Health Update: Back to FOLFOX

Due to the length of the update please excuse the lack of creative content while I simply provide you with an update on the current state of the battle. An actual blog will eventually follow once treatment settles in and things calm down a bit.   =-)

Much Love – Teej

Health Update: Previous to last October I was on a treatment FOLFIRI Erbitux for about about a year. This cocktail of drugs was extremely successful at keeping the cancer in my ...

 body stable for that year. Erbitux (Cetuximab) is a targeted therapy that is specifically an EGFR(Epidermal Growth Factor) inhibitor. At the end of last summer I had increased symptoms of my cancer becoming active and scans showed that in fact the cancer in my body was growing resistant to the therapy I was on. At that time I was given a few options as to my next course of therapy, there was no easily accessible tumor for biopsy, so a biopsy if performed came at an elevated risk. With biopsy not being on the table this reduced my next therapy choice to best educated guess. I could return to FOLFOX, which is the standard frontline chemotherapy for colorectal cancers. FOLFOX was extremely effective for me the first time around, yet it comes with some pretty harsh neural side effects. I could choose an Immunotherapy clinical trial which at the time for colorectal cancers have not shown too promising, especially without knowing the genetic profile of my tumors through biopsy. Or I could choose a new clinical trial that was designed specifically for individuals in my situation who had recently grown resistance to EGFR treatment.  The clinical trial intended to use a drug called trametinib along with another EGFR inhibitor panitumumab to side step the resistance and hopefully kill/stabilize the cancer cells. Along with recommendation from my medical team I chose the targeted therapy clinical trial as it seemed the most practical and promising for my given situation.

After the first few cycles of the clinical trial it appeared it was working as my scan showed that some of my lung nodules had shrunk. However, I was experiencing some very difficult side effects mostly in the form of rash. My entire body was covered in acne like rash that was extremely itchy, when the rash would dry out, it would dry out so much that the area would crack and bleed. There were other areas that was similar to a sunburn that simply wouldn’t heal, just painful raw skin for weeks on end. After multiple dose reductions it appeared we may get the side effects under control and in early January I had another scan to see performance of the trial. The scan showed a complete reversal in response from my original scan and that the cancer was in fact active and possibly spreading. This news would normally seem catastrophic to most people but it actually presented an opportunity. The growth of the cancer in my liver was primary located in a tumor at the very front of my body. So for the first time since my original surgery we had the ability to take a biopsy of my cancer. Having a biopsy potentially opens the doors to more clinical trials and provides you with the ability to make better decisions on treatment paths. A few days following my scan I went in for a non-intrusive needle biopsy of my liver that was guided by CT scan. The biopsy was successful and they were sent out immediately for what is called a Tumor Snapshot on rush order, the genetic profile of my tumor was expected in less than a month.

Fast forward one month to last week when I met with my medical team to discuss the results of my biopsy and our next treatment path. The biopsy showed that my Tumor had three mutations APC, EGFR and TP53. It also presented that my tumors was what they call Miscrosatellite High, MSI or Microsatellite Instable. Lately, there has been some clinical evidence that the patients who have been responding to immunotherapy drugs are individuals with MSI tumors and so they are attempting to learn more on this through further clinical trials. This is great new as it means that I am eligible for more break through trials that could potentially have high impact, durable, possibly curable response. With that being said they are still trying to further the science and find more effective ways to achieve larger and more durable responses.  So knowing that I have the immunotherapies and other clinical trials in my back pocket I have elected along with the advice of my oncologist to return to FOLFOX treatment to see if it still effective (it kicked ass the first time) while they advance immunotherapies against colorectal cancers.

The best way to put it, this battle I am fighting is not a race to get the disease out of me (like it is with early and initial diagnosis of the disease) but rather a marathon to keep it stable while they advance the science and create more effective and possibly curative treatments. They are on the brink of scientific breakthrough and have made this breakthrough on some cancers. Therefore I will continue to trudge forward and endure through the pain, side effects and mental battle of this disease as long as I have to. As I said from the beginning, I will not stop until I have rid every last drop of this disease from body, I will reach the light at the end of this deep dark tunnel. The battle continues, FOLFOX Round 2 cycle 1 starts tomorrow.

p.s. I should have a pretty good indication of its effectiveness early on as a metastases inside my Manubrium (the bone at the top of the sternum) although, nonthreatening at the moment causes unbearable pain even with slight growth or activity. Pressure from the inside of the bone makes its sensitive to the touch as if in a constant state of breaking while it pushes on the collar bones and the rest of the rib cage and their ligaments also causing significant pain. This pain should basically dissipate as the chemo gets to work. (I’ve gone through this similarly twice before.)  Odd to say but I am looking forward to treatment.