Advanced Colon Cancer Treatment Options and Challenges

Q: Advanced Colon Cancer Treatment Options and Challenges

Hello： Some questions are not ones that I, as a general physician, can or should answer; you need to ask your father's primary physician. <br>Therefore, I will only address some research-related inquiries： 2. <br>All Ras gene mutations indicate that targeted therapies for a speci

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 at the time of discovery.
After surgically removing the tumor at the junction of the colon and rectum, he began chemotherapy, initially with Avastin, Irinotecan, and 5-FU.
He underwent this treatment for over a year and a half, during which the tumor slightly shrank at one point but then stabilized.
Once his health insurance coverage was exhausted, 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.
It seems that none of these treatments have been effective, as the tumor has gradually grown since the medication changes.
After exhausting the first to third-line drugs covered by health insurance, the doctor administered Mitomycin-C, which is less commonly used.
Currently, we have discovered metastasis to both lungs, and his white blood cell count has exceeded 10,000 for the first time, possibly due to lung inflammation.
He is still able to move freely but experiences occasional fatigue and persistent coughing.

I would like to ask the doctor:
1.
Is Mitomycin-C helpful for colon cancer? After exhausting the first to third-line drugs, are there really no options left?
2.
I found that my father's report indicates an allras mutation; how does this affect treatment and medication? Is it hereditary? The report states negative for EGFR; what does this mean?
3.
I saw a blood test for BRAF V600E; what is this?
4.
After lung metastasis, considering his cough, what should we be aware of regarding liver and lung metastasis?
5.
With metastasis to the liver and lungs, how much longer can he hold on?
6.
Is it appropriate to self-pay for Avastin in combination with other treatments?
7.
After exhausting all health insurance medications and with further metastasis, I am unsure whether to seek other medical opinions.
However, I feel that changing hospitals could be very taxing on my father's health.
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: 2022/07/24

Dr. Chen Yunfang reply Oncology

Hello: Some questions are not ones that I, as a general physician, can or should answer; you need to ask your father's primary physician.
Therefore, I will only address some research-related inquiries: 2.
All Ras gene mutations indicate that targeted therapies for a specific site (EGFR) are ineffective; for example, commonly used Erbitux cannot be utilized as it is ineffective.
Whether there is a hereditary component is still inconclusive.
3.
BRAF gene testing corresponds to other targeted therapies; the absence of mutations indicates that the drug is ineffective against that cancer cell.
As for the remaining questions, they cannot be answered through online consultations.
Thank you.

Reply Date: 2022/07/24

More Info

I'm sorry to hear about your father's condition. Advanced colon cancer, especially with liver and lung metastases, presents significant challenges, but understanding treatment options and potential outcomes can help you make informed decisions. Here’s a comprehensive overview based on your questions:
1. Mitomycin-C in Colon Cancer: Mitomycin-C is a chemotherapy agent that is not commonly used as a first-line treatment for colon cancer. Its use in advanced cases is generally limited and may be considered in specific scenarios, particularly in patients who have exhausted other treatment options. However, its effectiveness in colon cancer, especially in the context of liver and lung metastases, is not well established. It's crucial to discuss with your oncologist whether this treatment is appropriate for your father’s specific situation.

2. Allras Mutation and Treatment Implications: The "allras" mutation you mentioned might refer to alterations in the RAS gene family (KRAS, NRAS), which are significant in cancer treatment. RAS mutations can affect the efficacy of certain targeted therapies, particularly those aimed at the EGFR pathway. The report stating "negative for EGFR" indicates that your father’s cancer does not have mutations in the EGFR gene, which means that therapies targeting EGFR would not be effective. RAS mutations are not inherited in a typical Mendelian fashion, but they can be present in familial cancer syndromes, so discussing family history with a genetic counselor may be beneficial.

3. BRAF V600E Mutation: The BRAF V600E mutation is another genetic alteration that can occur in various cancers, including colon cancer. This mutation is associated with a more aggressive disease course and may influence treatment decisions. Targeted therapies, such as BRAF inhibitors, may be considered in cases where this mutation is present. If your father's report indicates this mutation, it could open up additional treatment avenues.

