastin when you are Stage III? I am getting a lot of resistance.

2. Are you encountering problems getting either Avastin or Erbitux approved with your insurance?

3. I take it from your last comment that you have had a recurrence. Is this true? If so, how long were you in remission and what are your docs now prescribing for you.

I look forward to your reply. If easier, you can also just email me at: jtower@citroncapital.com or call 415.810.1598.

Thanks so much.

ketel

[skier03]

Hi Ketel,

I e-mailed your personal e-mail address given in the post with responses to your questions. So check that out and let me know if I can help anymore.

Good luck!

Skier03

[Lifes2short]

Ketel,
My diagnosis and age are similar to yours. But I'm fairly conservative when it comes to treatment. Here's my story. Hope it helps.

Dx last December with Stage III n1 (or n2 depending which notes I look at) at age 41. I did concurrent radiation and chemo - ended up with eight painful weeks of radiation. Surgery in March with 19 out of 26 lymph nodes positive. Three of the nodes were fairly distant, two in the groin and one in the presacral area. So I came out of surgery knowing that I am an advanced stage III patient. In April we did a CT scan to use as baseline for chemo and found mets to my liver.

It might be worth noting that I had a pretty bad oncologist until recently. She was very distant and uninvolved. She intended to treat my advanced Stage III cancer with 5FU and Leukovoran. When I questioned why she wasn't being more aggressive, her reply was "this is what we do for stage III". End of discussion.

When the Stage IV diagnosis came, she recommended Folfox4 and Avastin. But she told me I was terminal, had months to a couple years to live and that the chemo would likely only buy me an additional three to four months. I tried to discuss various surgical options with her and she informed me that I am not a candidate.

So I chose to skip chemo and enjoy as much healthy time as possible with my two small children. We left the door open for chemo later when the cancer syptoms increased.

I am happy to say that I had a very fun and healthy summer with my kids. I visited friends and family and lived very well - all the while thinking that this might be my last summer.

As fall came on I was feeling more fatigued, losing more weight and my appetite was very bad. I decided it was time to give chemo a try. I did a lot of reading on Avastin and the potential for side effects scared me. So I opted not to have it. My Oncologist never discussed this decision with me. She just plain didn't care.

Right around this time I ran into a surgeon who told me that they are routinely doing liver resections on young healthy people like me. He looked at my scans and told me that I am a good candidate for resection. (I have five liver mets with the biggest one measuring 7cm). That changed everything. I got aggressive and found a great new Oncologist. My new Oncologist is up to date on all the latest treatments and stats. He pushed hard for me to consider Avastin. I was just about to begin my third round of chemo when I switched to him. So we agreed to do one more round w/out Avastin and see what the scans said.

I am happy to say that my latest CT scan shows shrinkage of all my liver mets. Even without the Avastin. But I did chose to follow my new oncologist's advice and I used Avastin on my most recent (4th) round of chemo. It did not increase my side effects. As a matter of fact, this has been the easist round yet.

I'm not sure what I'd do if I were you. The Folfox obviously does work alone and I'm always one to chose the least invasive and least toxic approach. Avastin appears to be doing wonderful things, but there is not yet any data available on long-term effects of the drug. It is simply too new. So I use it and hope for the best, but I can't say that I would if I were still considered stage III.

Best of luck to you in whatever decision you make.

[Hannah]

Hey there ketel,

I would definitely think about getting on FOLFOX + either Erbitux or Avastin. Although neither is "proven" or "standard" therapy for stage III, it is pretty evident that it won't hurt you, and may actually help. Since your insurance may not want to cover the costs, you may be able to get it through a clinical trial. Here are some trials that you might qualify for:

Phase III trials:
- http://www.emergingmed.com/pub_search_t ... e_sys_id=0
- http://www.emergingmed.com/pub_search_t ... e_sys_id=0
Phase II trial:
http://www.emergingmed.com/pub_search_t ... e_sys_id=0

Just FYI, this is from a 2005 press release from the American Society of Clinical Oncology: "New data from three clinical trials demonstrate that Erbitux(R) (cetuximab) in the first-line setting shows a consistently high response rate, leading to an increased potential for surgical intervention in patients whose metastases have previously been inoperable.(1-3) These preliminary findings, released today at the 41st annual meeting of the American Society of Clinical Oncology (ASCO), reinforce the potential of Erbitux not only to delay time to disease progression, but also the ability to shrink metastases to allow surgical resection with curative intent.(1-3)"

This study was for metastatic (stage IV) disease, but trial after trial has shown that Erbitux (and Avastin) have only added benefit with little chance of hurting you (like with any treatment, there ARE side effects that you need to be aware of, and some can be serious).

The bottom line is that if you have an oncologist who is not on the same page as you are, get a new oncologist with whom you can work. I would say that despite the lack of "hard" evidence, you should definitely consider FOLFOX + Erbitux or Avastin. You need a doctor who is "with it" in terms of your attitude and agressiveness. Look into getting what you need - whether that is through a clinical trial or finding a doctor who will prescribe this for you and go to bat with your insurance company.

Hannah