From the Desk of Dr. Lenz
Hope for Everyone on Easter
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.
Happy Easter.
This news article was originally posted on April 16th, 2009 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 April 16th, 2009
Tags: gene testing, metastatic colorectal cancer, surgery, Treating Colorectal Cancer
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Dan
April 16, 2009 at 9:12am
Happy Easter Dr. Lenz: thank you for everything you and so many others do to help us. We can truly maintain that hope and never give up!
Heinz-Josef Lenz
April 16, 2009 at 9:42am
Thank you that is very kind. HJL
Mirjana Miletic
April 16, 2009 at 4:51pm
Happy Easter our beautiful angel Dr Lenz!!!!!
I am crying as I am writing this. I am crying tears of joy, thanks to you our God sent angel.
It is true, 3 years ago on Easter Day that God gave us the miracle of You thanks to Dr Beart.
I am so gratful right now, and I know that I am speaking for my whole family and my beautiful little sister.
I feel that we are blessed and God has been looking out for my beautiful little sister on this journey by bringing her to you. Maybe it is all the good things she has done and does for everyone that we got lucky, but whatever it is, I want to thank you from the bottom of my heart and for my whole family for being there for my beautiful little sister.
I don’t know where we would be right now if it wasn’t for you, but I am so thankful not to know.
Thank you our dearest Dr Lenz, may God bless you, my beautiful little sister, and everyone that is going through anything like this.
May they all get a chance to have a Dr lenz of their own.
You are one amazing, beautiful human being, and with all of your knowledge, intelligence, I am still humbled by your modesty and great kindness for everyone.
Thank you a million times over.
A very greatful sister,
Mirjana
Thank you for giving us an Ester Miracle over and over again..Sunday is our Easter, and I can not express my gratitude enough to you.
We love you.
Heinz-Josef Lenz
April 16, 2009 at 5:00pm
i am blessed to get to know her and your family. HJL
Mirjana Miletic
April 16, 2009 at 5:34pm
Dearst Dr Lenz,
We are the blessed ones.
You just proved me right again, you beautiful little angel.
(Humble and sweet are such an undrestatement.)
Thank you from one of your greatest admirers, rightfully so.
I can not say enough good things about you, because no matter what I say it is not enough. You are just simply put: brilliant.
Mirjana
Barbara Barrington
April 16, 2009 at 7:54pm
May God be with you and your staff and your work.
Thank you,
Barbara
judy
April 16, 2009 at 9:42pm
how about people with lung and liver mets? is there any hope if both organs can be resected with clear margins? i know some one who had both 3 liver mets and 2 lung mets went through chemo and resection surgery and has been clear now for over a year. also had no lymphnode involvment and a cea of 1
Heinz-Josef Lenz
April 16, 2009 at 10:03pm
we have seen some amazing success stories, one of my favorite is a patients diagnosed in 1998 when there was only 5-FU approved with liver and lung mets. Whenever a new drug was approved we used it and even clincial trials, he underwent three liver surgeries and two lung surgeries and is disease free for almost 5 years…….yes there is hope. HJL
Susan
April 17, 2009 at 12:17am
I was in CALGB 80405 and received folfox and erbitux and avastin, and became a suitable candidate for surgery. I am now in remission. I have read about studies that show giving patients both erbitux and avastin is counter-productive. Yet I did well, as did your patient, and the study goes on. Does that mean that under some circumstances, the two drugs work well together? Susan
Jackie Martinoski
April 17, 2009 at 12:34am
Dear Dr. Lenz,
Thank you & your amazing staff for doing what you do…NOBODY does it better!!!
I am forever grateful & thankful that my Easter Angel was looking out for me 3 years ago. Words can not describe the emotion I felt, along with my family & friends, when we were contacted by you & Dr. Beart.
When the first doctor told me there was nothing they could do, that I was not a candidate for treatment, and that I had 3-6 months to live, I was shocked by the prognosis. I couldn’t imagine telling my loved ones that I had 3 months to live.
Amazingly, on my lucky Easter Sunday, I reached out to doctors who were going to do everything in their powers to help me live a longer life. I wasn’t even thinking about a “cure” at that point. When you looked through my CT scans & medical records and said you believed you could cure me, well, I was finally given hope & the courage to do whatever was necessary to get better.
I am a “living” testament that, with the right doctors, specialized care at a cancer research center, and an incredible support system; there is always hope for a cure & that Stage IV Cancer is no longer a death sentence.
Dr. Lenz, thank you for proving the other doctors wrong and for giving me another chance at life.
On behalf of all your patients at USC Norris, thank you for helping us fight the fight and for giving us a chance to live again.
You are one in a million and simply the BEST!!!
