From the Desk of Dr. Lenz
Introducing: From the Desk of Dr. Heinz-Josef Lenz
Beginning in January, I will be blogging here at the C3 website.
I am a Gastrointestinal (GI) Oncologist at the University of Southern California (USC)/Norris Comprehensive Cancer Center. I am what people describe as a physician scientist, which means I do see patients and write a lot of clinical trials, but I also have a laboratory focusing on the molecular make up of tumors.
Through my work with patients in my practice and all over the world, it became clear that a blog written by a medical professional would be a fantastic way to share information with anyone interested in the latest news for people affected by colon cancer. On the Revolution Health web site, I developed a colon cancer curriculum which summarizes the latest news as well as the background information on risks, screening, detection and treatment of colon cancer. Feel free to browse their archives to find information on a wide variety of subjects.
With this information available online, it makes for a better patient experience in my practice. Patients are not stressed out if they don’t have everything written down. They can go to the web at any time and look up information, and then bring their questions back to me to discuss.
I’m pleased my blog has found a new home at C3. From my unique perspective, I will share the latest developments in the treatment of colon cancer, and will be able to respond to questions you leave in the comments. I welcome your ideas and suggestions to make this a successful endeavor.
I am very excited to work with the C3 team in the new year and wish you a happy holiday season and a Happy New Year, but first and foremost I wish you all health and satisfaction.
This news article was originally posted on December 30th, 2008 and was accurate at the time of publication. Since then, information may have changed or links may now be outdated. Please call our Answer Line 1-877-427-2111 for the latest information, or talk to your doctor before making any medical decisions.
Posted by Heinz-Josef Lenz, MD on December 30th, 2008
Tags: Living with Colorectal Cancer
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david salk
December 30, 2008 at 7:59pm
We are thrilled!
Kathleen Gorlitz
December 31, 2008 at 12:49pm
My husband, a former patient of Dr. Lenz, and unfortunately deceased, respected Dr. Lenz and his staff tremendously. He was always honest and forthright. And no question was unanswered. You will not find another physician who will work harder for you and take better care of you and your family.
Good luck and God Bless, Dr. Lenz
Jack Straw
January 2, 2009 at 10:16am
I had a PMS2 mismatch and StageIIIB. I received Folfox as my chemo. Based upon what uyoumentioned in this article, was my treatment not the right one since it had 5fu in it?
Anonymous
January 3, 2009 at 12:47pm
Sue, this is a wonderful trial for you since with your staging many would argue that there is no benefit of chemotherapy or at least very little.
Hi again Dr.,
You just answered my question from another site and directed me to this new site.
Another question, if the Folfox has shown to not be that beneficial for stage II with the genetic marker, can I/should I push to try to get the additon of avastin? Will the trials allow this.
Sue
There was no survival benefit with folfox in stage II colon cancer, however with the 18 q deletion and MSS you are at higher risk for tumor recurrence which would justify more aggressive chemotherapy such as FOLFOX. you are doing the right thing by evaluating the tumor risk with cutting edge molecular diagnostic. what we dont know is that the benefit of FOLFOX in this situation is. follow my blogs on the C3 website i have moved. HJL
Sue
January 3, 2009 at 12:52pm
Dr,
You answered my question from a different site and directed me to this site.
Another question, with the genetic marker, it is my understanding that reoccurance is high (maybe 50%) and folfox has not shown even with reoccurance to be very effective and that is what the avastin study is for. Can I/should I push somehow to get avastin added since I was randomized to folfox only. And if so, how should I go about it?
Sue
Sue, this is a wonderful trial for you since with your staging many would argue that there is no benefit of chemotherapy or at least very little. There was no survival benefit with folfox in stage II colon cancer, however with the 18 q deletion and MSS you are at higher risk for tumor recurrence which would justify more aggressive chemotherapy such as FOLFOX. you are doing the right thing by evaluating the tumor risk with cutting edge molecular diagnostic. what we dont know is that the benefit of FOLFOX in this situation is. follow my blogs on the C3 website i have moved. HJL
Jo-Ellen
January 3, 2009 at 3:39pm
Dr Lenz,
It has been greatly missed by advocates. Yours is a trusted site I feel good about referring new patients to. Thank you for joining C3! A terrific new venture for both while we, the patient/survivor/advocate, benefit.
