beach sunrise wrote:Hey pccr, 2 consults down. One here and the other with msk today. The lymphnode is deep in middle right lobe, very tiny but SUV of 1.3. I have 2 more super tiny ones they can see, one in right lower lobe and one in left lower lobe measuting 1-2 mm. Word is tumor board most likely won't agree to removing middle lobe and both offer SBRT first then go from there. One idea was heavy chemo first (msk) to see what it would do. I turned that down.
One thing that most don't understand, probably including some of your consults and none of the indirects (uninterviewed "tumor boarders"), is how "politely" heavy duty the chemo is that you are doing.
For starters, you have done higher Xeloda treatment levels than I've ever seen on
anyone on the boards, after your first oncologist flunked on Folfox, to stop and drive CEA down. My "2nd place" memory for xeloda level (BSA adjusted) is a CSN forum guy who did 5000 mg/d, on European dosing levels, for two weeks out of three, successfully both for full length treatment and non recur (stage 3 RC), after nearly flunking Xeloda tolerance. I told him about the folic acid fiasco etc. He still had a somewhat tough time on side effects because he didn't do IV vitamin C, PSK etc.
Second, you have the ++ of gray zone CRC inhibitor drugs, including celecoxib.
Which for my wife, celecoxib added to our supplement stack enabled her to pull out of a CEA recur flare.
Third you have the ++ of somewhat targeted supplementation, anti-inflammatories, immune support, and perhaps additively inhibitory stuff.
Presumably, their idea of heavy chemo is still folfiri + Avastin.
In the early ADAPT patients (no +++), they tended to not respond to ADAPT after full Folfiri. In that case, I would try to identify the worst masses and cut them out, to try to improve chemo response, like my wife did. Also, I noticed that some early ADAPTers with Lin were playing around with low level Xeloda, even TID, to avoid Xeloda side effects.
In my eves, low level xeloda is more an anti-circulating cell strategy and a weaker hope on immune control or chemo sensitivity, especially without extra targeted stack items.
Good luck on establishing a dialogue in Germany with Rolle's follow ons.