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What Do My Lab Test Results Indicate?

Posted on Sat, 6 Aug 2016

Question: Dear Doctor: I was diagnosed colon cancer stage 4 this April. - Metas to the lungs-- 4 leisions found. From size 0.5--2.2 cm. I started chemo at nearby hospital. 5 u,oxiliplatin, irinotecan, and Leucovorin of course. Finished 4 cycle. Just had ct of chest done after chemo. The tumors shrinking only about 25%. What is your recommendation? What else should I do? Any new agents out there ? I know I will have surgery eventually. You guys have better alternative? Thanks ! Looking forward to hear from you!

Answered by Dr. Deepak Sundriyal (2 hours later)

Brief Answer:
Hello dear. targeted therapy can be added..

Detailed Answer:

Hello dear. Welcome to HCM.
I understand your concern.

In your case, there are 2 options:

As there is a partial response, we can continue the same drugs but again response will be slow.

We can go for RAS mutation analysis on your tumor and depending upon the results a targeted therapy in the form of either drug Avastin or drug Cetuximab can be added. These drugs causes better response rate and increased survival.

Please discuss these options with your doctor.
Thanks and regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Deepak Sundriyal (19 hours later)

The mutation results back it was negative. So the target therapy not applie to me. What else can a oncologist do? So I am run out choices?

By the way, thanks so much!

Answered by Dr. Deepak Sundriyal (3 minutes later)

Brief Answer:
if mutation is negative it means targetted can be used.

Detailed Answer:
Hello dear. Mutation negative in colon cancer means both erbitux and avastin can be used one by one. So you have more options. Please discuss it with your doctor.
Thanks and regards

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Deepak Sundriyal (35 minutes later)

Hi dr deepak: Kras g12 v. (-) cetuximan, (-) panitumumab, fda approved therapy-- none. So my oncology told me that target therapy not apply to me. I am confused. Additional disease- relevant genes with no reportable alteration identified. He told me the opposite. My plan is: 3 month chemo, then surgery. Then another 3 month chemo. Any clinical trial agents? Thanks so much. Very helpful!

Answered by Dr. Deepak Sundriyal (7 hours later)

Brief Answer:
hello dear. my vision is opposite.

Detailed Answer:
Hello dear. Iam referring you to national comprehensive cancer network guidelines USA...which states that unmutated kras ( wild type) is a target for cetuximab and panitumumab. However uf your oncologist is nit comfirtable with it, he can try avastin which can be used irrespective of kras status. It can be combined with chemo drugs. Another option is regorafenib. Discuss it with the oncologist.
Thanks

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Deepak Sundriyal (1 hour later)

Dear dr deepak: thanks so much for the knowledge and info you offered. I am satisfied with your answers. But I have more questions to ask you. Is it ok with you? What do you recommend for me, maybe choose another comprehensive cancer center? Which one do you recommend? MD XXXXXXX in Houston? Or others? What about UW- university of XXXXXXX in Seattle? Please point out for me! I am desperate and scared... You may save a life for doing it. Please I am begging! Looking forward to it. God bless you! Respectfully.

I live in southern Los Angeles. So you know. Thanks!

Answered by Dr. Deepak Sundriyal (5 minutes later)

Brief Answer:
hello. please be chill. nothing to be afraid of.

Detailed Answer:
Hello dear. Please be relax n calm yourself. You have enough of life still to live with. MD XXXXXXX is a research centre and one of the best. You can go there. Whatever i have said is evidence based medicine and you can discuss it with your doc.
Thanks n regards

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Above answer was peer-reviewed by : Dr. Nagamani Ng