Advice - Adjuvant Chemo

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L0729
Posts: 25
Joined: Sat Mar 26, 2022 4:40 pm

Advice - Adjuvant Chemo

Postby L0729 » Wed Nov 16, 2022 9:13 am

Reaching out to get some input/thoughts for adjuvant chemo after LAR surgery. Plan at diagnosis was 6 rounds of Folfox 6, surgeries, 6 rounds of Folfox 6.
I did 4 rounds of Folfox (last one no oxipalitin) which I had good response with, had liver resection. Just had LAR with temporary ileostomy. Pathology showed partial response with 1 out of 9 nodes, a 1.6 cm area of cancer cells, still EMVI positive, clear margins) Being stage 4 I knew there would be clean up chemo.

Oncologist says I will receive 4 treatments of either Folofx or Folfieri (he left the choice to me ) I am inclined to go with the Folfox as I had good response to it, it's the devil I know, and I want to save the Folfieri for reoccurrence. He would reduce the oxi to 50 % dosage, as it affected my liver enzymes quickly when I first took it. I do have KRAS g12v, TP53, and a germline mutation (RAD51D) - from my reading the germline mutation responds to platinum based chemo. oncologist does not discuss mutations with me as far as treatment.

Is there anything I should consider with either chemo regime? Scans have been clear so far, I will be having scans again in a couple of weeks, if anything shows up of course he may just go Folfieri.
Hoping for a reversal sooner than later after chemo.
2/22 - Dx with stage 4 rectal cancer 4cm on/1cm from AV - age 60
T4, EMVI + MSS
3/22 - CT/MRI 2 liver mets 2.1 cm and 1cm
3/22 3 Folflox 6 1w/o oxi.
5/5 - CT/MRI, liver lesions red. to 1.1 and .9cm, rectal tumor/suspicious lymph node red..
6/7 - Liver resection, liver abaltion
7/7 28 days chemoradiation
10/26 - LAR, temp. ileo. (1/9 nodes, partial response - T3, moderately diff)

Rock_Robster
Posts: 720
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: Advice - Adjuvant Chemo

Postby Rock_Robster » Thu Nov 17, 2022 3:45 am

Wow our cases are/were EXTREMELY similar (down to number of nodes).

If you’ve handled the oxaliplatin OK from a neuropathy perspective then my thinking would be to finish on the FOLFOX. I believe oxaliplatin is the preferred treatment in the adjuvant setting, where FOLFIRI is generally only used if the patient can’t have oxaliplatin (I had an allergic a reaction to my 8th FOLFOX exposure).

Permanent neuropathy risk increases exponentially after 8-9 full-dose cycles, so one to keep an eye on there.

Also as you say, it is likely you’ll do a few rounds of adjuvant chemo and that will be the end of that, but also quite likely you may need further treatment some years down the road - so good to keep some powder dry.

On the liver enzymes, mine went bananas on full-dose FOLFOX (ALT over 800), but my onc pushed on without dose reduction and they recovered by themselves over the next couple of cycles. No lasting problems. Livers are tough man.

Good luck,
Rob
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. Nov-22: 19
11/18 FOLFOX
3/19 Liver resection
5/19 Pelvic IMRT
7/19 ULAR
8/19 Liver met
8/19 FOLFOX, FOLFOXIRI, FOLFIRI
12/19 Liver resection
NED 2 yrs
11/21 Liver met, sub-cm lung things
3/22 3 Liver mets & PALNs. Lymphadenectomy
4/22 Liver SBRT
9/22 Small liver spot, PALNs
10/22 PALN SBRT
11/22 Liver mets, possible peri nodules. Xeloda+Avastin

L0729
Posts: 25
Joined: Sat Mar 26, 2022 4:40 pm

Re: Advice - Adjuvant Chemo

Postby L0729 » Thu Nov 17, 2022 9:45 am

Thank you Rob for your input, you and others on here have been so helpful for me dealing with this, your advice helped me through the radiation a lot! I appreciate being able to draw on the experience of others . .... you have a very calming presence, while offering your take on everything this diagnosis/disease entails . . . it's a lot to absorb.

I have found some similarities in your diagnosis and treatment with mine - I hope you have put the worst behind you! And although I'm hopeful, I feel I'm pretty realistic on what I"m facing.

My oncologist has been very protective of the liver from the onset - I know he didn't want it compromised by oxi prior to my liver resection, but other than the large jump after treatment 3 my liver enzymes were high, but didn't seem outrageously high. Fortunately surgical resection was possible at diagnosis, with chemo helping to shrink down mets. I'm hoping the reduced dosage won't compromise the effectiveness of the treatment - and I will be watching for neuropathy symptoms. We shall see how it goes....Thank you everyone on this forum who post their stories, you may not know it but it helps a lot of people who don't always post, but look for hope and answers.
Lori
2/22 - Dx with stage 4 rectal cancer 4cm on/1cm from AV - age 60
T4, EMVI + MSS
3/22 - CT/MRI 2 liver mets 2.1 cm and 1cm
3/22 3 Folflox 6 1w/o oxi.
5/5 - CT/MRI, liver lesions red. to 1.1 and .9cm, rectal tumor/suspicious lymph node red..
6/7 - Liver resection, liver abaltion
7/7 28 days chemoradiation
10/26 - LAR, temp. ileo. (1/9 nodes, partial response - T3, moderately diff)


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