Stage 4 Chemo Break??

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csfl
Posts: 4
Joined: Mon Apr 06, 2020 3:48 pm

Stage 4 Chemo Break??

Postby csfl » Tue Jan 05, 2021 1:36 pm

My sister’s local oncologist recommended the “chemo for life” approach when she was diagnosed stage 4. (She did say that she could take short breaks occasionally.) We met with a doctor at MSK for a second opinion. He said that since nothing was showing on her most recent scan, he would be inclined to recommend a 3 month break and then re-scan. She has been tolerating the Folfiri pretty well after being taken off Folfox due to Oxi reaction. The MSK doc is supposed to talk to her local onc. My sister is nervous to stop chemo in case the cancer starts growing again. Any advice for chemo breaks for stage 4 patients?
Caregiver for 45 y/o sister
1/20-diagnosed stage 4 CC signet ring type (1 spot on liver/1 precardiac ln)
MSS with no other mutations
2/20-right hemicolectomy due to partial blockage
3/20-5/20 5 rounds Folfox/Avastin
5/20-current-switched to Folfiri/Avastin due to Oxi reaction
11/20 CT scan showed no evidence of nodal/liver mestasis
2/21-clean scan, start 2 month chemo break

Claudine
Posts: 524
Joined: Tue Mar 12, 2019 2:41 pm
Location: Montana

Re: Stage 4 Chemo Break??

Postby Claudine » Wed Jan 06, 2021 9:36 am

Good morning,
My husband (also stage 4) has been on break for a year now, after 18 cycles of Folfiri plus Avastin. His CEA values are rising but his scan his stable; his onc said, « we treat for quality of life, and we don’t treat numbers » and in the chart wrote that he recommends the break continues until something does show up on scan. He told my husband that studies do not show any benefit of doing chemo when the only sign of cancer is a high CEA.
I have to say, my husband is very happy not to have chemo; we also feel that should he need to resume it, the break gave his body lots of time to build his strength back up (he cycles a lot, 10-20 miles a day), grow back his hair and beard, and this way he did not develop resistance to a treatment that worked well for him.
Just a personal opinion, but we’re all for a break! His onc does not seem to be a « chemo pusher », either...
Wife of Dx 04/18 (51 yo). MSS, KRAS G12A
No primary (involuted?)
Lytic tumor L4 vertebrae, EBRT 04/18, SBRT 02/19
Resect small intestine 05/18 (no cancer - Crohn's)
Failed adjuvant Xelox
Folfiri + Avastin 03/19 to 01/20
6.7 cm left adrenal mass 03/19, successful resection 02/20
CEA since 03/19: high 58, low 3.2, now 75.5
Scan 03/19: Multiple small lung nodules, now gone/calcified
PET 04/20 uptake by L4
L3-L4-L5 fusion surgery and partial corpectomy 05/20
Scan 06/17/2021: stable

Brearmstrong
Posts: 107
Joined: Sun Mar 26, 2017 3:24 pm
Location: CT

Re: Stage 4 Chemo Break??

Postby Brearmstrong » Wed Jan 06, 2021 8:14 pm

I have also been on chemo break since last surgery in August. Microscopic cancer cells were found in the wash during surgery but I had been on chemo for four years so my oncologist has me on a break to regain strength and weight, etc. i also was lucky to have Signatera testing but after surgery was still slightly positive at 0.1. So, we know it will show up again at some point. It is scary but just trying to squeeze the most out of this time for as long as it lasts. Surreal though to feel like a normal person again.
48 F Jan 17 2 sons
tumor appendix/colon
Muc Adeno 4cm
mod diff G2 T4aN2
nodes 8/50
CEA 4.6 after surgery <.05
KRAS G12D MSS
FOLFOX Apr-sep 17
Clean CT Jul 2017, oct 17, CEA 3.4, 8.1. May 18 2.3,1.0,1.3, 1.3, 1.0, 2.3, 2.2, 2.1,2.2,1.6,1.4,1.5,2.8,2.2
Oct 2017 clean CT
Nov 17 PET para aortic nodes Stage IV
Folfori w/avastin Dec 17
May 18- surgery on nodes xeloda continues
Aug 18-CT NED Clear CT's Nov 18-May 20
July 20- it’s back! Rt ovary Full hysterectomy CEA 1.7 chemo break

csfl
Posts: 4
Joined: Mon Apr 06, 2020 3:48 pm

Re: Stage 4 Chemo Break??

