What other therapies are recommended with folfiri chemo - Stage 4 CRC

Posted by iris0106 @iris0106, Jun 14, 2023

What other therapies are recommended with folfiri + bev chemotherapy?

My boyfriend (age 42) was diagnosed with stage 4 CRC in Dec. 2022. (KRAS g13d) Tumor has metastasized to mainly to liver, lymph in abdomen, stomach lining, etc. I would say median size for the tumors in liver are 7cm x 5cm, and there are a lot of them. We don't know how big the initial tumor in colon is, the scope could not go through during colonoscopy. We started with folfox chemotherapy which seemed to have worked in the beginning, but after about 8th session, the tumors in his liver stopped responding. We just received folfiri for our 12th session... and his doc says he is eligible for a clinical trial that uses folfiri as the base, but with the shortage of chemo medicine, not sure if this will happen. =(

His condition lately: Stomach looks and feels very bloated. We also had paracentesis (for abdominal ascites) done last week because he couldn't eat or sleep from the fullness of his stomach... this went on for about 3-4 weeks before getting the paracentesis. Afterwards, his hands and feet started swelling up. Doc told him that it's because he doesn't have enough protein and advised to take protein shakes. Swelling has gone down a bit after keeping his legs up and lymph massaging. But they still look huge. I think his liver is leaking a lot still. He hasn't been urinating much for the past month, but that has improved today. His bowel movements are on the both ends of the spectrum, either constipated or "going" every hour. Low energy on most days, naps 4-5 times a day.

I just want to know if there are any other therapies that can be combined with his chemo so that he can live... at the least, without pain. Is it too greedy to hope for a cure...?

Thank you in advance.

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@susan159

mogwa823: I saw your post. I just don't have any advice for you. I've been getting chemo with the 48 hour pump every 2 weeks for over a year now. I also have an HAI pump implanted in me which shoots chemo directly into my liver. It's no fun. I also had chronic diarrhea, but mine was from gall bladder surgery, not chemo. I take something called cholestryamine (sp?) which removes excess bile from my digestive tract and slows down the diarrhea. I doubt that would help you bc your diarrhea is due to chemo drugs. But I do understand how awful that chronic diarrhea is. I dealt with it for a few months after my surgery before I got the cholestryamine. My weight kept dropping and I was unbelievably weak and tired from it. You can't go anywhere or do anything. You have no energy and so you can't get any exercise. I couldn't recover from my surgery at all. (Colon resection, gall badder removal, and HAI pump implantation). I wish I had some idea that could help you. Well, there is one thing that helped me: When I cut gluten out of my diet my diarrhea slows down precipitously. I'm more of a gluten avoider than an absolute no gluten person. But when I have gotten off track and had quite a but of gluten, the diarrhea gets much worse and I have to take more doses of the cholestyramine than I had been taking previously. (I hate the stuff, so I try to take it as little as possible.) I have also noticed that I get acid reflux sometimes after I've eaten gluten. So maybe there's a chance that cutting out gluten would help you. It might be worth a shot...Many Drs pooh pooh the gluten intolerance thing, but lots of them believe it's a thing too. Good luck! I hope you find a solution. I know it's hard to go through treatment when the treatment is taking away your quality of life in big chunks. I just don't see any other way. I want to live!!! Fingers crossed that you find something that helps....

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Talked with my oncologist and nurses today. They’re going to let me skip the next chemo session and try to recoup my strength.
Thank you for your response. Sometimes I feel so alone with this disease.

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I'm so sorry that you're feeling alone. I'm very lucky to have a pretty fantastic support system (Husband kids, siblings, friends and neighbors who have all stepped up in a huge way), and it really does help. I bet a cancer support group would help you. I'd ask your Dr. about one. I've been going through treatment for over a year so people aren't checking in as often as they were when this was new. But I do find that of all my friends and family that I am communicating with ongoing, I have developed a pretty special bond with the ones who have also gone though bouts with cancer. We belong to a special club with a unique joint history/understanding of what each other has gone through. I think regaining your strength will be a big help too. Feeling like you're only getting weaker just gets you down and makes you feel hopeless. I hope the break from chemo does the trick for you. I know it's not easy, but you can do this. You've done it before so you've got what it takes. Good Luck! I'll remeber you in my prayers.

