Dad's Update: Liver Mets Confirmed, Chemo Started and Visit to Surgeon

npatel22526

Hello All,

Just a quick background, my father was diagnosed with colon cancer with liver mets August 2019 and completed FOLFOX in April 2020. Scans right after his last therapy showed elevated CEA. CT scan of liver coupled with liver biopsy revealed infection but “NO lesions”. The blood culture-confirmed the growth of “Klebsiella Oxytoca”. While we waited for insurance for IV antibiotic, his condition worsened, he was admitted to the ER, and JP drain was placed. The drain took 8 weeks to come out, meanwhile, he got COVID ( thankfully very mild symptoms). Multiple CT scan results were inconsistent so Onc requested MRI (last week Nov 2020) and Biopsy ( First week Dec 2020). We were looking into two clinical trials one at MSKCC and another at RWJ.

Now, the MRI and Biopsy confirmed the liver mets, the CEA almost doubled in a month from 40.4 to 76. Initially, we wanted to be part of a Clinical trial for his HER2 amplification and KRAS/NRAS negative but MSKCC said that dad needs to be all the other treatments (5-Fu, oxaliplatin, irinotecan, bevacizumab) and the trial at RWJ may take 3 additional weeks to be started and with 50% chance that he will be in the trial group.  But given his rising CEA, we quickly started his chemo, thanks to the amazing team at Overlook summit. The oncologist suggested that we’ll start with FOLFIRI and next cycle she will add bevacizumab. She did this because she wanted to see that from irinotecan and bevacizumab, which one will give him diarrhea if at all. Further, on the bright side, she said we wouldn’t have to go through a clinical trial and she can get HER2 targeted therapy approved outside for clinical trial but in order for that to happen my father has to try the second line of therapy.

A visit to the Surgeon left us with a lot of emotions. He reviewed the scan with us and counted a bunch of lesions (over 5)  in the liver on both lobes.  But he was also confident that surgery can be performed on one lobe where most of the lesions are and ablation can be done on the other side with 1-2 lesions. He said it will be open surgery and while he is at it the abdomen hernia will also be fixed. My dad had 4 CT scans + MRI in the last 6 months. Initially, we thought the tumor must be hidden under the infection and so missed it in the scan of May and September. But he confirmed that none of the lesions overlap with the site on infection so the liver was visibly clean until September and here we are in two months with multiple lesions with the largest being 3.7 X 3.5 CM. The point being the tumor is very aggressive.

A lot happened over the last couple of weeks but I am glad for many things, first, surgery is an option. Second, the chemo has started and I am very hopeful that the faster the tumor is growing the faster it will be killed by chemo. Finally, we have a plan in place, should things not go as expected with the second line of chemo.

Wish everyone and family Merry Christmas and a healthy and safe new year.

flutemon

Thanks for the update. 

Thanks for the update.  Having a plan in place makes all the difference.  And having a backup plan is good, too. I know we don't want to buy trouble, but this is like chess in that I like to think several moves ahead.  Hoping for great outcomes for your dad.

npatel22526

flutemon said:

Thanks for the update. 

Thanks for the update.  Having a plan in place makes all the difference.  And having a backup plan is good, too. I know we don't want to buy trouble, but this is like chess in that I like to think several moves ahead.  Hoping for great outcomes for your dad.

Thank you !! it is great to

Thank you !! it is great to hear from you. The "Chess" analogy is to the point. To me, It helps tremendously to stay positive and focused.  Being informed gives you a sense of security.

How did your scans go?

flutemon

npatel22526 said:

Thank you !! it is great to

Thank you !! it is great to hear from you. The "Chess" analogy is to the point. To me, It helps tremendously to stay positive and focused.  Being informed gives you a sense of security.

How did your scans go?

Finally got the Monday

Finally got the Monday afternoon scan results Thursday - a day after my most recent infusion and oncologist appointment.  Onc had the preliminary scans but they had not been read when I saw him.  He said it was hard to tell what was going on with the liver with the recent resection/ablation/radiation so he wanted to wait on the radiologist to read it and compare it to previous scans.

