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 stage 4 rectal cancer T4 4cm, 1cm from AV - age 60
EMVI + MSS 2 liver mets 2.1 cm and 1cm
Kras G12V, TP53, RAD51D
3/22 3 Folflox 6 1w/o oxi.
6/7 - Liver resection, liver abaltion
7/7 28 days chemoradiation
10/26 - LAR, temp. ileo. (1/9 nodes, partial response - T3, moderately diff)
12/22-2/23 4 Folfox at 50%
4/3 - Reversal
3/8 scan clear, monitoring lung nodules
6/29 scan, new liver 3cm met, 3 lung nodules increasing, susp. subcarinial lymph node