Stage 2B (iiB) and Optional Chemo - Very interesting.

laurie83833

Hello all,

K my Husband Denny was diagnosed with Stage iiB (2B) cancer and he was offered adjacent therapy (Chemo) at that time the Oncologist said that in this stage they cannot tell if Adjacent Therapy give the patient a better chance of survival or not as it is in a grey area and they simply do not know for sure in stage iiB.

I then thought there has got to be some trials test done on patients somewhere that showed why they could not specify if the adjacent treatment helped or not and for the longest time I could not find anything except that it would show a lower rate for Stage iiB overall survival but no explanation as to why just that possibly due to Stage III having Chemo and Stage IIB not. After hours or searching I finally found the test the "American Joint Committee on Cancer" did regarding chemo for stage iib and survival rate compared to Stage 3 (in a chart)

Here was the findings:

Group of patients

Stage iib - 117 Patients in clinical test-
5-year overall Disease-specific survival rate - 89.0% -
5-year Overall disease-free survival rate 53.7% (NED/remission)
Stage III(3)- 82 Patients in clinical test
5-year overall Disease-specific survival rate - 94.1% -
5-year Overall disease-free survival rate 66.0% (NED/remission)

Now above the overall looks better for Stage III compared to Stage IIB so one would think this was due to the Adjacent Chemo - BUT then if you below how they broke it up.

Stage iiB - 52 patients HAD chemo -
85.3% - 5year Disease-specific survival rate -
43.8% - 5year disease-free survival rate(NED/remission).
Stage III(3) - 68 patients HAD chemo -
96.3% - 5year Disease-specific survival rate -
68.3% - 5year disease-free survival rate 68.3% (NED/remission).

Stage iiB - 65 Patients NO-Chemo -
91.6% - 5year Disease-specific survival rate -
61.2% - 5year disease-free survival rate (NED/remission).
Stage III(3)-14 patients NO-Chemo -
83.9% - 5year Disease-specific survival rate -
55.6% - 5year disease-free survival rate 55.6% (NED/remission).

So I see now why they have a problem saying Chemo helps for Stage iiB as it seems in this small test anyways Stage IIB did better without having the Adjacent Chemo. The American Joint committee on Cancer" Stated they do not understand the outcome as it appeared that Stage IIB patients did better without Chemo while Stage III did slightly better with Chemo.

Just thought I would share this if anyone was wondering themselves.

Have a nice Weekend everyone!
Laurie

PGLGreg

confusing
That's "adjuvant", not "adjacent". It is confusing, and apparently not just to us patients, but also confusing to the pros. As I understand it, comparison to other stages suggests that chemo should be beneficial for stage 2 patients, but it has been hard to find direct evidence that this is actually true. As a practical matter, patients might (in my inexpert and uninformed opinion) look for some sort of compromise -- a chemo regimen with relative mild side effects. For stage 2a rectal cancer, I had 10 injections of 5FU + leucovorin. Maybe Denny could run that idea past his oncologist and see what he thinks about something along those lines.

--Greg

laurie83833

PGLGreg said:

confusing
That's "adjuvant", not "adjacent". It is confusing, and apparently not just to us patients, but also confusing to the pros. As I understand it, comparison to other stages suggests that chemo should be beneficial for stage 2 patients, but it has been hard to find direct evidence that this is actually true. As a practical matter, patients might (in my inexpert and uninformed opinion) look for some sort of compromise -- a chemo regimen with relative mild side effects. For stage 2a rectal cancer, I had 10 injections of 5FU + leucovorin. Maybe Denny could run that idea past his oncologist and see what he thinks about something along those lines.

--Greg

Will Do
Greg - Thanks will run it by Denny (the injections) and see what he says. Sorry about the adjuvant", not "adjacent" I didn't realize I was typing it the other way.

Have a nice weekend!

Unknown

This comment has been removed by the Moderator

KathiM

Interesting....but....
How many also had/did not have rads?

How many were true colon...not rectal, not anal? (adenocarcinoma vs highly radio sensitive squamous cell carcinoma?)

What were the age groups in the study?

Not that this isn't great news...but, I also have seen studies where the same outcome was used to argue both sides of the coin...lol...

Thanks for the info, it bears looking into other sources, as well!

Hugs, Kathi

fighting for mom

KathiM said:

Interesting....but....
How many also had/did not have rads?

How many were true colon...not rectal, not anal? (adenocarcinoma vs highly radio sensitive squamous cell carcinoma?)