CEA went up from 6 to 11 since mid November - not a lot but I never am very high. Probably because a previously 6mm liver met has grown to 3.4 cm since August. There was another small met in August that is not showing up now.  The MRI says other than the 3.4 cm met, there are no new lesions identified.

The chest CT is problematic now.  It showed 3 new nodules (subcentimeter) and the previous small nodule has now grown.  And there is also a mass of some sort in the base of one lung - but doc thinks that might be from the sbrt treatment in September/October. Nothing on the report classifies the nodules as metastatic, so who knows?There v were no scans done right before starting the herceptin/perjeta treatment, so I wonder if all of this mess happened before or during this current treatment.  I'll see the doctor tomorrow morning and hopefully re-adjust the plan.  I assume the first plan of action will be to find out if the lung nodules and mass are metastatic or not.  I also assume the herceptin/perjeta will stop and we'll try something else systemic.  

Not the way I wanted to start a new year, but we take what we're given and move forward!

Trubrit

Missed this one

I will blame it on Christmas. 

Sorry to have not responded to your post.  Thank you for all the information about your dad.  Wow, what a journey he has had. 

I am glad there are options on the table, and wish your dad the best as he moves forward. Hopefully 2021 won't be quite such a traumatic year for him.

Tru

npatel22526

flutemon said:

Finally got the Monday

Finally got the Monday afternoon scan results Thursday - a day after my most recent infusion and oncologist appointment.  Onc had the preliminary scans but they had not been read when I saw him.  He said it was hard to tell what was going on with the liver with the recent resection/ablation/radiation so he wanted to wait on the radiologist to read it and compare it to previous scans.

CEA went up from 6 to 11 since mid November - not a lot but I never am very high. Probably because a previously 6mm liver met has grown to 3.4 cm since August. There was another small met in August that is not showing up now.  The MRI says other than the 3.4 cm met, there are no new lesions identified.

The chest CT is problematic now.  It showed 3 new nodules (subcentimeter) and the previous small nodule has now grown.  And there is also a mass of some sort in the base of one lung - but doc thinks that might be from the sbrt treatment in September/October. Nothing on the report classifies the nodules as metastatic, so who knows?There v were no scans done right before starting the herceptin/perjeta treatment, so I wonder if all of this mess happened before or during this current treatment.  I'll see the doctor tomorrow morning and hopefully re-adjust the plan.  I assume the first plan of action will be to find out if the lung nodules and mass are metastatic or not.  I also assume the herceptin/perjeta will stop and we'll try something else systemic.  

Not the way I wanted to start a new year, but we take what we're given and move forward!

Your attitude is very

Your attitude is very encouraging .

Is your CEA test done every couple of weeks?  because they are sometimes very strange. My father's CEA drop from 76 to 51 before the chemo and after the first cycle it stayed at 51, so I will give it a couple more cycles.

I guess the real effect of the treatment will be evaluated after the second CT scan right, because like you said it could be before it was started.

Wish you the best for your next steps.

npatel22526

Trubrit said:

Missed this one

I will blame it on Christmas. 

Sorry to have not responded to your post.  Thank you for all the information about your dad.  Wow, what a journey he has had. 

I am glad there are options on the table, and wish your dad the best as he moves forward. Hopefully 2021 won't be quite such a traumatic year for him.

Tru

Not a problem at all and glad

Not a problem at all and glad to hear from you.

When I started visiting the thread it helped me greatly understanding all the details from wonderful fellow members. So I started providing as many details as I can with the hope that it will be useful for someone.   From the post of flutemon I realized that the drugs can be offered outside trials which then I was able to discuss with an oncologist , and I can not appreciate that enough. So I want to keep it doing it .

 

Yes, may 2021 bring the best for all, a Very Happy New Year to you and loved ones.