Colorectal cancer metastasis to liver and lung

[Alex83]

In November 2017 my mom (65 years old) had an operation in colon, doctor found a tumor (7*4*3 cm) and the pathology result was: adenocarcinoma moderate differentiate and 3 lymph nodes was Mal out of 9.
Unfortunately my mom didn't take a chemotherapy treatment after the operation, but while the checking up in September 2018 the ct scan showed (lessions in liver and nodules in lung the biggest was 20 mm ).
We have started the trip, the oncologist suggested to be having metatsis and the status is stage 4.
Mom started the treatment cycle (oxaliplatin and avastin) for 9 cycle along with Xeloda drugs each 14 days with 1 week rest.
the result was good and in January 2020 the nodules gone and the disease consider stable.
in 13th may 2020 the CT scan showed nodules in lung aging and the biggest was 25mm and the cea test is 3.78. So the oncologist suggested to start a new treatment (folfiri +zaltrap) starting from today 1st June 2020 every 14 days for 6 cycle and then checking up on CT scan.

My question is anyone try the protocol folfiri and zaltrap and what is the side effect of that protocol? Anyone has the same status of mom.

PS: the kras mutated is g12c.

Thanks a lot
Alex

[claudine]

Hello Alex,
I had to google Zaltrap as I'd never heard of it. It looks like it's similar to Avastin, with the same goal of cutting blood access to the tumors. That part of the treatment shouldn't give your mom side effects that are different than when she was on Avastin - for my husband, it was bloody nose when he'd blow it, but that's about it. Your mom was on Avastin before; any reason they're switching to Zaltrap now?
Folfori - some people here report heavy fatigue, intense nausea; but not DH, compared with his previous chemo (Xeloda + Oxaliplatin) Folfiri was a breeze. A little fatigue, but not much; no nausea to speak of (except towards the end of treatment - he had 18 cycles) ; hair thinning, but he never got completely bald, and it's all grown back since.
But like I said, others have been hit really hard by Folfiri. Fingers crossed your mom isn't one of them, and that the treatment hits her mets hard!

[boxhill]

Alex, why didn't your mom have chemo after surgery with lymph node involvement? How often was she scanned?

It sounds like things are back on track now, but I'm wondering if anyone has discussed maintenance chemo, assuming she responds to this? Has there been any discussion of any of the possible non-chemical lung treatments?

ETA: I just reread your post, and I'm not sure whether the liver lesions are gone...

[Alex83]

Hello Alex,
I had to google Zaltrap as I'd never heard of it. It looks like it's similar to Avastin, with the same goal of cutting blood access to the tumors. That part of the treatment shouldn't give your mom side effects that are different than when she was on Avastin - for my husband, it was bloody nose when he'd blow it, but that's about it. Your mom was on Avastin before; any reason they're switching to Zaltrap now?
Folfori - some people here report heavy fatigue, intense nausea; but not DH, compared with his previous chemo (Xeloda + Oxaliplatin) Folfiri was a breeze. A little fatigue, but not much; no nausea to speak of (except towards the end of treatment - he had 18 cycles) ; hair thinning, but he never got completely bald, and it's all grown back since.
But like I said, others have been hit really hard by Folfiri. Fingers crossed your mom isn't one of them, and that the treatment hits her mets hard!

Sounds good caludine, while mom took avastin there were not much side effects. And the oncologist said after 6 cycle of (folfiri+zaltrap) she will be checking up on CT. How ever what we need is to become stable with clear CT
Thanks

[Alex83]

Alex, why didn't your mom have chemo after surgery with lymph node involvement? How often was she scanned?

It sounds like things are back on track now, but I'm wondering if anyone has discussed maintenance chemo, assuming she responds to this? Has there been any discussion of any of the possible non-chemical lung treatments?

ETA: I just reread your post, and I'm not sure whether the liver lesions are gone...

Mom didn't take chemo after surgery since the doctor said everything are fine and no need to have chemo (it is just 3 nodes out of seven)
But while we check up after 7 months the nodules on lungs and livers appears. And yes now there are no lessions on liver after 1st line chemotherapy.
I'm really scared about what will happen if the 2nd line therapy become inactive.
I always pray.

Thanks

[Alex83]

Hello Alex,
I had to google Zaltrap as I'd never heard of it. It looks like it's similar to Avastin, with the same goal of cutting blood access to the tumors. That part of the treatment shouldn't give your mom side effects that are different than when she was on Avastin - for my husband, it was bloody nose when he'd blow it, but that's about it. Your mom was on Avastin before; any reason they're switching to Zaltrap now?
Folfori - some people here report heavy fatigue, intense nausea; but not DH, compared with his previous chemo (Xeloda + Oxaliplatin) Folfiri was a breeze. A little fatigue, but not much; no nausea to speak of (except towards the end of treatment - he had 18 cycles) ; hair thinning, but he never got completely bald, and it's all grown back since.
But like I said, others have been hit really hard by Folfiri. Fingers crossed your mom isn't one of them, and that the treatment hits her mets hard!