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I feel your boyfriends pain. I’m living on Imodium pills and don’t want to leave the house most days.
I’m suppose to have my next infusion this coming Tuesday but I’m going to ask for a break. I want to feel human again.
The Folfiri+bev has made the skin on my fingertips crack and it feels like my tongue has been shredded by razor blades. My oncologist prescribed Magic Mouthwash for me but I haven’t been able to get it filled because there is a shortage of lidocaine.
I’m am so looking forward to not having chemo this coming week. Also going to ask my oncologist about chemo every 3rd week. My makers have gone from 21.4 down to single digits. Hoping the lymph nodes show regression in my next scan. By the way I was cancer free for 8 years then diagnosed with advanced colo/rectal cancer in May. Best of luck to you both!

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@mogwa823

Been on chemo w/figuring for 10 weeks. After infusion I wear a computerized pump for 48 hours. I need to find something that will help me get back on my feet after the pump is removed. Suffer from chronic diarrhea, fatigue and heartburn. I’ve lost 20 pounds since this last March and am having difficulty maintaining my weight. By the time I do feel functional I have 4-5 days before my next infusion. The treatment seems to be working. My markers have fallen from 20.2 to 4.4 over the 5 sessions of chemo I’ve had. Hard to believe I will be doing this for the rest of my life.

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Sorry for the late response, been a bit busy taking care of my boyfriend. He's been on chemo since December, had 12 total rounds - and having ileostomy - he has lost about 60 pounds. We tried Enterade (hydration drink made by oncologists), he said it made his colon feel "cool". Between diarrhea and constipation for chemo side effects, we used imodium and colace respectively... but we had to stop imodium because it caused atrial fibrillation in his heart. That's great to hear your markers are going down! We also started with Folfox, 11 rounds... around 8th round, the metastasis in his liver stopped responding. After he recovers from the surgery, we will continue with Folfiri + Avastin.

You might not have to do this for the rest of your life. Chemo might shrink the tumors and surgeons can remove them. After that, it's all maintenance. Don't give up! Getting treatments and eating right is one thing, but your mentality also plays a big role. You will get through this.

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@susan159

mogwa823: I saw your post. I just don't have any advice for you. I've been getting chemo with the 48 hour pump every 2 weeks for over a year now. I also have an HAI pump implanted in me which shoots chemo directly into my liver. It's no fun. I also had chronic diarrhea, but mine was from gall bladder surgery, not chemo. I take something called cholestryamine (sp?) which removes excess bile from my digestive tract and slows down the diarrhea. I doubt that would help you bc your diarrhea is due to chemo drugs. But I do understand how awful that chronic diarrhea is. I dealt with it for a few months after my surgery before I got the cholestryamine. My weight kept dropping and I was unbelievably weak and tired from it. You can't go anywhere or do anything. You have no energy and so you can't get any exercise. I couldn't recover from my surgery at all. (Colon resection, gall badder removal, and HAI pump implantation). I wish I had some idea that could help you. Well, there is one thing that helped me: When I cut gluten out of my diet my diarrhea slows down precipitously. I'm more of a gluten avoider than an absolute no gluten person. But when I have gotten off track and had quite a but of gluten, the diarrhea gets much worse and I have to take more doses of the cholestyramine than I had been taking previously. (I hate the stuff, so I try to take it as little as possible.) I have also noticed that I get acid reflux sometimes after I've eaten gluten. So maybe there's a chance that cutting out gluten would help you. It might be worth a shot...Many Drs pooh pooh the gluten intolerance thing, but lots of them believe it's a thing too. Good luck! I hope you find a solution. I know it's hard to go through treatment when the treatment is taking away your quality of life in big chunks. I just don't see any other way. I want to live!!! Fingers crossed that you find something that helps....

