Choice to make?

impactzone

Kinda good news. dx stage 4 colon cancer 9/06, liver mets. Colon sugery 9/06, chemo (folfox), liver eesection 2/07, chemo...lung mets discovered 11/07. lung lobectomy 11/07. I just met with my oncologist at Stanford. The issue is adjuvant chemo. He feels that right now none is necessary. He says that essentially, there is currently nothing to track, I have had chemo before and he feels that the lung mets were there originally. I did have liver response (shrinkage) when I was on chemo before (avastin, erbitux, Xeloda, oxylaplatin.

I asked about the use of irenotecan and he said essentially:
Irinotecan Not Effective in Adjuvant Therapy for Colon Cancer

Both irinotecan and oxaliplatin have demonstrated important clinical activity in metastatic colorectal cancer. Although they appear to have similar activity in metastatic disease, only oxaliplatin has demonstrated efficacy in the adjuvant setting. Despite a survival advantage of single agent irinotecan in the second-line metastatic setting and a survival advantage for irinotecan added to first-line metastatic treatment, irinotecan has failed to show a survival or disease-free survival benefit in the adjuvant setting, and at the present time there is no role for irinotecan in the adjuvant treatment of colon cancer. In contradistinction, the addition of oxaliplatin to 5-fluorouracil/leucovorin has improved disease-free survival in two large randomized adjuvant trials. Data for overall survival in these trials have not yet demonstrated statistical significance but are expected to with maturation. Oxaliplatin/5-fluorouracil/ leucovorin should, therefore, be regarded as a reference standard for adjuvant therapy.

So... i am going back for a scan in Jan which will be 7 weeks post surgery. He will leave open the issue of follow-up chemo to me and is not adverse to giving me 4 - 6 months of it. He feels that if nothing shows in blood work or scan, I do not need adjuvant therapy. I am confused...
I am a healthy 48 year old and want all the advantages I can get but also don't want to use all the tricks available at this time and subject me to increased toxicity if not necessary. He mentioned there are clinical trilas going on right now using erbitux (which i got a huge rash from) in adjuvant setting but the data is not in yet. He said I am kinda unique in that most Stage 4's can't be operated on initally and I was lucky enough for 2 operations.

Should I insist on adjuvant therapy?

brn2ride

I don't know enough about chemo to give any advice but I do wish you well and hope your new adventure in tampa is a great one.
bob

Hanac

Hi,

I would get a second opinion. I am from the Bay Area as well and I would recommend my oncologist Dr. Peter Yu at Camino Medical Group in Mountain View. He is a former researcher and is totally up to date on all of the latest developments....Or you could go to UCSF. UCSF has one of the best cancer centers in the Country.

Hugs and prayers,

Hana

sladich

I'm also a Stage 4. I've had my lower left lung removed, liver resection, and 2 rounds of chemo (Folfox and Irinotecan). I had a recurrence in the liver and had a chemoembolization and RFA done. I now have a tumor in my upper left lung. I didn't do any chemo between my liver recurrence and my recent lung recurrence. After my RFA on my lung, I will not have any chemo either. My onc will continue to watch me (scans every 2-3 months) because for right now the only cancer I have is in the lung and it will be gone with the RFA. For me, I don't want the chemo unless needed and if they don't see any cancer why put all that poison in your body? Just my thoughts. I feel I'm being watched very closely. Ultimately, the decision is your's. Best of luck in your decision.

Debbie

shmurciakova

I had a very similar case to yours. They also believe that my liver and 2 lung mets were there from the beginning. I had adjuvent chemo with Irinotecan after my liver resection, several months later the lung mets showed up. Following the lung mets and subsequent resection I did not have chemo, just as your doctor is advising. I also will tell you that I was treated at MD Anderson by one of the countrys leading surgical oncologists. I agree with sladich. I have been just "watching and waiting" for three years now and things are looking very good for me! Why put yourself through chemo unless you absolutely have to. Besides, save it in case, God forbid you need it later. I agree with your doctor. No, you should not insist on adjuvant therapy IMO. Feel free to e-mail me if you would like. I never had Oxy, Avastin, or Erbitux..just 5-FU/Leukovorin and then FOLFIRI following my liver resection.
Sincerely,
Susan H.

taraHK

Yes, it is a choice to make. I have a somewhat similar story to yours. Stage III rectal treated with presurgical chemoradiation then surgery then chemo. Two years later, I had a solitary lung met: surgery followed by chemo. One-and-half years later, another solitary lung met. Surgery -- and then I did have 6 mos chemo (FOLFOX plus Avastin).

The problem with "people like us" (ie with mets that can be removed surgically) is that there are so few of us that there is very little research which shows that a particular treatment is better or worse than another. My onc was quite frank with me about this. My situation was complicated by the fact that CEA has never been an effective marker for me.

It sounds like your doc is right on top of all the current research. And I was interested in Susan H's story: her doc from Mayo Clinic seemed to share the same view. This should give you some assurance about the path your doc is recommending. However, you might want to seek a second opinion -- if you are feeling uncertain.

Whatever decision you make will be the right one! And I wish you all the best.

Tara

2bhealed

hi impact,

With my Stage 3 colon cancer adjuvant chemo was advised. I did not have a CEA so my onc would not know if it was working or not. For many other reasons besides this I opted to not do any chemo of any sort and post surgery I dove full bore into optional treatments ie, diet, (macrobiotics & juicing), Traditional Chinese Medicine (acupuncture, massage, herbals), counseling (ridding toxic emotions), and many many supplements, yoga, exercise.....anything and everything to make my body hostile to cancer cells and welcoming to whole health.

So far so good since I have remained cancer free for over 6 years now.

Just thought I would share that you DO have choices that may not include chemo but many many many healthy and healing options.

peace, emily the juice chick

hopefulone

Tough decision and the jury is still out on this one I believe as I was doing a lot of research on it when we believed my hubby NED. ( we still don't know yet either way). At one point we were leaning towards xeloda only or limited chemo, maybe 3-6 mos regimen. Onc had said she was not opposed to observation either and no chemo if he remained NED. Good luck with your decision. God Bless,
Diane