What were the age groups in the study?

Not that this isn't great news...but, I also have seen studies where the same outcome was used to argue both sides of the coin...lol...

Thanks for the info, it bears looking into other sources, as well!

Hugs, Kathi

This is intersting....
Very interesting. My Mom was dx with stage 2 cc by onc and stage 3 by surgeon due to T4 and adenocarcinoma. I have never understood how/why they can't be on the same page.

Her onc said she didn't need the chemo. Her surgeon said she did due to it being a T4 and such an aggressive form of adenocarcinoma. For her, she chose to do the chemo 5FU + Leuvo + oxi so she 'felt' she woulndn't look back and wish she had done everything/anything she could. She had a really hard time with the chemo - Potassium trouble, bowel obstruction- multiple hospitalizations resulted. She finished all her 12 rounds but like someone else said they decreased the dosages of the 5FU and got rid of the oxi after 8 rounds. That made it much more managable for her. Again, her surgeon told her it was important to finish it out---but her oncs gave her multiple opportunities to stop.

It is so hard to know what the right decision is. It was especially hard for my dad-as she got where she needed a lot of help and it was just hard for him to see.

But- follow colonoscopy yesterday was all clear. So- it was worth it for her. Who knows if it would have been all clear without the chemo. But she feels like she has done everything she could for the best possible outcomes. I tried to get her to alter her diet and increase exercising but that hasn't gone so well.

I will pray for you as you guys make your decisions.

Susan

nudgie

I was
DX with Stage II colon cancer in 2006 by emergency surgery, no CEA marker used. My Onc informed me that chemo had not been offered to patients with Stage II until recently and it was called adjuvant chemotherapy (Mosiac Study), like an insurance policy and due to my age at the time, 42, he recommended I do the chemo to make sure that there were no microscope cancer cells running around in my body.

So after discussions with family and friends, I decided to do the chemo and finished in Nov 06. I have been NED ever since.

PGLGreg

I haven't found the reference you cite, so could you give a web reference?

Here is the summary of evidence of benefit for adjuvant treatment of stage 2 cr cancer in Adjuvant Treatment of Colorectal Cancer (2007).:

No single randomized clinical trial has demonstrated a survival benefit for adjuvant therapy in patients with Stage II colon cancer. Subset analyses of trials that have included patients with Stage II and III disease have also repeatedly failed to demonstrate a statistically significant survival benefit for Stage II patients. A pooled analysis of 7 studies demonstrated a 5-year overall survival of 81% in patients who received fluorouracil-based adjuvant therapy and 80% in patients who underwent surgery alone (P = 0.11).65

Two published reports have been cited as favoring the administration of adjuvant therapy in Stage II disease. A retrospective subset analysis of four consecutive National Surgical Adjuvant Breast and Bowel Project (NSABP) trials noted a similar proportional survival benefit for Stage II and Stage III patients who received fluorouracil-based therapy, leading the authors to recommend adjuvant treatment for patients with both Stage II and III colon cancer.91 Results from the Quick and Simple and Reliable (QUASAR) study, a complex comparison of four different fluorouracil-based regimens with observation alone in a heterogeneous patient population, support a marginal survival benefit for patients with Stage II colon and rectal cancer; these results have thus far been reported only in abstract form.92

After systematically reviewing the available literature, the Cancer Care Ontario Program in Evidence-Based Care,93 an expert panel convened by the American Society of Clinical Oncology (ASCO),94 and the National Comprehensive Cancer Network (NCCN)95 independently recommended against the routine administration of adjuvant therapy in patients with Stage II disease. In addition, the ASCO panel determined that a sample size of 9,680 patients per group would be required to detect a 2% survival difference between treatment and control arms (90% power with a significance level of 0.05).94

It has been proposed that adjuvant chemotherapy may benefit patients with Stage II disease and T4 tumor stage, bowel perforation, or clinical bowel obstruction.94 Although this hypothesis has not been validated in a prospective, randomized clinical trial, a retrospective subset analysis of 318 patients with Stage II disease enrolled in the ECOG INT-0035 study of fluorouracil and levamisole suggested a survival benefit for adjuvant therapy in these patient subgroups.25 Although other high-risk features, such as inadequate lymph node sampling, lymphovascular or perineural invasion, poorly differentiated histology, microsatellite stability, and loss of heterozygosity at chromosome 18q, are also known to carry a higher risk of recurrence,18 the potential benefit of chemotherapy is not known in patients with these factors.

laurie83833

PGLGreg said:

I haven't found the reference you cite, so could you give a web reference?