With love & respect,
Jackie
Your Miracle Patient & Friend
TKandra
April 17, 2009 at 9:22am
How strong is the evidence regarding TS and ERCC-1? I have beeen getting mixed replies in the importance of treatment selection – FOLFOX vs FOLFIRI. Any references you would suggest?
Heinz-Josef Lenz
April 17, 2009 at 11:27am
Susan and Jackie……..you are examples why we have not fully understand the issue of the two antibodies story do they help or harm…..we will know more in the future but so pleased that you both are beating this disease. HJL
Heinz-Josef Lenz
April 17, 2009 at 11:58am
the data are very consistent when gene expression are measured, there are conflicting data using immunohistochemistry. for ercc-1 even prospective data in lung are available and is now part of the NCCN guidelines. there are many publications and meta analyses showing the same results if TS or ERCC-1 are high 5-FU and oxaliplatin are less likely to work. HJL
Mirjana Miletic
April 18, 2009 at 4:19am
Dr Lenz, and my beautiful little sister Jackie,
I could not sleep, and as usual I check in on your blog Dr Lenz.
My heart almost jumped out of my chest when I saw that my beautiful little sister had written here.
I saw flashbacks of desperation , and then HOPE, and we are living proof, and thank God for that, that there are angels among us, (You for one) and that miracles truly do happen.
You and your team have made this miracle a reality and words can never express on how grateful we are to all of you dearest Dr Lenz.
I will never as long as I live forget what one woman, also a stage 4 CC fighter, Donna Richno told me, she said “you have to find a partner to fight this battle”, and Dr Lenz, you are one of the greatest fighters I know against this battle, and I thank God for you every single day of my life, and I will forever.
My beautiful little sister Jackie is my inspiration, my hero and the bravest girl in the world, and I am so proud to call her my sister.
Thank God, and thank you for saving her life.
Did I ever tell you how amazing you are?????You are a brilliant doctor, super busy, yet you still take time to write this.
Just reading your blog can help someone get the kind of help that they should and deserve to have to save their life.
As my little sister said it,
“You are one in a million and simply the BEST!!!”
Amen my beautiful little sister.
May God bless you and everyone fighting this disease and Dr Lenz , more power to you, our God sent angel.
A very grateful sister,
Mirjana Miletic
Happy Easter this coming Sunday Dr Lenz, it is the Orthodox Easter.
Everyone reading this blog, I wish all of you your very own Easter Miracles.
Louise Fletcher
April 20, 2009 at 11:08am
Dear Dr. Lenz,
You and Jackie are brave warriors and it is again my privilege to add my wonder and admiration for you both. Thank you for sharing this remarkable, heroic story with us. I can’t help but believe that blessings have been sent to you both.
Jim Broutman
April 21, 2009 at 11:54am
Dear Dr Lenz, Taline and your entire staff,
Thank you for what you have done for Jackie. She is a true inspiration to all of us that know and care about her. Her remarkable story would not be complete without your dedication to saving lives and providing hope to her as well as all your patients. I was at the initial meeting she had with you and will always remember the look on her face when you mentioned the word “cure”. Its amazing how one word can alter a persons entire outlook on “life”…prior to meeting with you we were all very scared and once you became a part of her “life” things have been all uphill for our dear friend Jackie who is a true warrior…I am very excited for the future and what you have to offer us as followers of your great work..god bless you..
Edward
April 22, 2009 at 2:43am
Is pork red or white meat with regard to colon cancer risk?
Heinz-Josef Lenz
April 22, 2009 at 4:09pm
pork is white meat…..enjoy your schnitzel. HJL
Erica
May 3, 2009 at 10:48pm
Dr. Lenz,
Hello! My name is Erica and I have been battling Metastatic Colon Cancer in the liver and lungs for two years. I am 28 now, and after having the primary tumor in my colon removed, the majority of disease resected from my liver, regular FOLFIRI + Erbitux treatments, and HAI therapy with FUDR, I am doing amazing and have very little disease left in both lungs and on the left lobe of my liver. My last scan in March showed great response and decrease. My Doctors at Sloan Kettering want me to stay on this course, but think that a bi-lateral lung nodule removal is possible. Besides the normal chemo days side effects, I feel great, and work out almost everyday. Based on the information I have given you, do you think that a cure could be possible for someone in my situation? And, do you have any other recommendations for treatments or procedures? You are an amazing soul and doctor. Thank you for giving so many of us hope but also giving an honest perspective. God bless you!
Erica
Reston, VA
Heinz-Josef Lenz
May 4, 2009 at 9:42am
as you can imagine that is very difficult to evaluate….but it seems that you are in great hands and your docs take great care of you, bilateral lung lesions are difficult depending on size number and location. so would discuss with thoracic surgeon too. HJL