Chemo every 2 weeks vs 3 weeks

Please feel free to read, share your thoughts, your stories and connect with others!
Rikimaroo
Posts: 430
Joined: Tue Dec 20, 2016 8:48 pm
Location: Florida

Chemo every 2 weeks vs 3 weeks

Postby Rikimaroo » Wed Jul 20, 2022 1:22 pm

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
RC T3N1M0 12/16
MSS - NRAS Mutation
Chemo Rad, CCR - W&W 5/2017
Recurrence 11/2017
CT Scan 11/2017 Liver Met 5.5cm Stable, Stage IV
LAR/Liver Resect 4/2018
Reversal 10/18
CEA highest 500, lowest .8 throughout process, waiting for latest
Recurrence left vesical/pelvic sidewall - 10/7/2019 resect perm bag,
CEA rise Feb/May 3.7, 8.8, 30, Recurrence in Pelvic
CEA 40 right now, but was 57, so folfiri to beat it back down.
Lots of chemo for the past 4 years.

Rock_Robster
Posts: 702
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: Chemo every 2 weeks vs 3 weeks

Postby Rock_Robster » Wed Jul 20, 2022 7:04 pm

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
Last edited by Rock_Robster on Wed Jul 20, 2022 7:48 pm, edited 1 time in total.
40M Australia
2018 RC, 12cm high
G2 EMVI LVI. 4 liver mets
pT3N1aM1a Stage IVa MSS NRAS G13R
CEA: Nov-18: 14 then <2. Jun-22: 5. Sep-22: 10
11/18 FOLFOX
3/19 Liver resection
5/19 Pelvic IMRT
7/19 ULAR & ileo
8/19 Liver met
8/19 FOLFOX, FOLFOXIRI, FOLFIRI
12/19 Liver resection
NED 2 years
11/21 Liver met & node, 2 tiny lung things
12/21 PVE
3/22 Nodes & 3 liver mets. Lymphadenectomy
4/22 Liver SBRT
6/22 Liver clear.
10/22 Small liver spot. Some PALNs. Planning PALN SBRT.

MadMed
Posts: 174
Joined: Sun May 02, 2021 5:52 pm
Location: Massachusetts

Re: Chemo every 2 weeks vs 3 weeks

Postby MadMed » Wed Jul 20, 2022 7:09 pm

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.
52M DX: RC lower rectum, guessing now 2cm from AV 4/27/2021
T3N0M0 adenocarcinoma with signet ring cell features
Tumor size 30mm
Tumor grade: G3
Baseline CEA 1.0
MSI status: MSS pMMR
Started Folfox 5/12/2021
Switched to FOLFIRINOX from session 2. 8 rounds total.
CT+MRI tumor contained shrunk 80%, no spread to other organs.
CRT started xeloda + 28 days Radiation 9/27-11/04
NED as of 4/06 CT/MRI/sigmoidoscopy
On W&W 04/06/2022

Rikimaroo
Posts: 430
Joined: Tue Dec 20, 2016 8:48 pm
Location: Florida

Re: Chemo every 2 weeks vs 3 weeks

Postby Rikimaroo » Thu Jul 21, 2022 3:47 pm

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!!
RC T3N1M0 12/16
MSS - NRAS Mutation
Chemo Rad, CCR - W&W 5/2017
Recurrence 11/2017
CT Scan 11/2017 Liver Met 5.5cm Stable, Stage IV
LAR/Liver Resect 4/2018
Reversal 10/18
CEA highest 500, lowest .8 throughout process, waiting for latest
Recurrence left vesical/pelvic sidewall - 10/7/2019 resect perm bag,
CEA rise Feb/May 3.7, 8.8, 30, Recurrence in Pelvic
CEA 40 right now, but was 57, so folfiri to beat it back down.
Lots of chemo for the past 4 years.

michelle c
Posts: 1926
Joined: Wed Dec 02, 2009 3:58 am

Re: Chemo every 2 weeks vs 3 weeks

Postby michelle c » Tue Aug 09, 2022 9:54 am

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
May 25 2009 Dx with CC (sigmoid colon) 2 days after my 44th b'day
CEA prior to surgery 4.7
Jun 3 2009 LAR - Stage III 3/10 lymph nodes
Jul 6 - Dec 10 2009 - 12 cycles FOLFIRI
Genetic testing - inconclusive for Lynch
Jul 2012 port removed & hernia repair