Mom shifted to zaltrap and folfiri protocol after last CT in May 2020 showing lung nodules (biggest is 25mm) and she was treated with oxapalatin and avastin (9 cycles) and Xeloda since October 2018

[Alex83]

Hello,
Today we went to lab to inspect the MSI.
does anyone has an idea about this test?
I read a lot of article about it, I came to know that there are 3 resuls: MSI-H (high) and MSI-L (low) and MSS (stable).
so which result is the best and how it helps the treatment?

Thank you

[claudine]

People who are MSI-H are good candidates for immunotherapy; from what the oncologist told us, that is the case for only about 5% of CRC folks, unfortunately. But some people who are MSS can also benefit from it, if their mutation burden is high - there was a long thread a while back about this (you can do a search on mutation burden in this forum).

[Rock_Robster]

Hello,
Today we went to lab to inspect the MSI.
does anyone has an idea about this test?
I read a lot of article about it, I came to know that there are 3 resuls: MSI-H (high) and MSI-L (low) and MSS (stable).
so which result is the best and how it helps the treatment?

Thank you

Just to add to the above, my understanding is that MSI-L is the same as MSS (ie low instability is the same thing as stable). Happy to be corrected on this however.

[beach sunrise]

Hey Rob, I was told I was MSI- because report said low probably of MSI. So I would say you are correct.

[Alex83]

Hello,
Today i got the result of (MSI)
no loss of nuclear expression of mmr proteins: Low probability of MSI-H, so that means the patient not a good candidate of immunotherapy?

[Rock_Robster]

Hello,
Today i got the result of (MSI)
no loss of nuclear expression of mmr proteins: Low probability of MSI-H, so that means the patient not a good candidate of immunotherapy?

Correct, it means the currently approved immunotherapies (being anti-PD-1 checkpoint inhibitors) are very unlikely to work. There may be other useful immunotherapies available through clinical trials however.

[boxhill]

Mom didn't take chemo after surgery since the doctor said everything are fine and no need to have chemo (it is just 3 nodes out of seven)

Okay, I am not a doctor. But this has me fuming. In the first place, 7 is a VERY low number of lymph nodes to biopsy. Recommendations have varied, but AT LEAST 12 has been recommended, more if possible. The lower the number of nodes taken, the higher the chances of recurrence due to missed disease. As a patient with almost 50% of sampled lymph nodes positive, I think that most--if not all--competent oncologists would DEFINITELY recommend adjuvant chemo for a patient of your mother's age! And this wasn't a decade ago, this was 2017!!

Was this doctor a surgeon or an oncologist? Whatever his/her specialty, I sincerely hope your mother is not using that doctor now. It's not my business, I know, but I would have no confidence in him/her. I hate to see people get sub par treatment that doesn't even explore more aggressive strategies that aim for NED. It makes me angry.

[Alex83]

Mom didn't take chemo after surgery since the doctor said everything are fine and no need to have chemo (it is just 3 nodes out of seven)

Okay, I am not a doctor. But this has me fuming. In the first place, 7 is a VERY low number of lymph nodes to biopsy. Recommendations have varied, but AT LEAST 12 has been recommended, more if possible. The lower the number of nodes taken, the higher the chances of recurrence due to missed disease. As a patient with almost 50% of sampled lymph nodes positive, I think that most--if not all--competent oncologists would DEFINITELY recommend adjuvant chemo for a patient of your mother's age! And this wasn't a decade ago, this was 2017!!

Was this doctor a surgeon or an oncologist? Whatever his/her specialty, I sincerely hope your mother is not using that doctor now. It's not my business, I know, but I would have no confidence in him/her. I hate to see people get sub par treatment that doesn't even explore more aggressive strategies that aim for NED. It makes me angry.

Actually the surgeeon did that during the surgery and he removed the tumor, whatever after 8 months we follow up with CT scan and it showed the metastases then we start with the oncologist.
You are right the hospital should advise the patient what to do.

[boxhill]

Actually the surgeon did that during the surgery and he removed the tumor, whatever after 8 months we follow up with CT scan and it showed the metastases then we start with the oncologist.

I am shocked that your mother was not referred to an oncologist after surgery, since she had positive lymph nodes. I am also very surprised that they waited that long to do a scan.

I suppose that it water under the bridge at this point, but I would be wary of the standard of care where you live. It's good that you are here and asking questions.