Stage 4 Colon Cancer Treatment: Chemotherapy and Targeted Therapy

Q: Stage 4 Colon Cancer Treatment: Chemotherapy and Targeted Therapy

Hello： For stage IV colorectal cancer, according to current standard treatment, the first-line therapy consists of chemotherapy combined with the targeted drug Avastin. <br>Based on previous research findings, the expected probability of tumor shrinkage is over 50%. <br>The avera

Cancer treatment

Dear Dr.
Chen,
My husband, Cheng-Chung, was diagnosed with stage IV colorectal cancer (metastatic colorectal cancer) in May 2021.
A CT scan on May 11 at National Taiwan University Hospital revealed liver metastases, with multiple small tumors, approximately 7-8 in total, the largest measuring 2.2 cm and another 1.98 cm, located in the liver.
On May 28, he underwent a resection of a 6.3 cm tumor in the sigmoid colon at Shuang Ho Hospital.
He was discharged on June 4, and on June 15, the physician informed us that the pathological report indicated stage III colorectal cancer, with liver metastasis classified as stage IV.
The hematology-oncology physician recommended postoperative chemotherapy for 2-3 months, with treatments every two weeks, and a CT scan scheduled for mid-August to assess treatment efficacy.
The first chemotherapy session was on June 23, followed by the second on July 7.

Before each chemotherapy session, blood tests for GPT, CEA, CA-199, etc., are performed.
He is currently receiving targeted therapy with Bevacizumab (Avastin), an anti-VEGF agent, as the physician indicated that his genetic profile has mutations that make this medication suitable.
He is also receiving anti-allergic and anti-emetic injections, with chemotherapy lasting approximately 5-6 hours each day.
After treatment, he will go home with a portable pump delivering 5-FU, which allows for a 48-hour home chemotherapy regimen, making it very convenient.
My first question is whether this combination of chemotherapy and targeted therapy can help shrink or eliminate the liver tumors, considering they are small and numerous but dispersed.
I would also like to know what the typical treatment outcomes are for patients after a certain period.
Instead of worrying daily about my husband's condition, I prefer to accept the reality and rationally consider the treatment effects in conjunction with the physician's guidance.

Hui Ting, 30~39 year old female. Ask Date: 2021/07/08

Dr. Chen Yunfang reply Oncology

Hello: For stage IV colorectal cancer, according to current standard treatment, the first-line therapy consists of chemotherapy combined with the targeted drug Avastin.
Based on previous research findings, the expected probability of tumor shrinkage is over 50%.
The average duration of disease control is about 10 to 12 months, after which it is necessary to switch to other second-line chemotherapy agents, and possibly even third or fourth-line drugs (the national health insurance currently covers up to a maximum of four lines of treatment).
Stage IV is considered terminal, and a cure is not possible; the focus is on prolonging the duration of control.
If there is a mutation in the EGFR gene (making the targeted drug Erbitux ineffective), even with aggressive treatment, the average survival is approximately two years.
Thank you for your inquiry.

Reply Date: 2021/07/08

More Info

Stage 4 colon cancer, also known as metastatic colorectal cancer, presents a significant challenge in terms of treatment and management. Your husband’s diagnosis, which includes multiple small tumors in the liver, indicates that the cancer has progressed beyond the primary site in the colon. The treatment plan involving chemotherapy and targeted therapy is a common approach for this stage of cancer, and understanding how these treatments work can help you and your family navigate this difficult journey.

Chemotherapy is a systemic treatment that uses drugs to kill cancer cells or stop them from growing. In your husband's case, the chemotherapy regimen includes 5-Fluorouracil (5-FU), which is a standard drug used in treating colorectal cancer. The addition of targeted therapy, such as the anti-VEGF (Vascular Endothelial Growth Factor) agent you mentioned, is designed to inhibit the growth of blood vessels that supply the tumor, effectively starving it of nutrients and oxygen. This combination of chemotherapy and targeted therapy can be effective in shrinking tumors and controlling the disease.

The effectiveness of this treatment regimen can vary from patient to patient. Factors that influence treatment response include the specific characteristics of the cancer, the patient's overall health, and how well they tolerate the treatment. In many cases, patients may experience a reduction in tumor size or stabilization of the disease after several cycles of treatment. The goal of therapy in stage 4 cancer is often to prolong survival and improve quality of life rather than achieve a complete cure.

It is important to monitor the treatment's effectiveness through regular imaging studies, such as CT scans, and blood tests that measure tumor markers like CEA (Carcinoembryonic Antigen) and CA 19-9. These markers can provide insight into how well the treatment is working. A decrease in these markers often correlates with a positive response to treatment, while an increase may indicate that the cancer is not responding as hoped.

In your husband's case, the fact that he is receiving a combination of chemotherapy and targeted therapy is promising. The small, multiple tumors in the liver can be more challenging to treat than a single large tumor, but many patients do respond well to this type of treatment. It is essential to maintain open communication with his healthcare team, who can provide guidance based on his specific situation and adjust the treatment plan as necessary.

As you navigate this journey, it is also crucial to focus on supportive care. This includes managing side effects of treatment, maintaining a nutritious diet, and ensuring that your husband has access to psychological support. Emotional well-being plays a significant role in coping with cancer treatment, and seeking support from counselors, support groups, or even friends and family can be beneficial.

In conclusion, while stage 4 colon cancer presents significant challenges, the combination of chemotherapy and targeted therapy offers a viable treatment option. Regular monitoring and open communication with healthcare providers will be key in assessing treatment effectiveness and making necessary adjustments. It is understandable to feel anxious about your husband's condition, but focusing on the present and supporting him through this process can help both of you cope with the uncertainties ahead.

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