How much Chemo

yesterday12345

Does anyone have any information that would indicate the correct number of chemo rounds for T3N1M0. It seems that the "traditional" number is 6 but are that many necessary? I am wondering this because it seems that the less one does the better chance of reducing damage to other organs. I have heard sooo many stories of negative responses to long term use. Any information you have would be welcomed.

My son, 41 with two young daughters, is the person in question here. He has never smoked, doesn't drink more than a couple of beers a month and is not overweight at all. Except for the EC he was in perfect health. The Drs. said it was an anomally but it is also our reality. We looked at all of the possible alternative approaches and could not find enough to warrant trying them at this time. He has had MI surgery and has had two rounds of Chemo (caprecitabine, epirubicin and oxalplatin). Three weeks apart. He has also had significant drops in his white cell count and has received shots to combat this side affect.

Thank you all for your contributions.
We are hopeful and confident that he will beat this dread disease.

His Dad,
Mark

Callaloo

Standard for surgical
Standard for surgical candidates for the 3-drug combo you describe (EOX) is 6 cycles total, 3 pre-op and 3 post-op . Is that what your son is doing? Of course doctors modify the regimen all the time.

This is according to the most recently published NCCN Guidelines. The following is the regimen for EOX, when used perioperatively (page 5 of ESPH-E):

Epirubicin 50 mg/m2 iv day 1
Oxaliplatin (Eloxatin) 130 mg/m2 iv Day 1
Capecitabine (Xeloda) 625 mg/m2 po bid on Days 1-21
Cycled every 21 days for 3 cycles peroperatively and 3 cycles postoperatively

I didn't have that particular regimen, but it may help you to know that my WBC dropped dramatically while I was on Cisplatin/5FU last year and I also had a shot of Neulasta in between chemo infusions. But I went from a low of about 1.5 to 3.9 where I am now, almost normal again. It only took about a month after the chemo ended for my WBC to start to normalize.

Also, the Capecitabine appears to be a low dose in this regimen. I'm now taking 3000 mg/day, and even my dose is slightly reduced from the "standard" 3600mg. Like I said, doctors modify doses for all kinds of reasons. Mine just likes to prescribe at the low end -- he says it's just a personal philosophy of his.

yesterday12345

Callaloo said:

Standard for surgical
Standard for surgical candidates for the 3-drug combo you describe (EOX) is 6 cycles total, 3 pre-op and 3 post-op . Is that what your son is doing? Of course doctors modify the regimen all the time.

This is according to the most recently published NCCN Guidelines. The following is the regimen for EOX, when used perioperatively (page 5 of ESPH-E):

Epirubicin 50 mg/m2 iv day 1
Oxaliplatin (Eloxatin) 130 mg/m2 iv Day 1
Capecitabine (Xeloda) 625 mg/m2 po bid on Days 1-21
Cycled every 21 days for 3 cycles peroperatively and 3 cycles postoperatively

I didn't have that particular regimen, but it may help you to know that my WBC dropped dramatically while I was on Cisplatin/5FU last year and I also had a shot of Neulasta in between chemo infusions. But I went from a low of about 1.5 to 3.9 where I am now, almost normal again. It only took about a month after the chemo ended for my WBC to start to normalize.

Also, the Capecitabine appears to be a low dose in this regimen. I'm now taking 3000 mg/day, and even my dose is slightly reduced from the "standard" 3600mg. Like I said, doctors modify doses for all kinds of reasons. Mine just likes to prescribe at the low end -- he says it's just a personal philosophy of his.

my son
hello callaloo. thanks for your prompt response. My son did not have Chemo prior to his surgery. The margins, after the surgery, were clear but as I noted he did have node involvement (11 of 24). His Dr. has ordered 6 coures of chemo and he is thinking about stopping at three which is the normal for post surgery. He, too, has experienced WBC counts dropping dramatically and has received shots to alleviate this problem. I do not know the dosage that he is receiving but I will find out.

Again, thanks and if you have any further thoughts it would be most helpful.

Callaloo

yesterday12345 said:

my son
hello callaloo. thanks for your prompt response. My son did not have Chemo prior to his surgery. The margins, after the surgery, were clear but as I noted he did have node involvement (11 of 24). His Dr. has ordered 6 coures of chemo and he is thinking about stopping at three which is the normal for post surgery. He, too, has experienced WBC counts dropping dramatically and has received shots to alleviate this problem. I do not know the dosage that he is receiving but I will find out.

Again, thanks and if you have any further thoughts it would be most helpful.

It seems risky to stop chemo
It seems risky to stop chemo early unless there's an urgent medical reason to stop. Such a large number of malignant nodes is a very serious matter. There's no guarantee that all the affected nodes were removed in the surgery.

As I read the treatment guidelines (and keep in mind, NCCN is only intended to describe options and recommendations, as there are no hard and fast standards when it comes to EC), the "normal" treatment using these 3 drugs includes 6 courses, not 3. The recommended 3 post-op courses assumes 3 courses pre-op, which your son did not receive. So I'm not sure he can rationalize the decision to stop at 3 quite so easily.

I did not have surgery, so maybe others who have only received post-op chemo are better able to answer your question. I do, however, have personal experience with lymph node metastases, and how quickly it can spread once it's in the lymphatic system.

Lu
Stage IVb

paul61

yesterday12345 said:

my son
hello callaloo. thanks for your prompt response. My son did not have Chemo prior to his surgery. The margins, after the surgery, were clear but as I noted he did have node involvement (11 of 24). His Dr. has ordered 6 coures of chemo and he is thinking about stopping at three which is the normal for post surgery. He, too, has experienced WBC counts dropping dramatically and has received shots to alleviate this problem. I do not know the dosage that he is receiving but I will find out.

Again, thanks and if you have any further thoughts it would be most helpful.

I also had 6 rounds post surgery
Mark,

I had Ivor Lewis surgery without pre-operative chemo. In the post surgery pathology they found 1 of the nodes that had been removed positive for cancer. I had 6 rounds of chemo following surgery. I must admit it was hard to complete the 6 rounds while recovering from surgery. But I did complete them and I am glad I did. At least if I do have a recurrence I will know I did all I could to deal with the cancer.

Given the number of positive nodes found I would want to do all I could to insure I had killed all the cancer cells I could. Of course there are no guarantees; but I agree with Lu it seems risky to stop early.


Best Regards,

Paul Adams
McCormick, South Carolina

DX 10/22/2009 T2N1M0 Stage IIB
12/03/2009 Ivor Lewis
2/8 through 6/14/2010 Adjuvant Chemo Cisplatin, Epirubicin, 5 FU
6/21/2010 CT Scan NED
3/14/2011 CT Scan NED

Life may not be the party we hoped for, but while we are here we might as well dance!

Callaloo

I would also caution against
I would also caution against taking too much from discussions regarding the harsh effects of chemo. I noticed you posted your question under the "Big Canons" thread, which focused on when enough is enough. That is a Stage IV issue. I think everyone who posted under that thread had already gone through at least one or more full chemo regimens, which your son has not. Persons with stage IV are not curable and the big question is finding milder treatment options that preserve quality of life while prolonging it.

I'm assuming that your son is still stage III and not stage IV and that he is considered curable. If that is the case, treatment with curative intent is bound to be tougher than the kind of chemo that is prescribed with palliative intent alone, but well-worth it, IMHO.

If I had the chance to be cured, I'd do whatever it took, and not anything less.

Lu

Unknown

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