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I can't imagine all the things you've went through and going through still. Your mental strength is inspiring!! I will also try the gluten-avoiding diet for my boyfriend. He also gets acid reflux these days, but I wasn't sure where that's from since we had to stop chemo for the surgery and recovery. Thank you for sharing! Keep fighting! Let's all come out winners!

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@laser

Is there a support group at the hospital? Maybe talk with them and get some more help. I did have chemo every 2 weeks and carried a pump home for 48 hours when I was getting my chemo in 2019. I remember it was such a pain in the ---. My chemo was Folfox. But I had Chemo for what seemed like about 3 or 4 months if I remember. I still am experiencing the peripheral neuropathy in my fingers but not as bad as it was during the chemo. I also have peripheral neuropathy in my feet and legs although I had that before due to my diabetes but it has gotten worse. I guess I can live with this because I am living without the rectal Cancer I had. Then I had radiation therapy for a month. Check with the hospital though. They might be able to help.

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Our hospital gave us a handout for support group information. There is definitely a support group you can reach out to. For patients and caretakers. =)

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@mogwa823

I feel your boyfriends pain. I’m living on Imodium pills and don’t want to leave the house most days.
I’m suppose to have my next infusion this coming Tuesday but I’m going to ask for a break. I want to feel human again.
The Folfiri+bev has made the skin on my fingertips crack and it feels like my tongue has been shredded by razor blades. My oncologist prescribed Magic Mouthwash for me but I haven’t been able to get it filled because there is a shortage of lidocaine.
I’m am so looking forward to not having chemo this coming week. Also going to ask my oncologist about chemo every 3rd week. My makers have gone from 21.4 down to single digits. Hoping the lymph nodes show regression in my next scan. By the way I was cancer free for 8 years then diagnosed with advanced colo/rectal cancer in May. Best of luck to you both!

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Oh so sorry to hear that.. our doctor recommended "udder cream" for the cracks/dry skin from folfiri, I was able to order from Amazon. It's not the best smelling lotion, but it does seem to hydrate the skin pretty well. For the dry mouth, we bought a decent sized humidifier - it has helped him sleep better. I have it on 24 hours now. Chemo every 3 week might be better for you so you can recoop your energy. I did notice the decline in energy with every session... hang in there!

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@iris0106

I can't imagine all the things you've went through and going through still. Your mental strength is inspiring!! I will also try the gluten-avoiding diet for my boyfriend. He also gets acid reflux these days, but I wasn't sure where that's from since we had to stop chemo for the surgery and recovery. Thank you for sharing! Keep fighting! Let's all come out winners!

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Thanks Iris0106. Gluten free isn't as hard as it sounds. Trader Joes has some good (in the fridge section) gluten free fettuccine. The gluten free breads are not great and I think you always have to toast them. But as long as you put something on them (jam, cheese, peanut butter), they are passable. You can bake stuff with gluten free substitute flours and mostly it turns out OK. But I find that baked goods made with gluten free flour are only good for 2 or 3 days. So I try to make things that don't require any flour naturally. For instance, I eat macaroons for my cookies and I found a recipe for corn bread that is made with only cornmeal, no flour. I hope it helps. I know how awful it is to feel like you don't dare leave your house. Good luck and thanks for your kind words.

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@susan159

Thanks Iris0106. Gluten free isn't as hard as it sounds. Trader Joes has some good (in the fridge section) gluten free fettuccine. The gluten free breads are not great and I think you always have to toast them. But as long as you put something on them (jam, cheese, peanut butter), they are passable. You can bake stuff with gluten free substitute flours and mostly it turns out OK. But I find that baked goods made with gluten free flour are only good for 2 or 3 days. So I try to make things that don't require any flour naturally. For instance, I eat macaroons for my cookies and I found a recipe for corn bread that is made with only cornmeal, no flour. I hope it helps. I know how awful it is to feel like you don't dare leave your house. Good luck and thanks for your kind words.

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We can do macaroons and corn bread! Thank you so much for sharing. I'll also share if I come across anything that my boyfriend has positive reaction to =)

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@iris0106

We can do macaroons and corn bread! Thank you so much for sharing. I'll also share if I come across anything that my boyfriend has positive reaction to =)

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Thanks!

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