I cannot tell you how often I visited your Revolution blog! Every day once I signed up
Welcome aboard!
Nancy
January 4, 2009 at 1:21pm
I am very glad you’re here. Thank you!
Nancy Roach
Patti Hollenback
January 4, 2009 at 1:26pm
What a wonderful way to start the New Year!! Dr. Lenz’s Blog is a perfect fit with the C3 Team.
Between he and Kate,(and Joe,Carlea, Nancy,Judi, Dusty and Kim,too) we’ll have lots of great information to share. Thanks
Sue
January 5, 2009 at 11:38pm
Another question, with the genetic marker MSS and 18q LOH, it is my understanding that reoccurance is high (maybe 50%+) and folfox has not shown even with reoccurance to be very effective and that is what the avastin study is for. Can I/should I push somehow to get avastin added since I was randomized to folfox only. And if so, how should I go about it or is there anything better out there?
Sue
Heinz-Josef Lenz
January 9, 2009 at 12:20pm
Thank you all for your kind responses. I had to find out on this new web site how to respond.
Sue, qith 18q deletion and MSS tumor we know you have a higher risk of tumor recurrence but we dont know is FOLFOX as effective as in other tumors. Since it is an increased risk this trial tests also if avastin will further increase effectiveness which we dont know (C08 trial is completed we are awaiting the results). so would not push for it.
Anonymous
January 9, 2009 at 1:49pm
Could you write a blog entry on immunotherapy clinical trials? effectiveness, risks, etc.
Heinz-Josef Lenz
January 9, 2009 at 4:04pm
Jack, FOLFOX was the right treatment since you have stage III disease so you are fine, the controversy is in stage II disease what the benefit of 5-FU in MSI tumors is. HJL
Heinz-Josef Lenz
January 9, 2009 at 4:28pm
would be nice to hear what the interest are to write about……..will look in the immunotherapies but want to hear from all the others particular questions or themes…..HJL
fsmaer
January 26, 2009 at 9:35pm
Thanks for your work in getting medical info to the public. I am an 8 year veteran of stage 4 rectal cancer whose 10-15 liver tumors very slowly diminished over a five year period with chemo and complementary therapies. I have now been NED for over three years. Staying informed was critical.
Heinz-Josef Lenz
January 26, 2009 at 10:57pm
congratulations…….that is very interesting…….we continue to learm more and more about these cancers……will share in the next couple of months stories from patients like yours who were metastatic and beat the disease….and completely agree INFORMATION and being part of the decision making is critica. HJL
Mary
February 2, 2009 at 12:43am
Welcome Dr. Lenz. I am a colon cancer stage 4 survivor currently on chemo. I look forward to hearing much of what you have to offer to stage 4 patients. I did have some peritonial mets when i had surgery and 98% removed , but had Folfiri and avastin postop and now on 5fu and avastin. So i am always looking for info. Thanks again
Heinz-Josef Lenz
February 2, 2009 at 10:43am
very glad to hear that you are being treated with a successful regimen FOLFIRI/avastin……..if diseaase is controlled you can continue with 5-Fu avastin. IF the disease is only in the peritoneum, you may want to discuss with your oncologist the possiblitity of exploration and IP chemo, this is done rarely but for some cases it may be very helpful. HJL
Kathleen
February 4, 2009 at 6:23pm
Dr. Lenz,
My husband and I will meet you tomorrow (2/5/09). We have read much of what you have written on this blog and the revolution blog. We believe he is Stage IIIc. He has had surgery and is looking for the right chemo regime. We truly appreciate all we have learned from you so far.
KT
Heinz-Josef Lenz
February 4, 2009 at 6:37pm
have reviewed you file/records and looking forward to meeting you. glad to hear that you have already collected a lot of information which makes my job so much easier. HJL
John
February 9, 2009 at 4:21pm
Dr. Lenz-
I appreciate your expert advice and care you have given me over the last 20 months. I am glad you are on my team.
Will you elaborate on the suggested waiting period between any chemo (FOLFOX/Avastin or Xeloda/Avastin) before a PET/CT Scan or other tests? Are there studies that suggest a “clean-out” period makes for a better test?
