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Treatment decision

flutemon's picture
flutemon
Posts: 24
Joined: Jan 2019

I'm struggling right now to make a treatment decision.  

My back story:  Diagnosed Feb. 2018 with colon cancer and had right hemi-colectomy right away.  Stage 3 - 1 of 22 lymph nodes.  Xeloda as clean-up.  Then 6 months later scans show mets to the liver.  Folfiri + Avastin (6) then resection surgery for 3 mets.  2 mets were deep so I did SBRT. Then followed up with Folfox (6).  I was clean for another 7 months until we found mets had returned to the liver.  Doc suggested a clinical trial for Cetuximab+Monalizumab+Durvalumab.  They were looking for MSS with kras etc. wild, which I am.  I did this trial for 6 months but stopped when another met showed up and CEA started going up.  Then had liver resection + ablation to clear the liver again.

That brings us to now.  2 months after surgery CEA jumped so scans were done. There is a 3 cm met in the liver that wasn't there 2 months ago, as well as 2 other subcentimeter mets. And now there's a spot (6mm) in the lower lung that they don't think is a met, but it could be.  Results of ctDNA showed that the cancer has changed - HER2 amplified.

So there are choices to make!  The oncologist wants to do either targeted therapy drugs herceptin and perjeta alone or with chemo.  The radiation oncologist wants to do SBRT on the 3 cm met to stop it since it grew so fast. And we had talked about HAI pump with the liver surgeon/surgical oncologist before the last liver surgery in June.  

I don't think the spot in the lung is cancer.  The scan report said most likely infection - less likely met.  I'm more concerned about the fact that things pop up in the liver and feel like HAI pump would control that.  

So I'm just struggling with what to do.  Oncologist didn't seem keen on the HAI pump.  He was worried about lung, I guess.  It seems I could do HAI pump infusions along with targeted therapies. And on top of all of this, I just turned 65 and am adding a Medicare supplement plan so will need to wait until it's in effect.  Gives me time to figure it out.

Has anyone used herceptin/perjeta?  Alone or with something else?  Just wish I had a crystal ball to know what will work.  That clinicsl trial kinda burned me. What to do, what to do.

Thanks in advance for any advice.

abita's picture
abita
Posts: 814
Joined: Dec 2017

I am on a targeted drug after lung mets appeared while on flolfox, but on a different one. Erbutix with irintecan. Was not given option to not have the chemo as I guess the original study was with both. The liver mets shrunk to can't be seen on ct. The lung mets shrunk a bit at the first scan, now are stable. For some reason, lung mets are harder to get rid of. Sorry can't answer about the specific targeted drugs you are taking. I would ask about the studies, and how much adding the chemo changed the effectiveness.

Annabelle41415's picture
Annabelle41415
Posts: 6528
Joined: Feb 2009

Sorry to hear that you are going through all this and the decisions that you are faced with.  I'm not able to help with this, but I'm sure there are others on the board that have had the type of procedure you are talking about.  Wishing you the best.

Kim

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