Treatment Options for Advanced Colon Cancer with Metastasis

Questions about colorectal cancer treatment?

As a child seeking advice for my father: My father, in his seventies, was diagnosed with colon cancer that had metastasized to the liver.
After surgically removing the tumor at the junction of the colon and rectum, he began chemotherapy with a regimen of Avastin, Irinotecan, and 5-FU for over a year and a half.
Initially, the tumor slightly shrank, but then it stabilized until we exhausted our health insurance coverage.
We considered paying out of pocket, but the doctor mentioned that prolonged use of the medication could lead to drug resistance.
We then tried Oxaliplatin, and after about six months, switched to Stivarga, and three months later to LONSURF.
None of these seemed effective, and since changing medications, the tumor has gradually grown.
After completing all first to third-line medications covered by insurance, the doctor prescribed Mitomycin-C, which is less commonly used.
Currently, the cancer has metastasized to both lungs, and his white blood cell count has exceeded 10,000 for the first time, possibly due to pneumonia.
He can still move around freely but experiences occasional fatigue and a persistent cough.
I would like to ask the doctor: 1.
Is Mitomycin-C helpful for colon cancer? 2.
I found that my father's report indicates an ALK mutation; how does this affect treatment options? Is it hereditary? 3.
I noticed a blood test for BRAF V600E; what does this mean? 4.
With lung metastasis, considering his cough, what should we watch for regarding liver and lung metastases? 5.
With metastases to the liver and lungs, how much longer can he expect to survive? 6.
Is it appropriate to consider returning to Avastin in a self-paid regimen? 7.
After exhausting all health insurance medications and with new metastases, should I seek additional medical opinions? However, I feel that changing hospitals could be physically taxing for my father; what is your advice? 8.
What are your thoughts and any recommendations? I would be immensely grateful.
9.
What is the current effectiveness of immunotherapy for colon cancer?

Xiao Wu, 30~39 year old female. Ask Date: 2022/07/20

Dr. Chen Shidian reply Gastroenterology and Hepatology

Consult an oncologist.
You can inquire about the cost and effectiveness of immunotherapy if chemotherapy has failed.

Reply Date: 2022/07/20

More Info

I'm sorry to hear about your father's situation. Advanced colon cancer with metastasis, especially to the liver and lungs, presents significant challenges in treatment and management. Here’s a comprehensive overview addressing your questions:
1. Mitomycin-C in Colon Cancer: Mitomycin-C is a chemotherapy agent that has been used in various cancers, including colorectal cancer. However, its use is not standard for advanced colon cancer, especially after multiple lines of therapy. Its effectiveness in this context is limited, and it is typically reserved for specific cases or clinical trials. Given your father's history of multiple treatments, it may not provide the desired benefit.

2. Allras Mutation: The "allras" mutation you mentioned might refer to the "KRAS" mutation, which is common in colorectal cancer. KRAS mutations can affect treatment options, particularly with targeted therapies. If your father's cancer has this mutation, it may not respond to certain therapies like EGFR inhibitors (e.g., cetuximab or panitumumab). This mutation is not hereditary in the traditional sense; it occurs in the tumor cells rather than being passed down from parents to children.

3. BRAF V600E: The BRAF V600E mutation is another genetic alteration found in some colorectal cancers. This mutation is associated with a poorer prognosis and can influence treatment decisions. Targeted therapies are available for tumors with this mutation, and it is essential to discuss these options with your oncologist.

4. Monitoring Lung Metastasis: With lung metastasis, it’s crucial to monitor for symptoms such as persistent cough, shortness of breath, or chest pain. Regular imaging studies (like CT scans) can help assess the extent of lung involvement. If your father is experiencing a cough, it could be related to the metastasis or other factors like infection, so it’s essential to evaluate this symptom promptly.

5. Prognosis with Liver and Lung Metastasis: The prognosis for patients with metastatic cancer varies widely based on numerous factors, including the extent of disease, response to treatment, and overall health. While it's difficult to predict exactly how long someone may live, the presence of multiple metastases typically indicates a more advanced stage of disease, which can shorten survival. Engaging in palliative care can help improve quality of life.

6. Reintroducing Avastin: Avastin (bevacizumab) is a targeted therapy that can be effective in combination with chemotherapy for colorectal cancer. If your father previously responded to this treatment, it may be worth discussing with his oncologist. However, the potential for developing resistance after prolonged use should be considered.

7. Seeking Other Opinions: If you feel that your father's current treatment plan is not effective, seeking a second opinion can be beneficial. However, consider the physical and emotional toll that changing hospitals may have on him. It’s essential to balance the potential benefits of new insights with his current well-being.

8. General Recommendations: Focus on maintaining your father's quality of life. This includes managing symptoms, ensuring nutritional support, and providing emotional and psychological support. Palliative care specialists can offer valuable assistance in this regard.

9. Immunotherapy for Colon Cancer: Immunotherapy has shown promise in certain subsets of colorectal cancer, particularly those with mismatch repair deficiency (dMMR) or microsatellite instability (MSI). If your father's cancer has these characteristics, immunotherapy could be a viable option. Discussing this with his oncologist is crucial to determine eligibility.

In conclusion, navigating advanced colon cancer treatment requires a multidisciplinary approach. Open communication with healthcare providers, understanding the implications of genetic mutations, and considering palliative care options are essential steps in managing your father's condition. Your support and involvement in his care are invaluable during this challenging time.

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