Thanks,
John
Heinz-Josef Lenz
February 9, 2009 at 4:30pm
we usually wait 2 weeks prior to a pet scan to reduce the false negative results chemotherapy can reduce tumor activity and show negative results, for CT scan time does not matter at all….you can do it any time HJL
Kathleen
February 12, 2009 at 8:20pm
Hello Dr. Lenz,
It was great meeting you last week with my husband. We have 2 questions. The first is us just trying to understand the chemo with the Erbitux. We were wondering if you could give a little explanation about why the Erbitux can work with the FOLFOX. Does the Erbitux stop blood flow to the cancer? If so does it stop the chemo from getting through to the cancer.
Second, we know that strong antioxidents can interfere with Chemo. Before my husband had cancer, we ate blueberries every day, drank some orange juice every day, ate spinach and even had some acai drink every day. Is it OK to keep these foods as part of a balanced diet during chemo? Also, is Flaxseed oil ok and is an Omega 3 supplement OK?
Thank you very much.
Aloha,
Kathleen
Heinz-Josef Lenz
February 12, 2009 at 9:36pm
Kathleen, was my pleasure meeting you both in person. about erbitux it is inhibit a receptor on the tumor cells called EGFR by doing so it can kill tumors alone but in combination with chemo such as FOLFOX it increases the efficacy infact in wt kras patients the response rate goes up to 60% (meaning more than 50% shrinkage of the tumor) by inhibiting the EGFR it also decreases tumor blood vessel but does not jeopardize flow to the cancer.
we discourage high doses of anti oxidants wiht chemo but you can eat blueberries or OJ, no problems with flaxseed or omega 3 very good infact. Aloha HJL
Howard Grace
February 16, 2009 at 5:18pm
Hello Dr. Lenz
My brother in law was diagnosed with colon cancer in Dec 08′ had his surgery done at M. D. Anderson to remove the tumor in December. It had metasized to 4 lesions in his liver, was in one lymph node, and other tumors in the odom? which they removed. He started his Chemo treatment the end of January and just finished his second round of 6 this past weekend. We were thown for a loop by the oncologist at MD Anderson this past weekend, that said the scan they did before this first treatment came back and not good, and that he was not a canidate now for possible surgery to remove the tumors, and basically gave him 6 months to 2 years, depending upon whether he wanted to continue chemo treatments. So we are grasping for options now. Would like to get 2-3 other opinions just to make sure. Mr brother in law lives in Missouri but was having his treatments at Md. Anderson. He can go anywhere to get another opinion. How would it work to come see you, do you do this?, we have all of his medical records (3 sets of all files and scans)and who else would you recommend, we are trying to cover all bets. Thanks
Heinz-Josef Lenz
February 16, 2009 at 8:56pm
sorry to hear about your brothers diagnosis and progress would love to know where the tumor grew after surgery, sometimes because of surgery tumors seem to get a growth spur which is another reason to do chemotherapy, more than happy to see him in second opinion if you are interested you can call our patient referral office at 323 865 3111 they will help if any problems you knmow how you can get in touch. HJL
Kathleen
February 18, 2009 at 6:18pm
Hello Dr. Lenz,
My husband will start chemo + Erbitux at the beginning of March. I was wondering why some people have FOLFOX with Avastin and others have FOLFOX with Erbitux. We are enjoying the time between surgery and chemo as his body gets ready for chemo.
Aloha,
Kathleen
Heinz-Josef Lenz
February 18, 2009 at 9:38pm
very difficult question to answer since i dont know the detail of your husband cancer and treatment history, usually when a patient is newly diagnosed with metastatic colon cancer patients receive either a combination of 5-FU and oxaliplatin (FOLFOX) or with irinotecan (FOLFIRI) either chemo regimens is usually combined with Avastin, since erbitux is not approved for first line chemotherapy. however there are exception such as clinical trials when patient is wild type kras or the patient has contraindication of avastin stroke heart attacks or not healing wounds, erbitux can be given sometimes in these situations……hope this helps. dont be shy and ask your oncologist. HJL
Kathleen
March 15, 2009 at 3:05pm
Hello Dr. Lenz,
My husband starts Folfox on Tuesday. He will be getting the Calcium and Magnesium before and after the Oxy. We have also read about the benefits of Alpha Lipoic Acid to help with Neuropathy. I believe there is a trial going on which tells me that some researchers believe Alpha Lipoic Acid may be helpful. What is your opinion and what do you recommend for your patients who want to supplement with this?
Thank you.