Here is the summary of evidence of benefit for adjuvant treatment of stage 2 cr cancer in Adjuvant Treatment of Colorectal Cancer (2007).:

No single randomized clinical trial has demonstrated a survival benefit for adjuvant therapy in patients with Stage II colon cancer. Subset analyses of trials that have included patients with Stage II and III disease have also repeatedly failed to demonstrate a statistically significant survival benefit for Stage II patients. A pooled analysis of 7 studies demonstrated a 5-year overall survival of 81% in patients who received fluorouracil-based adjuvant therapy and 80% in patients who underwent surgery alone (P = 0.11).65

Two published reports have been cited as favoring the administration of adjuvant therapy in Stage II disease. A retrospective subset analysis of four consecutive National Surgical Adjuvant Breast and Bowel Project (NSABP) trials noted a similar proportional survival benefit for Stage II and Stage III patients who received fluorouracil-based therapy, leading the authors to recommend adjuvant treatment for patients with both Stage II and III colon cancer.91 Results from the Quick and Simple and Reliable (QUASAR) study, a complex comparison of four different fluorouracil-based regimens with observation alone in a heterogeneous patient population, support a marginal survival benefit for patients with Stage II colon and rectal cancer; these results have thus far been reported only in abstract form.92

After systematically reviewing the available literature, the Cancer Care Ontario Program in Evidence-Based Care,93 an expert panel convened by the American Society of Clinical Oncology (ASCO),94 and the National Comprehensive Cancer Network (NCCN)95 independently recommended against the routine administration of adjuvant therapy in patients with Stage II disease. In addition, the ASCO panel determined that a sample size of 9,680 patients per group would be required to detect a 2% survival difference between treatment and control arms (90% power with a significance level of 0.05).94

It has been proposed that adjuvant chemotherapy may benefit patients with Stage II disease and T4 tumor stage, bowel perforation, or clinical bowel obstruction.94 Although this hypothesis has not been validated in a prospective, randomized clinical trial, a retrospective subset analysis of 318 patients with Stage II disease enrolled in the ECOG INT-0035 study of fluorouracil and levamisole suggested a survival benefit for adjuvant therapy in these patient subgroups.25 Although other high-risk features, such as inadequate lymph node sampling, lymphovascular or perineural invasion, poorly differentiated histology, microsatellite stability, and loss of heterozygosity at chromosome 18q, are also known to carry a higher risk of recurrence,18 the potential benefit of chemotherapy is not known in patients with these factors.

Actually was -
Actually where I found the information was specifically for Stage II(B) - (Stage IIA was not included) and I was not sure if it was alright to post links so I did not, but now I know is fine ~ here is the sourcelink

http://jnci.oxfordjournals.org/cgi/content/full/97/22/1705

"As O'Connell et al. had predicted, patients with stage IIIa tumors received adjuvant chemotherapy more frequently than patients with stage IIb tumors (83% versus 44%, P<.001). We noted that overall, 5-year disease-specific survival (DSS) and 5-year disease-free survival (DFS) in our study were superior for patients with stage IIIA tumors compared with those with IIB tumors, although these differences did not reach statistical significance (Table 1). For the subset of patients who received chemotherapy, those with stage IIIa tumors had a statistically significant improved DFS relative to those with stage IIb tumors. In contrast, for the subset of patients who did not receive adjuvant therapy, earlier stage did indeed correspond to superior prognosis (Table 1)."

I'm not sure yet how to get the link to come up by clicking on it or if you have to copy and past.

PGLGreg

laurie83833 said:

Actually was -
Actually where I found the information was specifically for Stage II(B) - (Stage IIA was not included) and I was not sure if it was alright to post links so I did not, but now I know is fine ~ here is the sourcelink

http://jnci.oxfordjournals.org/cgi/content/full/97/22/1705

"As O'Connell et al. had predicted, patients with stage IIIa tumors received adjuvant chemotherapy more frequently than patients with stage IIb tumors (83% versus 44%, P<.001). We noted that overall, 5-year disease-specific survival (DSS) and 5-year disease-free survival (DFS) in our study were superior for patients with stage IIIA tumors compared with those with IIB tumors, although these differences did not reach statistical significance (Table 1). For the subset of patients who received chemotherapy, those with stage IIIa tumors had a statistically significant improved DFS relative to those with stage IIb tumors. In contrast, for the subset of patients who did not receive adjuvant therapy, earlier stage did indeed correspond to superior prognosis (Table 1)."

