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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for colon cancer

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Dr. Deepak Sundriyal

Oncologist

Practicing since :2005

Answered : 1452 Questions

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Posted on Wed, 15 Mar 2017 in Cancer
Question: Hi,

This is regarding my 65 yr old father who was diagnosed with colon cancer (moderately differentiated p3n1m0) in Aug 2013. He was operated upon and the affected part was removed and followed by 12 cycles of folfox chemotherapy.

Then 1 yr later he got a metastatic solitary node in the left lung, which was again resected followed by 10 cycles of folfiri.

After being stable for another year he got a solitary bone met in the 8th rib, along with multiple small size mets on the lungs surface. The Bone met was removed in april 2016 and he has since been taking capcitabine 500 OD, 5 days a week regularly.
Now we recently went for a ct scan and it was found that the bone met has again come bk at the same rib (8th),with size 6x4 cm and the multiple spots on the lungs are also increased slightly. Other organs are normal with no metastasis.
Can u suggest us what options do we have as treatment. As of now the patient is physically active with no complications, good appetite, normal blood reports, no weakness. Just mild pain at the rib met site. Also the KRAS mutation test showed mutation type wild.

In the attached report the ILD and nodules around the esophagus have been there and unchanged for many years.
doctor
Answered by Dr. Deepak Sundriyal 27 minutes later
Brief Answer:
Hello . Multiple option are available

Detailed Answer:
Hello. I have gone through the details. So a targeted agent has not been used in your case and hence a drug called avastin and other drug called cetuximab can be used along with capecitabine. Moreover, if the tumor is msi-high, then immunotherapy is also an optuon.lastly multitargeted drug called rigorafenib can be used.
Hope it helps.
Thanks and regards
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Deepak Sundriyal 3 hours later
Thank you for writing back, Dr XXXXXXX
Since the KRAS test shows the tumor mutation to be wild, can we still use Avastin or Cetuximab?
Is there any low cost alternative to regorafinab?
and can you give me a brief information about MSI- high and imunotherapy.
Also if you could tell me about the frequency cycle of this drug avastin / cetuximab, and is it given alone or in combination with some other chemo medicine?
doctor
Answered by Dr. Deepak Sundriyal 3 hours later
Brief Answer:
Hello. Any of the option is available

Detailed Answer:
Hello dear. So in a wild kras mutation, either of avastin or cetuximab can be used with chemo. These are usually given at 15 day interval. This is should be used first.
When this option has been exhausted, then imunotherapy nivolumab can be used. Tumor can be tested for microsatellite instability...msi. If it is high then nivolumab will work. After that, last option will be of regorafenib. Many generic brands maY be available which are cheaper.
Hope this helps you.
If you have further queries, do write to me.
Thanks and regards
Above answer was peer-reviewed by : Dr. Yogesh D
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