When chemotherapy stops working

Almost two months ago when I last blogged I was two rounds through what was supposed to be 8 rounds of Xelox. However after just three rounds I had to call it quits. During my three rounds of Xelox my CEA steadily rose, indicating that there was likely to be tumour growth rather than shrinkage. I ended up being admitted to hospital with severe pain a few days after round 3 which turned out to be due to some of the growing liver mets pressing on other organs. During that hospital stay they did a CT scan which confirmed that the Xelox was not working and the tumours were growing despite the chemo. This basically means that there is nothing more the public health system can offer me as I have now exhausted all the publicly funded treatment options for bowel cancer.

I was referred to a private oncologist in Palmerston North (there aren't any in Wellington) and he outlined that there are three options left to consider, each with their own hefty price tags. They are:
1. SIRT (Selective Internal Radiation Therapy)
2. Cetuximab (a targeted therapy)
3. Avastin (a targeted therapy)

Apparently Avastin isn’t really an option for me as based on how I have responded to treatment so far, there would only be about a 10% chance it would do anything. So, that leaves us with numbers 1 (SIRT) and 2 (Cetuximab). My current thinking is that we will do both. The plan would be to have SIRT (soon), then wait and see if it does anything and be closely monitored until things start growing again. When they do, we would start on Cetuximab which is weekly in Palmerston North. It would only take an hour and it wouldn’t make me sick (hurray!). They usually give it in combination with some of the other chemo drugs I have had, however the doc I saw in Palmerston North said that I was clearly “chemo resistant” now given that a) my cancer continued to grow despite being on Xelox and b) I didn’t have a huge response to Folfiri and the cancer started growing back very soon after I stopped having it. Even though I am KRAS and NRAS wild-type, there is still only a 33% chance Cetuximab will work, but we would know after about 4 weeks of treatment whether or not it was worth carrying on. 

Since I saw the doc in Palmerston North its been pretty full on. I had bloods done yesterday, a CT scan this morning and then I met with the Radiologist who does SIRT this afternoon. Based on my CT and bloods he has agreed to do it but it’s not quite as straight forward as I was hoping. The first step is to have an Angiogram where he threads a tube in through my arterial vein in my groin all the way up to my liver and pumps in some contrast to check that I am suitable to have the procedure and there isn’t going to be any leakage into other organs. Then there is about a two week wait until the results of that are through and they order, and receive, the radioactive goo that they need to do the SIRT. The SIRT involves a repeat of the angiogram procedure but they would pump in radioactive goo instead of contrast. It is usually a one-off procedure.

I am hoping to have the angiogram next week and the procedure the week of the 22^nd Sept. The doc said I can also expect to be really tired for about 4-6 weeks, but apart from that (and the risk of some really rare nasties happening) that should be about it. He said from clinical trials already published they know that SIRT works for about 66% of people who try it and it usually holds the cancer in a steady state (ie no growth) for about 3-5 months on average. 

Watch this space.........