4. Monitoring Lung Metastases: With lung metastases, it’s essential to monitor for respiratory symptoms, such as persistent cough, shortness of breath, or chest pain. These symptoms may indicate progression of the disease or complications like pneumonia. Regular imaging and clinical evaluations are crucial to assess the extent of lung involvement and to adjust treatment accordingly.

5. Prognosis with Liver and Lung Metastases: The prognosis for patients with advanced colon cancer and metastases to the liver and lungs can vary widely based on several factors, including the extent of disease, response to previous treatments, overall health, and age. While some patients may live for months to years with advanced disease, others may experience a more rapid decline. It’s essential to have open discussions with the healthcare team about realistic expectations.

6. Reconsidering Avastin: Avastin (bevacizumab) can be an option in combination with chemotherapy for some patients with metastatic colon cancer. If your father previously responded well to this treatment, it may be worth discussing with his oncologist. However, the potential for resistance after prolonged use of other agents should be considered.

7. Seeking Second Opinions: If you feel uncertain about the current treatment plan, seeking a second opinion can be beneficial. However, consider the physical and emotional toll on your father when changing hospitals or treatment teams. A new perspective may provide additional options or reassurance about the current plan.

8. General Recommendations: It’s crucial to maintain open communication with your father’s healthcare team. Palliative care services can also provide support for managing symptoms and improving quality of life. Encourage your father to maintain a balanced diet, stay hydrated, and engage in light physical activity as tolerated.

9. Immunotherapy for Colon Cancer: Immunotherapy has shown promise in certain subtypes of colon cancer, particularly those with mismatch repair deficiency (dMMR) or microsatellite instability (MSI). If your father’s tumor has these characteristics, immunotherapy could be a viable option. Discussing genetic testing for these markers with his oncologist may provide insights into potential treatments.

In conclusion, navigating advanced colon cancer treatment requires a multidisciplinary approach and ongoing communication with healthcare providers. Each patient's situation is unique, and treatment plans should be tailored to individual needs and responses. Your proactive involvement in your father's care is commendable, and I encourage you to continue seeking information and support.

Similar Q&A

Understanding Treatment Options for Advanced Colon and Liver Cancer

My brother is 51 years old and has stage III colon cancer, along with three malignant tumors in his liver. Initially, the doctors planned to perform surgery on both, but due to concerns about his ability to tolerate the procedure, they decided to first address the colon cancer at...

Dr. Lai Yicheng reply Oncology
Dear Ms. You, Regarding your brother's Stage III colorectal cancer, it has metastasized from the primary site in the colon to the liver. As for surgery, the attending physician will assess the patient's overall health to determine if they are a suitable candidate for t...

Managing Advanced Colorectal Cancer: Dietary Changes and Treatment Options

Hello Dr. Hou: My brother underwent surgery for an artificial stoma at Taichung Veterans General Hospital over two years ago and has been on oral chemotherapy since then. In early April of this year, due to the spread of cancer cells, he had his bladder and prostate removed and u...

Dr. Hou Yongji reply Surgery
Hello: Based on your description, radiation therapy could be considered. However, if you have already undergone radiation therapy and the dosage has reached the limit for human tolerance, then there may not be any further options available. Please discuss this with your attending...

Challenges in Treating Recurrent Colon Cancer with Organ Adhesions

Dear Dr. Ke, My father is 60 years old. Last August, he was taken to the emergency room due to unbearable abdominal pain. After examination, he was diagnosed with intestinal obstruction caused by a malignant tumor. He underwent emergency surgery to create a colostomy, followed b...

Dr. Ke Fangxu reply Surgery
Based on your description, the condition seems to be quite severe. If there are multiple metastases in the abdominal cavity after surgery, it can be said that Western medicine has no possibility of a cure. Targeted therapy can effectively extend survival by 3 to 6 months. Surgica...

Advanced Cervical Cancer Treatment Options and Patient Care Insights

1. Given the current medical technology, your mother may be eligible for various treatment options, including targeted therapy, immunotherapy, or clinical trials, depending on her specific condition and the characteristics of the tumor. 2. If the tumor is too large or if the can...

Dr. Cai Yonglong reply Obstetrics and Gynecology
Dear Flyliv, As you mentioned, it is suspected that your mother may be in the advanced stage of cervical cancer, which often leads to edema and uremia. Post-surgery radiation therapy is typically the most effective treatment, while chemotherapy tends to have limited efficacy. It...