54 year old male with colorectal cancer, after surgery he received radio chemotherapy with oxaliplatin. First regression treated with FOLFIRI, second regression treated with Irinotecan, thrid regression added Avastin!! what we can do for this third regression?
I'm just wondering why no biological agent has not been used in first line, and why irinotecan therapy was applied after progression on irinotecan containing regimen. The usage of bevacizumab (especially as monotherpay) in third line is also very questionable.
This treatment sequence is completely out of current recommendations and misses almost all opportunities provided by a state-of-the-art treatment.
For this patient I would offer oxaliplatin containig regimen, and I would ask for RAS-status to determine whether the patient is eligible for anti-EGFR treatment. As a last line regorafenib is also recommended.
This is a third recurrence of the tumor. Have you ever think about to send this patient to a salvatage surgery instead trying all the protocols above mentioned?.
It was supposed that all this trial of chemotherapy agents prescribed to the patient in every recurrence was because of cancer, or this patient was misdiagnosed?. Dr. Nasser is talking about "recurrence", and recurrence in a cancer patient is implying that he has cancer again and at least a biopsy to support his diagnosis no matter that in his text he denied "a new histology", otherwise how he can justify to the board of medical trials in his hospital so many chemotherapy agents for a benign lesion.
Thank you for your replay.
Dear Osama, you do stage and grade before the surgical procedure to planify your treatment. After surgery and chemo radiation this is not possible. By definition you can not grade and stage a recurrence. In one of my last comments I mentioned that a biopsy might be helpful to assure that this is indeed a cancer recurence or a benign lesion mimic a recurrence and then to propse your treatment. At this moment you have a recurrence by the third time, where obviously, any already know treatment combination is working at all. What Nasser is going to do after the fifth recurrence?.
My pleasure to have communication with you, Osama.
Best regards.
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