I'm not sure yet how to get the link to come up by clicking on it or if you have to copy and past.</p>

Thanks, I found it.
But since adjuvant chemotherapy worsened outcomes for stage IIB patients relative to stage IIIA, it's hard to see here any evidence favoring adjuvant treatment for stage IIB.

--Greg

laurie83833

PGLGreg said:

Thanks, I found it.
But since adjuvant chemotherapy worsened outcomes for stage IIB patients relative to stage IIIA, it's hard to see here any evidence favoring adjuvant treatment for stage IIB.

--Greg

Yeah is confusing.
I think that is where the T4 tumors come in - thus making it Stage II (B) and not stage II (A).

Do have a question though - I ordered copies of the path report and pathologist resport states this.

Pathologic state: pT4a, pN0, pMX

"Which from what I have read the pMX means (Distant metastasis cannot be assessed)

Why did the Onoclogiest say the stage was T4,NO, and them MO (which means no distant metastasis)?

Seems odd just wondered if this is something that is normal to do that.

PGLGreg

laurie83833 said:

Yeah is confusing.
I think that is where the T4 tumors come in - thus making it Stage II (B) and not stage II (A).

Do have a question though - I ordered copies of the path report and pathologist resport states this.

Pathologic state: pT4a, pN0, pMX

"Which from what I have read the pMX means (Distant metastasis cannot be assessed)

Why did the Onoclogiest say the stage was T4,NO, and them MO (which means no distant metastasis)?

Seems odd just wondered if this is something that is normal to do that.

pMX
I don't know, but pMX means "cannot be assessed pathologically", which leaves open the possibility that it can be assessed clinically, so I guess your oncologist has made a clinical assessment of M0. It's hard to see how there ever could be a "pM0" score, since the pathologist couldn't have tissue samples from all the possible places that metastases could turn up.

--Greg

dianetavegia

OLD info from early 2005
Laurie, that info was from 1999 -2004 and did not include the same chemo drugs available for Stage I, II and III as is used today.

Take all this stuff with a grain of salt. I'm Stage III and had chemo. They used a Stage III sampling of 14 patients but did not include age, sex, race, weight, health history.... KRAS, HPNCC, LYNCH, etc. Less than 1/2 of a person died during the five years. How'd they manage that? :oD

laurie83833

PGLGreg said:

pMX
I don't know, but pMX means "cannot be assessed pathologically", which leaves open the possibility that it can be assessed clinically, so I guess your oncologist has made a clinical assessment of M0. It's hard to see how there ever could be a "pM0" score, since the pathologist couldn't have tissue samples from all the possible places that metastases could turn up.

--Greg

Understand -
Thanks I understand - yeah what you said makes sense.

dixchi

My Story Again
Have told my story several times here but since you are commenting on
Stage 2......I was diagnosed Stage 2 with no lymph nodes affected and
there were about 28 removed and checked in 2004......no chemo just resection;
it was located near the appendix and had only moved into the mucosa lining....in
2008, a routine CT scan unearthed that I had Stage 4 in my liver....
I had resection of liver and 4 Folfox treatments prior to surgery and
8 Folfox treatments afterwards...am cancer free now and am being checked
by PET/CT and biphasic CT every three months; it has been 15 months....
I am 68 years old and have been healthy until now.....I understand that
there is a blood test they are giving to Stage 2ers to check for certain
genes to determine if chemo is warranted; in 2004 my oncologist was
using statistics about the outcomes for Stage 2ers on chemo and convinced
me I didn't need it at the time.....agree that it is a challenging and
puzzling stage....don't know how I was able to go for as long as I did
cancer free and then it reappeared.
Barbara

grandma713

KathiM said:

Interesting....but....
How many also had/did not have rads?

How many were true colon...not rectal, not anal? (adenocarcinoma vs highly radio sensitive squamous cell carcinoma?)

What were the age groups in the study?

Not that this isn't great news...but, I also have seen studies where the same outcome was used to argue both sides of the coin...lol...

Thanks for the info, it bears looking into other sources, as well!

Hugs, Kathi

Stege IIB
I only had a resection and have been cancer free for 6 years this month!!! Hurray

PGLGreg

grandma713 said:

Stege IIB
I only had a resection and have been cancer free for 6 years this month!!! Hurray

6 years NED.
Yes, that's great. Hurray for you!

--Greg