Kathleen
Heinz-Josef Lenz
March 15, 2009 at 6:22pm
Kathleen not real data yet but this would not harm in any way. Good Luck. HJL
Gil Ramirez
March 25, 2009 at 5:26pm
Dr. Lenz,
I am 39 years old and have been dianosed with stage 4 colon cancer. I was told the recomended tratment would be Avastin and Folfox for a duration of 6 months at 2 week intervals. I also have two open wounds in my abdominal area due to excessive drainage post surgery. If it takes 6 weeks for the wounds to heal will that significantly inpact the affectivness of the chemo treament? Also, is chemo treament every 2 weeks aggressive enough? is it too aggressive? Would you suggest another course of tretment?
Thank you for any insight you may have.
Sincerely,
Gil Ramirez
Heinz-Josef Lenz
March 25, 2009 at 5:37pm
Ms Ramirez, sorry to hear about your colon cancer. For patients with stage 4 disease, the most common used chemotherapy is FOLFOX with Avastin, however it is not fixed for a duration….it is given as long it works, depending where the tumors are you may be even evaluated for more surgery depending on the distribution of the metastases but there is no fixed 6 months. FOr your wounds, since avastin can interfere with wound healing we usually hold Avastin until the wound is healing very well or almost healed up. The regimen is given every 2 weeks which is the optimal cocktail. Hope this helps. HJL
Kathleen
March 26, 2009 at 12:02am
Hello Dr. Lenz,
My husband has Stage IIIc colon cancer and he had surgery in January 09 when they took out the tumor. He has started Folfox 6. He did well with his first treatment and is continuing to exercise. He is taking Vit D and 300mg of Vit B6. We have heard the Vit B12 may help with memory loss which we hear is very common (chemo brain). Is vitamin B12 OK during folfox and if so what dose is OK?
Thank you.
Kathleen
Heinz-Josef Lenz
March 26, 2009 at 10:35am
i agree witht the B6 300mg and vit D as well as calcium dont use the B12 since there are very little data HJL
Christina
July 21, 2009 at 1:14am
Hi! I just found this website as I am trying to find out how much benefit if any for Stage IIa Rectal cancer patients of taking Oxaliplatin instead of Xeloda. Could you please show me where to find the data that there is no benefit? I am very worried about the permanent neuropathy side effects of oxaliplatin. Thanks!
Heinz-Josef Lenz
July 22, 2009 at 10:53am
Christina, you are doing well, still treat with xeloda and oxaliplatin patients wiht rectal cancer. The chemo is more effective to prevent metastates however we were hoping that we could increase the rate of complete resolution of cancer with this chemo and radiation and that did not show does not mean this is not a good therapy. since in oxaliplatin is only given for max 6 months in this setting the rate of neurotoxicity is much lower than in patients who have advanced disease and get oxaliplatin for much longer. Hope this helps. HJL
Christina
July 24, 2009 at 7:59pm
Thanks Dr. Lenz! I was wondering why chemo radiation for Stage IIa rectal cancer is considered standard when the data has shown that although local re-occurence is lower with it that overall survival and disease free living is the same?
KAREN
October 31, 2009 at 2:03pm
I had my colon and rectum removed in May 2004 because of StageII rectal cancer, and a long history of ulcerative colitis. I was treated with 5FU for 3 weeks, and could not tollerate any more. In September 2008,4 1/2 years later, I had a metastasized tumor removed from my lung, and no chemo. I had another metasta sized tumor on my arm after I banged it on something a few months ago, and I am being treated with FolFox 4 with Avastin every 2 weeks for 6 months, and 15 Radiation treatments every day for 3 weeks. I started two weeks ago, and already notice a difference in the tumor.
My question is are vitamins and minerals good or bad during chemo treatment? Also, is there a good diet to follow during this time?
Thank you in advance for your advice.
Karen
Heinz-Josef Lenz
October 31, 2009 at 3:09pm
Karen, what an interesting course you had. Very glad that you are doing well with chemo. i recommend the following supplements for my patietns calcium 1500mg per day, Vitamin D 3000 IU, vitamin B6 300mg per day and tell them to avoid high doses antioxidants Vit C, E or selenium. FOr diet (see my other posts) but avoid red meat, no alcohol, prefer white meat and fish, medeterian food has been shown benefecial. hope this helps and god bless