What are the treatment options after FOLFOX and FOLFIRI?

Posted by berny @berny, Jul 28 7:34am

Hello, I am new to this group and to the Mayo Clinic. I was diagnosed with Stage 4 colon cancer 4.5 years ago. Treatment started with FOLFOX, then just the 5FU with Avastin. During that 3 year period I have a few very welcomed "treatment holidays" for a few months each. Treatment then turned to Panitumumab (Vectibix) for a few months after which it stopped working. Then to FOLFIRI since February this year, now having completed 11 treatments. Note, I had a Y-90 targeted treatment on my liver last fall that seemed to be effective and reduces concern about liver. FOLFIRI has stabilized the cancer but not reduced lymph size (left clavicle grew, so completed radiation on it). Switched back to FOLFOX due to concern of cancer growth and had bad reaction after one treatment, so back to FOLFIRI. At some point FOLFIRI will stop working, so wondering what the other main treatment pathways are for me. Thank you in advance for your feedback. Berny

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isadora2021 | @isadora2021 | Jul 29 5:50am

I’m sorry to hear that Folfox has had to be taken off the table (due to the oxyplatin) but glad to hear that Folfiri is currently working for you and keeping the cancer at bay for the moment.

I did well on Folfiri and Avastin so don’t currently need to look at other options, but I am aware there may be several depending on your cancer genome type and bio markers.

I do hope you have got an opinion from a major cancer research hospital?

berny | @berny | Jul 29 6:48am

In reply to @isadora2021 "I’m sorry to hear that Folfox has had to be taken off the table (due to..." + (show)

@isadora2021
Thank you so much for the thoughtful reply to my question. My wife and I have talked over this past year that, while I am under care of a good oncologist at Vanderbilt, we need to seek out another major cancer research hospital as you mention. Upon my diagnosis in late 2021 we got opinions from the University of Tennessee Hospital in Knoxville, MD Anderson in Houston, and Vanderbilt. We chose Vandy due to proximity to where we live and similar treatment recommendations from each.

Given that I am approaching 5 years of treatment and some options no longer available, we will be checking back with the physician at MD Anderson that we met with back then. I know Mayo Clinic is at the very top of the list of the best cancer hospitals and have also thought of exploring their expertise through even a TeleHealth call.

I hope you are doing well with your own battles from this disease. Sending you strength, as I have gained through your kind message. Berny

isadora2021 | @isadora2021 | Jul 30 6:46am

In reply to @berny "@isadora2021 Thank you so much for the thoughtful reply to my question. My wife and I..." + (show)

@berny I’m so glad I could help in some way. Thank you for your wishes. I think you’re on the right track about how to canvas your next steps. One of the treatments you might like to ask about is Lonsurf combined with Avastin.

Wishing you the very best and hope you stay engaged in our Mayo community

berny | @berny | Jul 30 7:11am

In reply to @isadora2021 "@berny I’m so glad I could help in some way. Thank you for your wishes. I..." + (show)

@isadora2021 Thank you. I will look into the Lonsurf/Avastin option. I have not heard of it so glad you brought it to my attention. All the best. Berny

wku | @wku | Jul 31 7:38am

Your question is very timely for me. I was also diagnosed with Stage 4 in early 2023. Folfiri and Avastin did a great job and for the next 2 1/2 years cancer was stable and confined to my liver. Then in 2025 I asked whether I could go on an oral medicine. I changed to capecitabin and everything was fine for about 6 months. My cea began to climb from 3 to 12 to 25. In January restarted Folfiri but numbers kept climbing. Switched to Folfox and though only three treatments I’m now up at 40. Dr says I have a lot of options. I’m just not sure what they are. While some tumors in liver have actually disappeared it’s not jumped into three lymph nodes.

berny | @berny | 4 days ago

In reply to @wku "Your question is very timely for me. I was also diagnosed with Stage 4 in early..." + (show)

@wku That's my main objective as well, to find out what the treatment options are now, so I can evaluate them some and be able to provide input back to the doctor. My cancer started in the colon, but has spread to lymphs. In the last couple years also to the liver. There were two lesions in the liver that were not responding to the chemo, so doctors recommended a targeted treatment together with the chemo: Y90. I had the Y90 done last October. There was a mapping of the blood vessels by entering a vein in the groin area and moving up to the liver. Then two treatments, one for each of the two largest leisons. The Y90 seems to have been quite effective and has reduced the size of the liver lesions. I wish you the very best as you work through these challenges. Berny

wku | @wku | 3 days ago

In reply to @berny "@wku That's my main objective as well, to find out what the treatment options are now,..." + (show)

@berny Thanks. I would like to add that as of yesterday my cea numbers showed the first sign of a decrease. Down from 49 to 45. Not much but in the right direction. Will have to wait for the next ct scan and pet scan to see if it has gone to roost elsewhere.

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