I have shared some inspiring stories with you of patients in my practice who I think are examples of how colon cancer therapies have changed. Today when patients walk into my practice with metastases only in liver or lungs, I know that I can cure some of them. The way we look at these patients has completely changed.
I have told you about a young cancer patient in her thirties, diagnosed with metastatic colon cancer with diffuse liver metastases. Only five years ago we would have not thought of cure looking at her. She was told by her HMO oncologist there there was little he could do and that her life expectancy was about six months. She could not accept this and started to look online for information.
It was Easter three years ago when she emailed Dr. Robert Beart, our colorectal surgeon. to find out if he could help. Within three minutes he answered her and asked her to contact me, which she did. I replied and set her up to come in to evaluate her options.
When we saw her we promised that we would do everything possible to make sure she got the best and most effective therapy. We tested her tumor for genetic markers to help us guide our treatment selection. Of course we did KRAS, which was which was normal wild type, and we also tested for two genes called TS and ERCC-1 which predict efficacy of FOLFOX versus FOLFIRI. We screen all our patients for these genes prior to start of treatment. She was enrolled in a clinical trial — CALGB 80405 — where we choose FOLFIRI and not FOLFOX because she would have not benefitted from FOLFOX. She received Erbitux and Avastin and had an incredible response allowing us to do a liver surgery with the intent to cure her.
Surgery went well, and we removed all the tumors. Since her tumor was all over in her liver, we were worried about it recurring in the liver so we also gave her chemotherapy after surgery and followed her very closely. About eight months later we found one spot in her liver. We treated her again with chemotherapy and were able to resect her again. She now has no evidence of cancer. The moral of this story is that you should never give up. Even when the tumor comes back, we can still beat this disease.
We have cured a number of patients who underwent multiples surgeries for liver or lung lesions and have no evidence of cancer today. We could have easily followed standard thinking that these surgeries are very rarely successful. However with more effective therapies this has changed. We are curing more and more patients, but not all. We should be aggressive, particularly in patients with metastatic disease in one organ.
Colon cancer is one of the few cancers which we can cure with resection of metastases. Selection of the most effective therapy is the first important step. We work closely with Response Genetics who have who developed a colon and lung cancer panel of gene tests.