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

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.