The Colon Club

So the statistics is, well there really not any if getting FolFiri every 2 weeks vs 3 weeks makes any impact to progression. Does anyone else have any ideas/recommendations. Right now I am going back on a 2 week schedule basically to attack the cancer as aggressive as possible, but honestly I don't know if 2/3 makes a difference. Of course aggressive is the key word regarding two weeks but does it really mean that LOL...

Thanks for any clarifications or thoughts. Doctors are kind of in the same boat with this question, not really a answer.

Riki

It’s a good question and my caveat is that very little in the below is evidence, just opinion:

- we know that there is a dose-dependent relationship between chemotherapy and disease response. That is - a therapeutic window (hopefully) where it can kill tumour cells without killing the patient. In aggregate, doing chemo every 3 weeks rather than 2 weeks would result in a ~35% dose reduction over a period of a year. For some people, a 35% reduction would still elicit a clinical response; for others it may not be enough to control disease. It’s going to depend a lot on individual disease biology.

- cell repair is also relevant. Almost as soon as they start getting damaged, cancer cells begin attempting to repair themselves. So this means that even during treatment there is a balance between cell damage and cell repair, hopefully favouring the former. One argument toward a more metronomic (continuous) style of chemo is that you’re reducing the time available for cellular repair to take place (particularly time where the damage effects of treatment may have worn off), and thus reduce overall tumour burden (and perhaps hypothetically, cell resistance to treatment).

- one area that’s interesting is in the use of capecitabine rather than 5FU (ie CAPIRI/XELIRI). In this case the irinotecan is generally given even 3 weeks, to allow a 2 week oral program of capecitabine, and a recovery week. The pharmacodynamic profile of the resultant 5FU is clearly different - ie via IV it’s given as a higher-dose 48 hour infusion, whereas as capecitabine it’s a lower daily dose over an extended period. Research seems to suggest that the 3-week CAPIRI regime is non-inferior to the 2-week FOLFIRI.

If I restart chemo I will almost certainly be doing it as CAPIRI, as I’d prefer not to get a new port, want to avoid the 48 infusion and extra hospital visits, and less frequent exposure to irinotecan. So if you’re thinking about a 3 weekly cycle, perhaps doing the 5FU as Xeloda could give you some confidence that the protocol has more research behind it. If you’re after an aggressive approach, you might also consider adding a targeted therapy like Avastin to the treatment.

Good luck,
Rob

I don’t think anybody knows. From my treatment and my conversations with my oncologist, chemo takes almost 1 week to run through your system. When I had to delay chemo, 3 weeks gap was no problem. My friend who is stage 4 goes on multiple 2-week cycles and then takes a break for a few months. She’s been able to control it well this way. My guess it all depends on the cancer itself. I imagine, it’s a trial/scan/adjust type deal.

Great advice from Rob, CAPIRI sounds good to me in case I go back.

Thanks Rob/Mad - Well said Rob...I will discuss with oncologist but that is what we are doing basically hitting it every 2 weeks to not give it options for cell repair (makes most sense to me). Things seems stable, I hope next week when I go back in CEA goes down. Right now CEA is at 264, was 261 last time, so it barely went up, that shows stability.

Will keep you guys posted. So informative!!

I remember wondering this too and asking my oncologist. I can’t remember what he said exactly but I know it was recommended to have chemo every two weeks - something about the cycle of the cancer and the timing to kill off the cancer cells before they could multiply or something like that. Sorry I’m not being very helpful with my answer - it was a very long time ago (about 13 years) but whatever he said at the time made sense and I trusted his reply

CEA went down to 199, good response to therapy but man is it hard to do right now. This will be on a 3 week cycle.

I'm on the 3-week XELIRI cycle. A lot easier for me to tolerate vs the 2-week FOLFIRI. Irinotecan really knocks me for a loop so nice to have that extra week, whereas the Xeloda is more tolerable over a longer period.

Hey Rikimaroo, cheering you on bud!
Fantastic that you are getting a good response.
What do mean by "It is hard to do right"
Please keep us posted, OK.

Hi Beach,

Basically I have been having a hard time gaining weight, cancer been really beating me up and taking some nutrients. I am doing better with eating so I am gaining some weight very slowly thought and when I get the chemo FOLFIRI eating because an issue for about 5 days sometimes 10 days where I don't want to eat for the first couple of days or drink and then I slowly start eating, but its nothing huge so weight gain is slow. Also the fatigue, you know typically side effects of chemo, trying to not eat and then throw up, so managing that and working around it.

I have been bleeding from my anus so I have been anemic, I am getting iron infusion for that and its helped with energy as I am low energy alot. BOOST has become a big part of my diet with protein and it has helped alot. THe bleed is because of the tumor that is there but after 3rd treatment its gotten better, but still bleeds but not as significantly. I am hoping there is some shrinkage, also the tumor has invaded my bladder at least that is what I think cause my pee if bloody then yellow and sometimes I pee blood clots, so yeah its been pretty rough up hill battle for me the past few weeks since last chemo on the 27th.

I am hoping things start getting better and we can do a trial soon. Even without a trial getting the cancer under control is a big deal, but there are some options for me per my 2nd opinion oncologist.

Thanks,
Riki

Hi Riki, I hope you get in a trial soon too. Keep on pushing to get there.
Thank you for sharing what is going on with you. I really feel for you going thru all that! Seems your mindset is dealing with the struggles pretty good.
Always thinking about you!