Rikimaroo
Posts: 430
Joined: Tue Dec 20, 2016 8:48 pm
Location: Florida

Re: Chemo every 2 weeks vs 3 weeks

Postby Rikimaroo » Tue Aug 09, 2022 11:51 am

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.
RC T3N1M0 12/16
MSS - NRAS Mutation
Chemo Rad, CCR - W&W 5/2017
Recurrence 11/2017
CT Scan 11/2017 Liver Met 5.5cm Stable, Stage IV
LAR/Liver Resect 4/2018
Reversal 10/18
CEA highest 500, lowest .8 throughout process, waiting for latest
Recurrence left vesical/pelvic sidewall - 10/7/2019 resect perm bag,
CEA rise Feb/May 3.7, 8.8, 30, Recurrence in Pelvic
CEA 40 right now, but was 57, so folfiri to beat it back down.
Lots of chemo for the past 4 years.

Nor Cal
Posts: 67
Joined: Sun Dec 06, 2020 8:18 pm

Re: Chemo every 2 weeks vs 3 weeks

Postby Nor Cal » Tue Aug 09, 2022 12:06 pm

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.
Dx June 2020, stage IV, w liver mets in both lobes. M, age 50. Right-sided colon tumor. CEA 120.
BRAF+ TMB 5% MSS TDL1-1%
July 2020 - Present: 35 cycles chemo (All the various 5-FU regimens)
December 2020 - February 2021 Y90 Radioembolization, Chemoembolization x2

User avatar
beach sunrise
Posts: 694
Joined: Thu Mar 05, 2020 7:14 pm

Re: Chemo every 2 weeks vs 3 weeks

Postby beach sunrise » Tue Aug 09, 2022 8:23 pm

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.
8/19 RC CEA 82.6 T3N0M0
Neoadj 5FU/rad 6 wk
High dose IVC 1 1/2 wks before surgery. Continue still twice a week
Surg 1/20 APR - margins T4bN1a IIIC G2 MSI- 1/20 LN+ LVI+ PNI-
pre cea 24/post 5.9
FOLFOX
7 rds 6-10 CEA 11.4 No more
7/20 CEA 11.1, 8.8
8/20 CEA 7.8
9/20 CEA 8.8, 9, 8.6
10/20 CEA 8.1
11/20 CEA 8's
12/20 CEA 8's & 9's
ADAPT+++ TM drug
MHL1+
PMS2+
MSH2+
MSH6+
POLD1 , KRAS Q61H
Chem-sens test NCI "Test failed, neo adj CR worked. Not enough ca cells to test"

Rikimaroo
Posts: 430
Joined: Tue Dec 20, 2016 8:48 pm
Location: Florida

Re: Chemo every 2 weeks vs 3 weeks

Postby Rikimaroo » Thu Aug 11, 2022 4:57 pm

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
RC T3N1M0 12/16
MSS - NRAS Mutation
Chemo Rad, CCR - W&W 5/2017
Recurrence 11/2017
CT Scan 11/2017 Liver Met 5.5cm Stable, Stage IV
LAR/Liver Resect 4/2018
Reversal 10/18
CEA highest 500, lowest .8 throughout process, waiting for latest
Recurrence left vesical/pelvic sidewall - 10/7/2019 resect perm bag,
CEA rise Feb/May 3.7, 8.8, 30, Recurrence in Pelvic
CEA 40 right now, but was 57, so folfiri to beat it back down.
Lots of chemo for the past 4 years.

User avatar
beach sunrise
Posts: 694
Joined: Thu Mar 05, 2020 7:14 pm

Re: Chemo every 2 weeks vs 3 weeks

Postby beach sunrise » Mon Aug 15, 2022 5:15 pm

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!
8/19 RC CEA 82.6 T3N0M0
Neoadj 5FU/rad 6 wk
High dose IVC 1 1/2 wks before surgery. Continue still twice a week
Surg 1/20 APR - margins T4bN1a IIIC G2 MSI- 1/20 LN+ LVI+ PNI-
pre cea 24/post 5.9
FOLFOX
7 rds 6-10 CEA 11.4 No more
7/20 CEA 11.1, 8.8
8/20 CEA 7.8
9/20 CEA 8.8, 9, 8.6
10/20 CEA 8.1
11/20 CEA 8's
12/20 CEA 8's & 9's
ADAPT+++ TM drug
MHL1+
PMS2+
MSH2+
MSH6+
POLD1 , KRAS Q61H
Chem-sens test NCI "Test failed, neo adj CR worked. Not enough ca cells to test"


Return to “Colon Talk - Colon cancer (colorectal cancer) support forum”



Who is online

Users browsing this forum: No registered users and 6 guests