Postby csfl » Mon Feb 22, 2021 4:38 pm

So what determines when to re-start chemo after a break? My sister had a clean scan and will take a chemo break for two months and then will be scanned again. If that scan is clean does the break continue?? Or might they start chemo again even if scan is clean as a preventative measure? I am assuming that if something shows up in the next scan she will be back on Folfiri but just not sure what to expect if scan is good.
Caregiver for 45 y/o sister
1/20-diagnosed stage 4 CC signet ring type (1 spot on liver/1 precardiac ln)
MSS with no other mutations
2/20-right hemicolectomy due to partial blockage
3/20-5/20 5 rounds Folfox/Avastin
5/20-current-switched to Folfiri/Avastin due to Oxi reaction
11/20 CT scan showed no evidence of nodal/liver mestasis
2/21-clean scan, start 2 month chemo break

Claudine
Posts: 524
Joined: Tue Mar 12, 2019 2:41 pm
Location: Montana

Re: Stage 4 Chemo Break??

Postby Claudine » Wed Feb 24, 2021 11:25 am

Well, my husband's scans have been stable (June, September, December) and despite his CEA rising, his onc isn't eager to resume chemo - he'd rather DH enjoys life chemo-free and I couldn't agree more, although of course the rising CEA does worry me... The way I see it, every day without chemo is a day DH gets stronger, so if it needs to resume (assuming the next scan does pick up a recurrence somewhere), he'll be better armed to fight?
I guess it also depends on oncologists and how aggressive the cancer is/was; like I said earlier, my husband's onc isn't a fan of "treating a number" (CEA value) when there's nothing obvious on scans. Also, my husband's cancer doesn't appear to be fast growing, so there's that...
Wife of Dx 04/18 (51 yo). MSS, KRAS G12A
No primary (involuted?)
Lytic tumor L4 vertebrae, EBRT 04/18, SBRT 02/19
Resect small intestine 05/18 (no cancer - Crohn's)
Failed adjuvant Xelox
Folfiri + Avastin 03/19 to 01/20
6.7 cm left adrenal mass 03/19, successful resection 02/20
CEA since 03/19: high 58, low 3.2, now 75.5
Scan 03/19: Multiple small lung nodules, now gone/calcified
PET 04/20 uptake by L4
L3-L4-L5 fusion surgery and partial corpectomy 05/20
Scan 06/17/2021: stable

boxhill
Posts: 719
Joined: Fri Apr 06, 2018 11:40 am

Re: Stage 4 Chemo Break??

Postby boxhill » Sun Feb 28, 2021 2:28 pm

Claudine, have you and your husband considered using one of the blood tests that detect cancer cells?

I suppose you could say that I'm Stage 4 on a chemo break, or at least a treatment break. After failing FOLFOX I started Keytruda, which brought me to semi-NED within 5-6 months. At that time I still had a tiny subcapsular liver mass that could not be definitively characterized. After about 18 mos on Keytruda with quarterly scans showing NED except for the unchanged tiny liver thing, everyone decided that the liver thing wasn't a met and that I was officially NED. (And probably had been since the previous spring.) Because I was suffering from painful arthralgia as a side effect of Keytruda, we decided to stop it and just continue to scan. No one really knows how much Keytruda is enough, but a year NED is a possibility.

So I have an MRI every three months for now. If anything changes, I'll go back on Keytruda. So it might be a break, or it might be permanent.
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
5/19 MRI stable/NED
Stop Key
All MRIs NED

behconsult
Posts: 252
Joined: Fri Jul 04, 2014 4:53 pm

Re: Stage 4 Chemo Break??

Postby behconsult » Sat Jun 05, 2021 11:49 am

I Take a break every 4 cycles otherwise I am too tired and weak to anything other than my work. Breaks give the body a chance to reboot. :D B
Stage 4 Age 56 BrafV660E 5/14
spot on perit/ Right side tumor
Resctn 6/9/2014
Folfox strt 7/2014. 6 of 12 tx
Chemo induced DM2
Pet 4 mets to lung (1 cm, 6 mm) Xeloda/Avastin 9/16 to present.
Cryo-ablation to four spots- Collapsed lung/chest tube 2x
Possible local recurrence in a spot or two on PET. Stable CT


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